CD4＋T淋巴细胞水平对HIV合并HBV感染患者HBV病毒复制及肝病的影响

Association of CD4 ＋ T lymphocyte count with HBV replication and progression of liver diseases in patients infected with HIV and HBV

回顾分析2007年1月至2013年12月确诊的459例HIV合并HBV感染患者的临床资料.确诊艾滋病时,CD4^＋T淋巴细胞计数＜50/μl组（89例）、50 ～200/μl组（134例）和＞200/μl组（236例）HBeAg阴性患者的HBV DNA阳性率分别为49.3％（37/75）、50.5％（54/107）和33.7％（66/196）,HBV载量分别为（6.37±1.71）、（5.82±1.86）和（4.36±1.64） log10拷贝/ml,肝功能异常率分别为29.2％（26/89）、29.1％（39/134）和10.6％（25/236）,终末期肝病发生率分别为16.9％（15/89）、14.9％（20/134）和5.1％（12/236）,病死率分别为10.1％（9/89）、9.7％ （13/134）和3.8％（9/236）.CD4^＋T淋巴细胞计数＞ 200/μl组的HBV DNA阳性率和HBV载量、肝功能异常率、终末期肝病发生率及病死率均低于CD4＜ 50/μl和50 ～ 200/μl组,提示HIV合并HBV感染者的HBV复制及肝病预后与CD4^＋T淋巴细胞水平有关.

The clinical data of 459 patients,who were first diagnosed as HIV/HBV co-infection from January 2007 to December 2013,were retrospectively analyzed.Among all patients,there were 89 cases with CD4 〈 50/μl,134 cases with CD4 50-200/μl and 236 cases with CD4 〉 200/μl,when HIV infection was diagnosed.In these three groups with different CD4 levels,the HBV DNA positive rates were 49.3% （37/75）,50.5% （54/107） and 33.7% （66/196）;the HBV viral load were （6.37 ± 1.71） log10 copies/ml,（5.82 ± 1.86） log10 copies/ml and （4.36 ± 1.64） log10 copies/ml;the rates of abnormal liver function were 29.2% （26/89）,29.1% （39/134） and 10.6% （25/236）;the occurrence rates of end-stage-liver-diseases were 16.9% （15/89）,14.9% （20/134） and 5.1% （12/236）;the mortality rates were 10.1% （9/89）,9.7% （13/134） and 3.8% （9/236）,respectively.The HBV DNA positive rates,HBV viral load,the rates of abnormal liver function,the occurrence rates of end-stage-liver-diseases and the mortality rates in CD4 〉 200/μl group were lower than that in CD4 〈 50/μl group and 50-200/μl group.The results suggest that for HIV and HBV co-infection patients,HBV replication level and prognosis of liver diseases are associated with CD4^＋ T lymphocyte count.