艾滋病相关性慢性腹泻隐孢子虫感染患者的临床特征

Clinical feature of cryptosporidium infection in HIV/AIDS patients with chronic diarrhea

目的探讨艾滋病相关性慢性腹泻患者隐孢子虫感染的临床特征。方法收集2009年11月至2010年12月253例艾滋病相关性慢性腹泻患者的标本，采用甲醛-乙酸乙酰沉淀法，对标本进行集卵，用改良抗酸染色法进行染色，检测隐孢子虫卵囊。根据患者血液中CD4＋细胞水平和年龄分别分为〈200、3200～〈500、3500个／ul3组和20～35、36～55、56～69岁3组，进行组间对比分析。结果253例粪便标本中，隐孢子虫阳性32例（12．6％），3种CD4＋细胞水平组隐孢子虫感染率分别为20．4％（20／98）、9．2％（12／130）、0（0／25），差异有统计学意义（x2=10．33，P〈0．01）。在32例隐孢子阳性患者中腹泻5次／d以上22例（68．8％），3种CD4＋细胞水平组各有15例（15／20）、7例（7／12）、0例，各组间差异无统计学意义（P〉0．05）。艾滋病慢性腹泻患者处于HIV无症状期、AIDS前期、AIDS期，隐孢子虫感染率分别为0（0／7）、21．3％（19／89）、8．3％（13／157），差异有统计学意义（x2=9．822，P〈0．01）。32例隐孢子阳性患者中引发肠炎者22例。城市与农村患者阳性率分别为6．7％（7／104），16．8％（25／149），差异有统计学意义（x2=5．596，P〈0．05）。253例艾滋病患者3个年龄组的感染率分别为7．3％（4／55），13．4％（22／164），17．6％（6／34），差异无统计学意义（x2=2．29，P〉0．05）。结论隐孢子虫感染率及临床症状的严重程度与CD4＋水平、艾滋病分期及疾病发展到直肠炎相关。

Objective To investigate the clinical feature of eryptosporidium infection in HIV/AIDS patients with chronic diarrhea. Methods 253 Stool samples were collected from HIV/AIDS patients with chronic diarrhea during Nov. 2009 to Dec. 2010. The samples were concentrated by Formalin-Ethyl Acetate Sedimentation technique and stained by Modified acid-fast stain （AFS） for the identification of oocysts by microscopy. Devided the cases into three groups according to their CD4 cell counts （ 〈 200, ≥ 200 and 〈 500, ≥500ul） ; meanwhile the cases were devided into three groups by their age（20 -35,36 -55,56 - 69）. Analyzed the groups by comparison. Results The total infection rate of Cryptosporidium in AIDS patients was 12.6% in 253 cases. CD4＋ T-lymphocyte counts was related to the infection rates of cryptosporidium, the difference was statistically significant （x2 = 10. 33, P 〈 0. 01 ） ： the infection rate were 20. 4% （20/98） , 9. 23 % （ 12/130 ） , 0 （ 0/25 ） separately. In the 32 Cryptosporidium positive cases , 22 （68.8%）cases stood with diarrhea above 5 times per day, the three kind of CD4 counts level were separately 15 （ 15/20）, 7 （ 7/12 ）, 0. The difference was no statistically significant （ P 〉 0. 05 ）. HIV/AIDS patients with chronic diarrhea who progressed during asymptomatic period, pre-AIDS period, AIDS period , had the infection rate of 0 （ 0/7 ）, 21.3% （ 19/89 ）, 8. 3% （ 13/157 ） respectively, the difference was statistically significant （X2 = 9. 822, P 〈 0. 01 ） ; 22 out of 32 Cryptosporidium positive cases in HIV patients were diagnosed with enteritis, the infection rate in urban area and rural area was 6. 5% （7/104） and 16.8% （25/149） separately, the difference was statistically significant （X2 = 5.596, P 〈 0.05）. Comparing different age groups, Cryptosporidium infection status were separately 7.3% （4/55）, 13.4% （22/164）, 17.6% （6/34）. Each group＇s comparative difference was no statistically significant （x2 = 2.29, P 〉 0. 05 ）. Conclusion The infection rate of cryptosporidium and clinical severity of cryptosporidium infection are statistically correlated with CD4 ＋ T-lymphocyte counts, with AIDS stage, with HIV associated proetitis.