先占性抗巨细胞病毒治疗影响艾滋病合并巨细胞病毒血症患者预后的临床研究

Clinical study on the effect of preemptive anti-cytomegalovirus therapy on prognosis of patients with acquired immunodeficiency syndrome and cytomegalovirus viraemia

目的 探讨先占性抗巨细胞病毒（CMV）治疗对艾滋病合并CMV血症患者预后的影响.方法 2011年7月1日至2013年6月30日住院的伴CMV血症的男性艾滋病患者共69例,按患者意愿,非随机对照分为2组,即治疗组（抗CMV组）57例、对照组（非抗CMV组）12例,治疗组采用更昔洛韦或膦甲酸钠静脉注射,CMV-DNA阴转后1周停药,3周末行抗高效逆转录病毒治疗（HAART）;对照组仅行HAART及其他对症治疗,评价入组时两组CMV-DNA载量、HIV-RNA载量、CD4＋T细胞计数、卡氏肺孢子菌肺炎（PCP）以及活动性结核的合并感染率有无差异.观察期12月,评价观察期末两组CD4＋T细胞计数、CMV视网膜炎的发生率、再住院率以及死亡率的差异.结果 入组时两组CMV-DNA载量、HIV-RNA载量、CD4＋T细胞计数差异无统计学意义（P＞0.05）;两组PCP、活动性结核的合并感染率差异无统计学意义（P＞0.05）.与对照组相比,抗CMV组12个月时CD4＋T细胞计数及再住院率明显得到改善（t=-3.850,P＜0.05;x2=6.078,P＜0.05）.观察期内两组均无CMV视网膜炎发生.两组死亡率差异无统计学意义（P＞0.05）.结论 先占性抗CMV治疗有利于艾滋病合并CMV血症患者的CD4＋T细胞计数增长及减少再住院率,并阻止了CMV视网膜炎的发生,有利于细胞免疫重建及改善艾滋病患者的生存质量.

Objective To explore the effect of preemptive anti-cytomegalovirus therapy on prognosis of patients with acquired immunodeficiency syndrome （AIDS） and cytomegalovirus （CMV） viraemia.Methods A non-random prospective study of male hospitalized patients were carried out who were newly diagnosed as AIDS during July 1,2011 to June 30,2013 in the First Affiliated Hospital of China Medical University.There were 69 patients who were divided into treatment group （57 cases） and control group （12cases）.The duration of anti-cytomegalovirus therapy was a week after plasma CMV-DNA becoming undetectable.Baseline age,CMV-DNA,human immunodeficiency virus （HIV）-RNA,CD4＋T cells,the rate of pneumocystis carinii pneumonia （PCP） and tuberculosis were evaluated between two groups.After 12-month follow-up,CD4 ＋ T cells,the rate of rehospitalization,CMV retinitis,and mortality were evaluated.Results There were no difference in CMV-DNA,HIV-RNA,CD4 ＋ T cells,the rate of PCP,and tuberculosis（P 〉 0.05）.At the end of 12 months,there were higher CD4 ＋T cells and lower rehospitalization rate in treatment group than control group（t =-3.850,P 〈 0.05;x2 =6.078,P 〈 0.05）.CMV retinitis was not found.The mortality was not different between two groups（P 〉0.05）.Conclusions Anticytomegalovirus therapy was beneficial to the increment of CD4 ＋T cells and decrement of rehospitalization,and prevention from CMV retinitis.