骨关节结核合并艾滋病患者CD4^＋T淋巴细胞计数对术后生存时间的影响

Impact of the CD4＋ T lymphocyte count on the post-operation survival time of the osteoarticular tuberculosis patients with HIV co-infection

目的观察术前CD4^＋T淋巴细胞计数对骨关节结核合并艾滋病患者术后生存时间的影响。方法收集2005年2月至2013年7月山西省大同市第四人民医院骨科和首都医科大学附属北京胸科医院骨科收治的18例骨关节结核合并艾滋病患者的临床资料，脊柱结核8例，关节结核10例；男10例，女8例，年龄16～65岁，平均年龄（36．5±10．0）岁；行病灶清除加植骨手术6例，单纯病灶清除术12例；手术时间40~240min，平均123．1min；出血量80~700ml，平均出血量287．8ml。按术前1周内CD4^＋T淋巴细胞计数是否〉200个／μl分为2组，第一组：≤200个／μl者5例；第二组：〉200个／μl者13例。18例患者随访1～72个月，平均38个月。2组患者术后生存时间及累计生存率绘制Kaplan-Meier生存曲线，应用log—rank检验进行2组累计生存率分析。结果截至末次随访，18例患者中死亡12例，失访2例，存活4例。第一组5例患者中：术后3个月内死亡3例，术后12个月死亡1例，1例存活；第二组13例患者中：术后22个月死亡1例，术后24~36个月内死亡3例，术后36~48个月内死亡4例，失访2例，存活3例。两组患者的Kaplan-Meier生存曲线提示第一组和第二组累计生存率有较大区别，两组的累计生存率经log-rank检验，x^2=12．42，P=0．0004，术前1周内CD4^＋。T淋巴细胞计数〉200个／μl组的累计生存率（生存3例，死亡8例，失访2例）大于CD4^＋T淋巴细胞≤200个／μl组（生存1例，死亡4例）。结论骨关节结核合并艾滋病患者术前CD4^＋T淋巴细胞计数〉200个／脚者行手术治疗，可能有助于延长术后生存时间。

Objective To evaluate the impact of CD4＋ T lymphocyte count pre-operation on the post-opera- tion survival time of the osteoartieular tuberculosis patients with HIV co-infection. Methods From February 2005 to July 2013,18 patients with osteoarticular tuberculosis who were infected H1V simultaneously were treated surgi- cally at the Fourth People＇s Hospital of Datong City or Beijing Chest Hospital Affiliated to Capital Medical University. There were 10 males and 8 females patients, with the ages ranged from 16 to 65 years （median, （36.5!10.0） years）. 6 cases received focal debridement and bone graft surgery. Twelve cases received simple debridement. The operation time was 40--240 minutes with an average of 123.1 minutes. The intraoperative blood loss was 80--700 ml with an average 207.8 ml. All the patients were divided into 2 groups according to the CD4＋ T lymphocyte count within 1 week before surgery. The first group： CD4^＋ T lymphocyte count was ≤200/μl in 5 cases; the second group： CD4＋ T lymphocyte count was 〉200/μl in 13 cases. The mean follow up time for the 18 patients was 38 months （1- 72 months）. Kaplan-Meier survival curves was drewed by the survival time and survival rate of two grops. The postoperative cumulative survival rate analysis of the 2 groups were compared with log-rank test. Results As at the end of follow-up, 12 patients died, 2 lost, only 4 case lived. In the first group, there were 3 patients died within 3 months of postoperation, 1 died after 12 months of postoperation and 1 patient was still alive. In the second group, 1 patient died after 22 months of postoperation, 3 patients died within 24--36 months of postoperation, 4 patients died within 36 48 months of postoperation, 2 patients were lost of follow-up and 3 cases were alive. Ka plan-Meier survival curves prompted there are significant difference in cumulative survival rate between two groups（x^2= 12.42,P=0. 0004）. The cumulative survival rate of patients in the second group was greater than that in the first group. Conclusion Patients with osteoarticular tuberculosis and AIDS co-infection whose pre-operation CD4＋T lymphocyte count 〉200/μl treated by surgerywill have a prolonged post-operation survival time.