381例艾滋病患者肠道感染情况及耐药性分析

Analysis of intestinal infection and drug resistance in 381 AIDS patients

目的探讨艾滋病相关慢性腹泻患者机体免疫状况及肠道感染和药物敏感情况,为临床治疗提供依据。方法收集2016年1月至2020年10月在广西壮族自治区龙潭医院住院的经粪便培养出真菌、细菌及结核分枝杆菌的艾滋病相关慢性腹泻患者381例为合并感染组,择取同期无机会性感染的住院艾滋病患者400例为对照组,对合并感染艾滋病患者肠道菌群进行分析及药物敏感试验,检测两组患者CD4^(+)T、CD8^(+)T淋巴细胞数量,评估其免疫状态。结果381例艾滋病相关慢性腹泻患者中粪便培养出真菌357例(93.7%),其中白念珠菌183例(51.26%),光滑念珠菌100例(28.01%),热带念珠菌37例(10.36%),克柔念珠菌24例(6.72%),近光滑念珠菌13例(3.64%);合并肠道结核分枝杆菌感染18例(4.72%);合并沙门菌感染6例(1.57%)。药物敏感试验结果显示每种真菌对两性霉素B、氟康唑、伊曲康唑、伏立康唑、5-氟尿嘧啶的敏感性差异均有统计学意义(P<0.05);合并结核分枝杆菌感染患者对常用抗结核药耐药率为38.89%~66.67%;合并沙门菌感染患者对常用抗生素敏感率为30.33%~100.00%。合并感染组患者CD4^(+)T淋巴细胞值为33.00(10,90)个/μl,CD8^(+)T淋巴细胞值为351.00(201,577)个/μl,CD4^(+)T/CD8^(+)T比值为0.11(0.04,0.22)。对照组CD4^(+)T淋巴细胞值为222.00(125,334)个/μl,CD8^(+)T淋巴细胞值为744.00(524,1144)个/μl,CD4^(+)/CD8^(+)比值为0.28(0.16,0.43),两组患者CD4^(+)T、CD8^(+)T淋巴细胞值及CD4^(+)T/CD8^(+)T比值差异有统计学意义(P<0.01)。结论艾滋病患者免疫力低下,导致肠道屏障功能障碍、细菌易位、肠道菌群失调,引发病原菌感染。应作病原菌培养及药物敏感试验,选择敏感的药物进行抗菌治疗,确保治疗的有效性。

Objective To investigate the immune status,flora distribution and their resistance of intestinal pathogenic bacterium in patients with AIDS-related chronic diarrhea,and to provide a basis for clinical medication selection.Methods A total of 381 AIDS patients with chronic diarrhea who hospitalized in Longtan Hospital of Guangxi Zhuang Autonomous Region from January 2016 to October 2020 were collected for flora analysis and drug sensitivity.Further,these patients were evaluated immune status by analyzing the contents of CD4^(+)T and CD8^(+)T lymphocytes.To compare the immune status of AIDS patients with chronic diarrhea,400 AIDS patients who without opportunistic infection were enrolled into the control group to assess immune status via performing flow cytometry as well.Results There were 357 cases found fungi in excrement,the types of fungi including183 cases of Candida albicans(51.26%);100 cases of Candida glabrata(28.01%);37 cases of Candida tropicalis(10.66%);24 cases of Candida krusei(6.72%);13 cases of Candida paraglabrata(3.64%);among of these fungus infection patients,some of them simultaneously infected with bacterial,there were 18 cases(4.72%)with intestinal Mycobacterium infection and6 cases(1.57%)with intestinal Salmonella infection.In the cases of fungal infection,the sensitivity of each fungus to amphotericin B,fluconazole,itraconazole,voriconazole and 5-fluorouracil was significant difference(P<0.05).Candida albicans infection is the most common and is sensitive to all five antifungal drugs.The drug resistance rate of those with tubercle bacillus cultured in stool was 38.89%~66.67%.The susceptibility to commonly used antibiotics in feces cultured with Salmonella infection was 30.33%~100.00%. AIDS patients with an intestinal bacterial infection will have lowercontents of immune cells than without intestinal infection. The results of flow cytometry showedthat CD4^(+)T lymphocytes 33.00(10,90) /μl, CD8^(+)T lymphocytes 351.00(201,577)/μl, and CD4^(+)T/CD8^(+)T 0.11(0.04,0.22) for test group. Control group CD4^(+)T lymphocytes 222.00(125,334)/μl, CD8^(+)T lymphocytes744.00(524,1144)/μl, CD4^(+)/CD8^(+) 0.28(0.16,0.43), two groups of CD4^(+)T, CD8^(+)T lymphocytes and CD4^(+)T/CD8^(+)T were significantly different (P <0.01). Conclusion The weakened immunity of AIDS patientsleads to intestinal barrier dysfunction, bacterial translocation, imbalance of intestinal flora, andultimateintestinalinfection. And the choice of antibacterial drugs should base on drug sensitivityand ensure the treatment efficacy.