外科手术对艾滋病感染者/患者CD4+水平的影响

Effects of Surgery on the Level of CD4+ in HIV-infected Person/Patients

目的外科手术对HIV感染者(HIV阳性者)免疫学指标的影响,为HIV阳性者行外科手术前的安全评估、围手术期的干预提供参考依据。方法选择2015-01/2018-12间由疾病控制中心检测并确诊为HIV阳性且在核工业416医院(成都医学院附属第二院)行外科手术的患者为研究对象,按照设计方案,收集研究对象的基本资料、临床资料及实验室检查结果,采用卡方检验及重复测量的方差分析、LSD法及主体内效应检验方法进行统计分析。结果共61例HIV阳性者纳入统计分析。术后HIV阳性者感染发生率为19.67%,CD4+<200个/μl组术后感染发生率为38.10%,CD4+≥200个/μl组术后感染发生率为10.00%,两组间差异有统计学意义(χ^2校正=5.22,P=0.02)。按照临床分期分为3组,显示HIV+Ⅰ组患者的术后7 d(D7)和术后30 d(D30)CD4+水平分别为(512±87)个/μl、(531±93)个/μl,HIV+Ⅱ患者D7和D30CD4+水平分别为(289±42)个/μl、(303±61)个/μl,HIV+Ⅲ患者D7和D30CD4+水平分别为(85±21)个/μl、(101±25)个/μl。3组患者手术前后3次CD4+计数组间比较,差异有统计学意义(P<0.05),进一步进行组内两两比较发现,术前(D0)vs D7、D0vs D30、D7vs D30CD4+计数间的差异均有统计学意义(P<0.05)。D0/D0、D7/D0、D30/D0CD4+百分比间的差异有统计学意义(P<0.05)。分析3组患者时间与分组因素之间的交互效应,显示各组CD4+计数、CD4+相对比的变化趋势及时间之间有交互作用,差异有统计学意义(F=14.357,P<0.05)。结论 CD4+水平越低,术后患者感染风险增加。手术对CD4+水平产生影响,不同临床分期患者CD4+水平术后变化速率不同,结合临床分期及CD4+水平,以积极应对围手术期风险。

Objective To analyze the effects of surgical operation on the immunological indexes of the HIV infected patients in order to provide reference for safety assessment and perioperative intervention of HIV infected patients before surgical operation. Methods Patients who confirmed to be HIV positive in the centers for disease control from January 2015 to December 2018 and underwent surgery in the second affiliated hospital of adult medicine of nuclear industry416 hospital were selected. Basic information,clinical data and laboratory examination results were collected. Chi-square test,repeated measure ment analysis of variance, LSD method and main body effect test method were used forstatistical analysis. Results A total of 61 HIV-infected patients were included in the statistical analysis. The postoperative infection rate of HIV-infected patients was 19.67%. The postoperative infection rate in the group with the count of CD4+<200 cell/μl(38.10%) was higher than that in the group with the count of CD4 +≥200 cell/μ l group(10.00%). There was significant difference between the two groups (χ^2 correction=5.22, P=0.02). The patients were divided into three groups according to clinical stage,and there were significant differences in the count of CD4+ before and after surgery among different groups(P<0.05). The count of CD4+ in the HIV+group I was 512±87 cell/μ l at 7 days(D7) and 531±93 cell/μl at 30 days(D30) after operation,respectively,and that in the HIV + group Ⅱ was 289 ± 42 cell/μ l at D7 and 303 ± 61 cell/μ l at D30 after operation,and the count of CD4+ in the HIV+group Ⅲ was 85±21 cell/μl at D7 and 1 01±25 cell/μl at D30 after operation,respectively. There were statistical differences between preoperative D0 vs D7,D0 vs D30 and D7 vs D30 in the count of CD4+(P<0.05). The differences of the percentages of CD4+between D0/D0, D7/D0 and D30/D0 were significant(P<0.05). The interaction effect between time and clinical stage was analyzed, showing that there was an interaction effect in count of CD4 + and the percentages of CD4 + between clinical stage and time, and the difference had statistically significant(F=14.357,P<0.05). Conclusion Patients with lower levels of CD4+ were at increased risk of infection after surgery. Surgery has an impact on level of CD4+. Patients with different clinical stages have different postoperative change rates in the level of CD4 +. In combination with clinical stages and CD4+ level,perioperative risks can be actively dealt with.