HIV/AIDS患者高效抗逆转录病毒治疗后免疫重建不良的特征及相关因素分析

Study on the characters and relative factors of poor immune reconstruction in HIV/AIDS patients with HAART

目的 通过回顾性研究,描述免疫重建不良HIV/AIDS患者的基本特征,探讨免疫重建不良的相关因素,发现HIV/AIDS患者免疫重建不良的预示指标.方法 以2005年1月-2011年8月在北京地坛医院起始HAART治疗≥96w的HIV/AIDS患者（503例）为研究对象,比较其中免疫无应答者（76例）与免疫应答良好者（427例）临床资料（人口学资料、基线CD4＋T细胞计数、机会性感染的合并情况、HAART（高效抗逆转录病毒治疗）方案和各种化验指标的差异,分析HIV/AIDS患者免疫重建不良的相关因素.结果 入组病例中免疫重建不良的发生率为15.11％;免疫重建不良组的基线CD4＋T细胞数、总淋巴细胞数目（TLC）及血红蛋白（Hb）显著低于免疫重建良好组（z=-9.056,P＜0.001;z=-5.541,P＜0.001;z=-3.014,P=0.003）.免疫重建不良组基线机会性感染合并率显著高于重建良好组（x2=14.834,P=0.037）.结论 低基线CD4＋T细胞数目、TLC及Hb均为免疫重建不良的相关因素,应对HIV感染的患者及早进行治疗,预防免疫重建不良的发生.

Objective To explore the characters and relative factors of poor immune reconstruction in HIV/AIDS patients,and find the indicators of poor immune reconstruction through retrospective study.Methods Clinical data of 503 HIV/AIDS patients in Beijing Ditan hospital who have received antiretroviral therapy for more than 96 weeks have been collected and studied.The differences of clinical data （demographic data,the baseline CD4 ＋T counts,opportunistic infection,HARRT regimen,laboratory tests results and so on） between 76 immune non-responders and 427 immune responders have been analyzed and the relative factors of poor immune reconstruction in HIV/AIDS patients have been carried out.Results The incidence rate of the poor immune reconstitution was 15.11% ; The baseline CD4 ＋ T counts,total lymphocyte count （TLC） and hemoglobin （Hb） were found to be significantly lower in immune non-responders than immune responders（z =-9.056,P 〈 0.001 ; z =-5.541,P 〈 0.001 ; z =-3.014,P =0.003）.The incidence rate of baseline opportunistic infections in immune non-responders was significantly higher than immune responders （x2 =14.834,P =0.037）.Conclusions The relative factors of poor immune reconstitution include low baseline CD4 ＋ T counts,TLC and Hb.early treatment should be provide for HIV/AIDS patients to prevent the occurrence of poor immune reconstitution.