浙江省嘉兴市无抗病毒治疗史的HIV感染者CD4^+ T淋巴细胞计数自然变化研究

Study on natural changes of CD4^+ T lymphocyte counts among HIV /AIDS patients without antiretroviral treatment in Jiaxing

目的探讨嘉兴市HIV感染者在无抗病毒治疗干预下的CD4+T淋巴细胞计数自然变化及其影响因素。方法对2008年7月-2013年6月嘉兴市无抗病毒治疗史或抗病毒治疗前至少接受过2次CD4+T淋巴细胞计数检测的HIV感染者进行回顾性队列研究,描述其计数自然变化速率,运用logistic回归分析计数显著下降的影响因素。结果共纳入研究对象293例,CD4+T淋巴细胞计数月均自然变化速率中位数为-3.6 cell/μl(IQR:-11.1~1.3)。约32.4%(95例)研究对象末次CD4+T淋巴细胞计数较首次表现为显著下降(≥30%),经logistic多因素回归分析显示,其显著下降与年龄、首次CD4+T淋巴细胞计数水平、首末次检测时间间隔存在关联。结论嘉兴市HIV感染者CD4+T淋巴细胞计数自然变化总体平缓,但部分感染者的计数下降显著与多因素有关。应定期随访HIV感染者的CD4+T淋巴细胞计数水平,以掌握病情进展并适时启动抗病毒治疗。

Objective To explore the determinants and natural changes of CD4^＋T lymphocytes counts among HIV-infected patients without antiretroviral treatment（ ART） in Jiaxing city of Zhejiang province. Methods From July 2008 to June 2013, HIV infectors with CD4^＋T lymphocytes counts at least twice before ART in Jiaxing were involved in a retrospective cohort study to describe the natural change rates of CD4^＋T lymphocytes counts. Logistic regression analysis was used to analyze the determinants of significant depletion of CD4^＋T lymphocytes counts. Results A total of 293 HIV / AIDS patients were included in the study. The median of the monthly natural change rate of CD4^＋T lymphocytes counts was-3. 6 cell / μl（ IQR：-11. 1 ~ 1. 3）. Compared to the first CD4^＋T lymphocytes counts,95 HIV-infected patients（ 32. 4%） were found significant depletions at the last CD4^＋T lymphocytes counts（ ≥30%）. The multifactor logistic regression analysis indicated that age,the CD4^＋T lymphocytes counts at the first time and the time interval between the first and the last CD4^＋T lymphocytes counting tests were statistically associated with the significant depletion of CD4^＋T lymphocytes counts. Conclu sion CD4^＋T lymphocytes counts showed gentle natural changes among HIV-infected patients without antiretroviral treatment（ ART） in Jiaxing city,but those were significantly decreasing in some patients. Regular follow-up of the CD4^＋T lymphocytes counts in HIV-infected patients is conductive to understand the progression of the disease and carry out ART timely,if necessary.