成人HIV/AIDS病人HAART前血小板减少的发生率及相关因素分析

Prevalence and risk factors of thrombocytopenia in Chinese adult HAART-nave HIV-infected patients

目的描述成人艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）在高效抗病毒治疗（HAART）前,发生血小板减少的基本特征,探讨HIV合并血小板减少的发生率及相关因素。方法以2003年6月至2015年12月,在北京地坛医院门诊就诊的3452例HIV/AIDS病人为研究对象,比较HAART前不同基本情况[人口学资料、身体质量指数（BMI）、CD4^＋T淋巴细胞（简称CD4细胞）计数、病毒载量、是否合并机会性感染及症状体征、其他混合性感染的合并情况及是否服用复方新诺明（SMZ-TMP）情况]的血小板减少的发生率,通过Logistic回归分析HIV/AIDS病人合并血小板减少症的相关因素。结果 HAART前合并血小板减少的有137例（3.97%）,其中轻度104例（3.01%）,中度19例（0.55%）,重度14例（0.41%）。血小板减少的发生率随CD4细胞计数的增加而降低（P〈0.001）。HAART前HIV RNA≥105拷贝/mL[调整OR值（AOR）=1.903,95%CI：1.125-3.218,P=0.016],CD4细胞计数≤50个/μL（AOR=8.828,95%CI：2.939-26.519,P〈0.001）及CD4细胞计数51-199个/μL（AOR=3.714,95%CI：1.317-10.479,P=0.013）,HBsAg＋（AOR=4.949,95%CI：2.372-10.323,P〈0.001）是发生血小板减少的危险因素。结论成人HIV/AIDS病人HAART前血小板减少发生率较低。低基线CD4细胞计数、高基线病毒载量及合并乙型肝炎是HAART前发生血小板减少的相关因素,因此对存在这些危险因素的病人及早的诊断和治疗是必须的。

Objective To explore the prevalence,characteristics and relative factors of thrombocytopenia among HAART nave adult HIV/AIDS patients.Methods The prevalence and risk factors of thrombocytopenia was evaluated retrospectively among 3452 HAART-naive patients in Beijing Ditan hospital from June,2003 to December,2015.Statistical analysis of the data（Chi-square test,Logistic regression）was conducted by SPSS 19.0.ResultsAmong the 3452 patients,the overall prevalence of thrombocytopenia among HIV/AIDS patients was 3.97%（3.06%,0.55% and 0.41%for mild,moderate,and severe thrombocytopenia）.HAART-naive HIV RNA〉 10^5copies/mL（AOR=1.903,95%CI：1.125-3.218,P=0.016）,CD4^＋counts ≤50cells/μL（AOR=8.828,95%CI：2.939-26.519,P〈0.001）and CD4^＋counts 51-199cells/μL（AOR=3.714,95%CI：1.317-10.479,P=0.013）,HBs-Ag-＋（AOR=4.949,95%CI：2.372-10.323,P〈0.001）were risk factors of thrombocytopenia.Conclusion The prevalence of thrombocytopenia is3.97% among HAART-naive patients.Thrombocytopenia is not common among Chinese adult HAART naive patients.Lower HAART naive CD4 counts,higher viral load and HBs-Ag positivity were associated with the risk of thrombocytopenia.Therefore,it is necessary to have early diagnosis and treatment of thrombocytopenia for those patients.