未治疗HIV/AIDS 中CD4^＋T淋巴细胞计数与机会性感染的相关性分析

Correlational Analysis between the CD4^+T Cell Counts and Opportunistic Infection in HIV / AIDS Patients with No Antiretroviral Treatment

目的探讨未抗病毒治疗HIV感染者/艾滋病病人(HIV/AIDS)CD4^+T淋巴细胞计数及其自然变化与机会性感染(OIs)1年内发生率之间的关联,为临床防治OIs提供依据。方法对新报告的739例HIV/AIDS开展为期1年、每3个月一次随访的队列研究,了解其1年内OIs出现情况,获取OIs出现与未出现者基线与末次CD4^+,CD8^+T淋巴细胞计数数据,描述并比较其末次与基线T淋巴细胞计数自然变化速率。结果 739例研究对象中207例(28.01%)1年内出现OIs,50岁及以上年龄组1年内OIs发生率(79.69%)较50岁以下年龄组(23.11%)高(P<0.05),随着基线CD4^+T淋巴细胞计数的降低,1年内OIs发生率由8.97%上升至69.02%(P<0.05);OIs各组的CD4^+,CD8^+T淋巴细胞计数值及CD4/CD8比值均显著低于无OIs组(P<0.05);CD4^+T淋巴细胞计数快速、平缓下降组OIs出现构成比分别为48.72%和25.18%,而CD4^+T淋巴细胞计数平缓、快速上升组OIs出现构成比分别为18.45%和9.01%,差异有统计学意义(P<0.05)。结论 CD4^+T淋巴细胞计数水平越低OIs增加越明显,无论基线CD4^+T淋巴细胞计数水平是高是低,CD4^+T淋巴细胞计数快速下降均对应着OIs出现几率的明显提高,CD4^+T淋巴细胞计数水平及其下降速率对OIs发生的预测、预防有重要的指导意义。

Objective To explore the correlation of the natural CD4＋T cell and the incidence of opportunistic infections（OIs）during a year of HIV/AIDS patients with no antiretroviral treatment so as to supervise the OIs treatment.Methods We collected 739 cases of newly reported HIV/AIDS, and the data of OIs incidence in a year and the counts of CD4＋, CD8＋T cell were collected through 4 times regular follow-up.The difference between the base line and the last CD4 ＋, CD8＋T cell counts was calculated and described.Results The total 207 cases（28.01%）of the 739 HIV/AIDS patients experienced HIV related OIs within the past year, the incidence of OIs of the people aged 50 or more and those less than 50 were 79.69% and 23.11% respectively（P〈0.05）.With decreased baseline of CD4＋T cell counts, the incidence of OIs were raised from 8.97% to 69.02%（P〈0.05）.The value of CD4＋, CD8＋T cell counts and CD4/CD8 ratios in the patients with OIs were lower than those without OIs（P〈0.05）.The ration of patients with significant and slow deletions of CD4＋T cell counts incurring HIV related OIs was 48.72% and 25.18%, while the patients with slow and significant increase of CD4＋T cell counts incurring HIV related OIs were 18.45% and 9.01%.There is statistical significance between two groups（P〈0.05）.Conclusion The low counts of CD4＋T cell might suggest higher risk of developing OIs, and the significant deletions of CD4＋T cell counts corresponds to the possibility of HIV related OIs risk.Dynamic detection of the counts and the changes related to the natural CD4＋T cell will be of great help for the prediction and prevention of OIs in patients with HIV/AIDS.