河南省部分艾滋病患者抗病毒治疗的临床效果以及基因型耐药性分析

Research of clincial efficacy in patients treated with antivirus drug and the untreated controls at partial region, Henan province and drug resistance

目的 了解河南省部分地区HIV 1感染者抗病毒治疗临床效果 ,分析服药依从性与治疗效果关系 ;与未进行抗病毒治疗的患者相比较 ,分析治疗后病毒耐药性突变发生和流行情况。方法通过问卷调查、CD4 +细胞测定评价抗病毒治疗的临床效果 ;用RT PCR方法扩增HIV 1 pol区基因 ,进行基因型耐药性分析。结果 接受抗病毒治疗的人群中 ,坚持服药的病人 55.0 8%病情明显好转 ,而未坚持服药的病人仅有 6 .78%病情明显好转 ,服药依从性对病情趋势变化具有显著影响 (P <0 .0 5) ;接受抗病毒治疗的病人CD4 +淋巴细胞均值为 ( 4 2 9.38± 7.89)个 /μl,未治疗的病人CD4 +淋巴细胞均值为( 2 0 1 .4 3± 8.72 )个 /μl,治疗后患者CD4 +淋巴细胞计数显著高于未治疗的患者 (P <0 .0 5) ;基因型耐药性检测结果表明 ,相对于未经治疗的患者 ,经过抗病毒治疗的患者对逆转录酶抑制剂的耐药性突变显著高于未治疗的患者 ( χ2 =1 9.4 2 85,P <0 .0 5) ;治疗人群与未治疗人群对蛋白酶抑制剂的耐药突变差异无统计学意义 ( χ2 =0 .3478,P <0 .50 ) ;耐药性突变主要发生在CD4 +淋巴细胞 <2 0 0个 /μl病人中。结论 用国产抗病毒药物治疗可取得较好的临床效果 ,服药依从性对治疗效果有重要影响 ,治疗后耐药性突变发生率显著升高 。

Objective To find the clinical efficacy of HIV infected patients treated with antivirus drug, analyze the correlation between the therapeutical effects and the drug compliance, and to observe the influence factors on drug resistance. Methods The clinical effects were examined by the standardized questionaire and the mensurement of CD4 + lymphocytes. The sequences of pol region were obtained by reverse transcription polymerase chain reaction(RT PCR). Then the drug resistance was analyzed. Results The illness state being well off in group of being sustained dosing was 55.08%, and of those being was not only 6.78%, so the drug compliance had prominent impact on change of illness state. Comparing the average counts of CD4 + lymphocytes between the treated group and the untreated, one was (429.38±7.89) entries/μl in the treated, the other was (201.43± 8.72 ) entries/μl. Obviously the CD4 + lymphocytes rised in the treated group. The result of genotype test indicated that the level of drug resistance of reverse transcriptase inhibitor in the treated was higher than the untreated (χ 2=19.4285, P <0.05), but the protease inhibitor was no evident change between the treated and the untreated(χ 2=0.3478, P <0.50), the drug resistance mainly occurred in the group that the CD4 + lymphocytes were less than 200 entries/μl. Conclusion The homemade drugs had achived better therapeutical effects, and drug compliance had great influence on the change of illness state; the level of drug resistance was higher in the treated than the untreated; the occurrence of drug resistance had consanguineous relation with CD4 + lymphocytes. So it was very necessary to improve drug compliance to reduce the emergence and prevalence of drug resistance virus.