艾滋病合并马尔尼菲青霉病患者二期预防性治疗影响因素的回顾分析

Factors influencing the duration of secondary prophylaxis in AIDS patients coinfected with Penicilliummarneffei： a retrospective analysis

目的探讨影响艾滋病合并马尔尼菲青霉病（PSM）患者预防PSM复发的二期预防性治疗时间长短的因素。方法回顾性分析92例广西壮族自治区疾病预防控制中心／无国界门诊确诊的艾滋病合并PSM成人患者，以停用二期预防性治疗时患者血CD4’T淋巴细胞计数水平为标准，将病例分两组，I组在CD4’T细胞I〉200X10qL后、Ⅱ组在100×106／L一〈200X10qL后停用PSM二期预防性治疗，比较两组的疗程和疗效，并分析患者临床脏器累及、合并症、抗真菌方案、抗病毒治疗时机等不同因素对二期预防性治疗时间的影响。运用SPSS13．0统计软件包完成数据分析。结果92例患者都得到高效抗逆转录病毒治疗（HAART），两组患者在性别、年龄、随访时间上差异均无统计学意义（P值均〉0．05），在器官累及、合并症、抗真菌治疗方案的构成以及疗效、抗真菌治疗时间的差异均无统计学意义（P均〉0．05），但Ⅱ组患者二期预防性治疗时间[（8．13±5．13）个月]较I组[（12．44±9．51）个月]短（P〈0．05）。HAART开始于PSM治疗后、合并其他感染、合并结核感染等因素导致二期预防性治疗时间延长，且三者的影响依次从大到小；而HAART开始于PSM治疗前较开始于PSM后二期预防性治疗时间短（P〈O．05）。结论艾滋病合并PSM患者HAART后，当CD4’T淋巴细胞恢复到≥100X10qL后3．6个月可以停用二期预防性治疗；影响二期预防性治疗用药时间的积极因素是抗马尔尼菲青霉治疗前开始HAART，负面因素有HAART开始于抗马尔尼菲青霉治疗后、合并其他感染或合并结核感染等。

Objective To explore the factors affecting the duration of secondary prophylaxis for penicilliosis marneffei in patients with acquired immunodeficiency syndrome （AIDS）. Methods A retrospective analysis was conducted. The study included 92 adult patients with AIDS and penicilliosis marneffei which were confirmed at the Guangxi Centers for Disease Control and Prevention/Medecins Sans Frontieres clinic. The patients were divided into two groups based on the counts of CD4~ T cells at the time of discontinuation of secondary prophylaxis with itraconazole. The patients with a CD4＋ lymphocyte count 〉 or = 200 ~ lO6 cells/L at the discontinuation of secondary prophylaxis were assigned to Group I, and those with a CD4~ lymphocyte count ranging from 100 x 106 to 200 ~ 106 cells/L to Group II. The treatment duration and clinical outcome were compared between the two groups, and factors which might affect the duration of secondary prophylaxis, including organ involvement, complications, antifungal regimen, antiviral treatment timing, and so on, were assessed. The SPSS 13.0 software package was used for statistical analysis. Results All the 92 patients received highly active antiretroviral therapy （HAART）. No significant difference was observed in the sex ratio, age, follow up duration, number of organs involved, occurrence of complications, composition and duration of antifungal treatment regimens between the two groups （all P 〉 0.05）. The duration of secondary prophylaxis was significantly shorter in Group II than in Group I （8.13 _＋ 5.13 vs. 12.44 _＋ 9.51 months, P 〈 0.05）. The commencement of HAART after the treatment of penicilliosis, coinfection with other pathogens or mycobacterium tuberculosis were associated with a longer duration of secondary prophylaxis, and the influence degree of these factors decreased in order, whereas the commencement of HAART before the treatment of penicilliosis was associated with a shorter secondary prophylaxis （P 〈 0.05）. Conclusions For AIDS/PSM patients receiving HAART, secondary prophylaxis could be discontinued 3 to 6 months after the CD4 ＋ lymphocyte count restores to 100 x 106 cells/L or more. The duration of secondary prophylaxis may beextended by the commencement of HAART after the treatment of penicilliosis, coinfection with other pathogens or mycobacterium tuberculosis, but shortened by the commencement of HAART before the treatment of penicilliosis,