广西儿童HIV/AIDS病人抗病毒治疗的免疫学效果及对其生长发育的影响

Analysis of immunological effect and influence on growth and development of antiretroviral therapy for children with HIV/AIDS in Guangxi

目的了解抗病毒治疗对广西儿童艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）免疫功能及其生长发育的影响。方法对截至2016年6月底在广西接受抗病毒治疗、年龄〈15岁、治疗时间≥3个月、基线和随访资料较完整的儿童HIV/AIDS病人,评估其治疗的免疫学效果及生长发育状况,采用t检验或F检验、χ~2检验或Fisher确切概率法作统计学分析。结果共纳入研究对象707例,开始治疗时平均年龄（56.95±35.96）个月,基线CD4~＋T淋巴细胞（简称CD4细胞）计数平均为（494.3±553.8）个/μL,最后一次随访检测CD4细胞计数平均值为（1 016.2±583.7）个/μL,平均增长（521.9±565.5）个/μL;不同治疗时点CD4细胞计数构成比差异有统计学意义（P〈0.001）。对各组治疗前后CD4细胞计数的差值作比较,不同初始治疗方案、复方新诺明使用情况、基线CD4细胞计数者间差异有统计学意义（P〈0.001）,初始治疗含阿巴卡韦（ABC）方案、使用复方新诺明、基线CD4细胞计数〈200个/μL者治疗后CD4细胞计数增长相对较多,平均增长分别为（689.0±678.5）个/μL、（581.9±569.9）个/μL、（695.7±433.8）个/μL。儿童HIV/AIDS病人身高、体重均低于正常儿童,差异有统计学意义（P〈0.001）,随着治疗时间的增加,儿童HIV/AIDS病人身高、体重与正常儿童的差距有逐渐缩小的趋势,但差异无统计学意义（P分别为0.987、0.449）。结论抗病毒治疗对儿童HIV/AIDS病人机体免疫力和生长发育有积极的改善作用,更长期的抗病毒治疗能否使儿童HIV/AIDS病人的生长发育水平达到正常,仍需继续追踪研究。

Objective To explore the immunological effect of HAART for children,and the impact on growth and development of children with HIV/AIDS in Guangxi.Methods The subjects of those receiving HAART≥3 months by the end of June 2016,and at the age〈15 years old were included,with complete data of baseline and follow-up.Chi-squared or Fisher exact test was used for statistical analyses.Results Among 707 patients,the mean treatment age was 56.95±35.96 months.The average growth of CD4~＋T cell count was 521.9±565.5 cells/μL after HARRT.The longer the treatment time（P〈0.001）,the more CD4~＋T cell counts increased.Comparison was made between groups on changes of CD4~＋cell count before and after treatment,initial treatment regimen with ABC,use of SMZ-TMP and baseline CD4~＋T cell count lower than 200 cells/μL,and the difference was statistically significant（P〈0.001）;and the average growth of CD4~＋cell count was 689.0±678.5 cell/μL,581.9±569.9 cell/μL,and 695.7±433.8 cell/μL,respectively.The height and weight of children with HIV/AIDS,lower than those of normal children at baseline,with the difference statistically significant（P 〈0.001）increased after antiviral therapy,but the difference was not statistically significant（P=0.987,0.449）.Conclusion The immunity of children has been improved with HAART,as well as the level of growth and development.Further research is necessary to see whether the longer-term HARRT can make the level of growth and development of children with HIV/AIDS to the normal.