人类免疫缺陷病毒感染母亲所分娩新生儿贫血原因的初步探讨

Preliminary study on the causes of anemia in newborns delivered by human immunodeficiency virus infected mothers

目的探讨人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染母亲所分娩新生儿贫血的原因。方法本研究为回顾性分析。纳入2010年1月至2019年5月于首都医科大学附属北京地坛医院就诊的HIV感染母亲分娩的42例新生儿。根据出生时新生儿血红蛋白水平分为贫血组和无贫血组。比较两组新生儿胎龄和出生体质量,以及其母亲妊娠期贫血和服用抗病毒药物情况、孕早期/服药前HIV RNA阳性比例和不同CD4^(+)T淋巴细胞计数的比例、分娩前HIV RNA阳性比例和不同CD4^(+)T淋巴细胞计数的比例等。采用受试者操作特征曲线下面积评估相关因素预测新生儿发生贫血的效能。组间比较采用χ^(2)检验。结果42例新生儿中,贫血组14例,无贫血组28例。两组新生儿的胎龄、出生体质量,以及母亲妊娠期贫血情况、分娩前HIV RNA阳性比例间差异均无统计学意义(χ^(2)=2.211、1.025、1.362、3.783,P=0.283、0.763、0.181、0.092)。贫血组11例母亲妊娠期服用齐多夫定,无贫血组为12例(42.86%),差异有统计学意义(χ^(2)=4.359,P=0.037)。孕早期/服药前贫血组母亲HIV RNA阳性8例,无贫血组为11例(39.29%),差异有统计学意义(χ^(2)=6.490,P=0.011)。孕早期/服药前贫血组13例母亲CD4^(+)T淋巴细胞计数≤500/μL,无贫血组为20例(71.43%),差异有统计学意义(χ^(2)=16.396,P<0.01);孕早期/服药前贫血组13例母亲CD4^(+)T淋巴细胞比例≤0.28,无贫血组为19例(67.86%),差异有统计学意义(χ^(2)=19.908,P<0.01)。分娩前贫血组14例母亲CD4^(+)T淋巴细胞计数≤500/μL,无贫血组为15例(53.37%),差异有统计学意义(χ^(2)=9.536,P=0.008);分娩前贫血组14例母亲CD4^(+)T淋巴细胞比例≤0.28,无贫血组为15例(53.37%),差异有统计学意义(χ^(2)=9.750,P=0.006)。根据受试者操作特征曲线分析示,分娩前母亲CD4^(+)T淋巴细胞计数预测新生儿贫血的曲线下面积、最佳临界值、灵敏度和特异度分别为0.708、476.0/μL、100.0%和50.0%;分娩前母亲CD4^(+)T淋巴细胞比例预测新生儿贫血的曲线下面积、最佳临界值、灵敏度和特异度分别为0.719、0.275、100.0%和53.6%。结论妊娠期服用齐多夫定、孕早期/服药前HIV阳性及分娩前低CD4^(+)T淋巴细胞水平可能与HIV感染母亲分娩新生儿发生贫血有关。

Objective To investigate the causes of anemia in newborns delivered by human immunodeficiency virus(HIV)infected mothers.Methods This was a retrospective study.Forty-two newborns delivered by HIV infected mothers during January 2010 and May 2019 in Beijing Ditan Hospital Affiliated to Capital Medical University were selected.According to the hemoglobin levels of newborns on the days of their birth,newborn cases were divided into two groups,anemia group and non-anemia group.The clinical data including gestational ages,birth weight,maternal anemia status during pregnancy,using of antiviral drugs during pregnancy,percentages of HIV RNA positivity in early pregnancy/pre-treatment and before delivery,maternal percentage of different CD4^(+)T lymphocyte counts in early pregnancy/pre-treatment and before delivery between two groups were compared.The efficacies of relative indicators for prediction of anemia in newborns were evaluated by the area under receiver operating characteristic curve(AUROC).Differences between groups were compared by chi-square test.Results Among 42 cases of newborns,14 cases were in anemia group and 28 cases in non-anemia group.There were no statistical differences in gestational ages,birth weight,maternal anemia status during pregnancy and positive percentage of HIV RNA before delivery between two groups(χ^(2)=2.211,1.025,1.362 and 3.783,respectively,P=0.283,0.763,0.181 and 0.092,respectively).In anemia group,11 mothers took zidovudine during pregnancy,which was 12(42.86%)in non-anemia group.The difference was statistically significant(χ^(2)=4.359,P=0.037).Eight cases of mothers with HIV RNA positive in early pregnancy/pre-treatment in the anemia group,which was 11(39.29%)in the non-anemia group.The difference was statistically significant(χ^(2)=6.490,P=0.011).The number of CD4^(+)T lymphocyte count≤500/μL was 13 in early pregnancy/pre-treatment in anemia group,which was 20(71.43%)in the non-anemia group.The difference was statistically significant(χ^(2)=16.396,P<0.01).The number of CD4^(+)T lymphocyte≤0.28 was 13 in early pregnancy/pre-treatment in the anemia group,which was 19(67.86%)in the non-anemia group(χ^(2)=19.908,P<0.01).The number of CD4^(+)T lymphocyte count≤500/μL was 14 before delivery,which was 15(53.37%)in the non-anemia group(χ^(2)=9.536,P=0.008).The number of CD4^(+)T lymphocyte≤0.28 before delivery was 14 in anemia group,which was 15(53.37%)in the non-anemia group(χ^(2)=9.750,P=0.006).According to the receiver operating characteristic curve results,the AUROC,optimal cut-off value,sensitivity and specificity of CD4^(+)T lymphocyte count before delivery in predicting neonatal anemia were 0.708,476.0/μL,100.0%and 50.0%,respectively.The AUROC,optimal cut-off value,sensitivity and specificity of maternal CD4^(+)T lymphocyte percentage before delivery in predicting neonatal anemia were 0.719,0.275,100.0%and 53.6%,respectively.Conclusion Low CD4^(+)T lymphocyte level in HIV-infected mothers before delivery,HIV positive in early pregnancy/pre-treatment and using of zidovudine during pregnancy may be associated with neonatal anemia.