粒细胞减少症治疗对降低艾滋病晚期患者再感染率的效果

Effect of treatment of granulocytopenia on reducing reinfection rate of patients with advanced AIDS

目的艾滋病(AIDS)晚期同时存在中性粒细胞减少及CD4^(+)T淋巴细胞数低下这两个免疫缺陷因素的患者高达50%,本研究拟观察采用高效抗逆转录病毒疗法(HAART)联合监测中性粒细胞绝对值(ANC)并定期注射重组人粒细胞集落刺激因子(rhG-GSF)在提升粒细胞和降低再感染率方面的效果。方法选取2018年9月至2020年12月梧州市第三人民医院门诊随访的AIDS晚期合并中性粒细胞减少症(ANC<2×10^(9)/L)患者138例,随机分为对照组(n=69)和干预组(n=69)。对照组采用HAART治疗,干预组在HARRT基础上通过监测ANC并定期注射rhG-GSF积极治疗粒细胞减少(缺乏)症。两组均观察6个月,比较再感染率及抗生素使用天数,通过Kaplan-Meier法比较6个月的无再感染生存率(DFS)。结果观察6个月后,干预组的ANC中位数为4.20×10^(9)/L,高于对照组的2.16×10^(9)/L(P<0.05);干预组的再感染率为46.4%,低于对照组的63.8%(P<0.05);干预组的抗生素使用时间中位数为10.5d,少于对照组的13.0d(P<0.05);生存分析结果显示,干预组无再感染生存时间长于对照组(P<0.05)。结论在HARRT前6个月的免疫重建初期,治疗粒细胞减少(缺乏)症对降低AIDS晚期患者再感染率有积极作用。

Objective In the severe stage of AIDS patients with neutropenia(lack) and CD4^(+) T lymphocyte count decreased at the same time, the number of these two immune deficiency factors is as high as 50%. To observe the effect of combined monitoring of absolute neutrophil count(ANC) with highly active antiretroviral therapy(HAART) and regular injection of recombinant human granulocyte colony stimulating factor(rhG-GSF) on increasing granulocyte and reducing reinfection rate. Methods 138 patients with advanced AIDS combined with granulocytopenia(ANC<2×10^(9)/L) were randomly divided into control group(n=69) and intervention group(n=69) during follow-up visits from September 2018 to December 2020 in the Outpatient Department of the Third People′s Hospital of Wuzhou. The control group was treated with HAART, and the intervention group was actively treated with granulocytopenia(deficiency) by monitoring ANC and regularly injecting rhG-GSF in addition to HARRT. The two groups were observed for 6 months, and the reinfection rate and days of antibiotic use were compared. The 6-month reinfection-free survival rate(DFS) was compared by Kaplan-Meier method. Results After 6 months of observation, the median ANC in the intervention group was 4.20×10^(9)/L, which was higher than that in the control group(2.16×10^(9)/L, P<0.05). The reinfection rate of the intervention group was 46.4%, lower than that of the control group(63.8%)(P<0.05). The median duration of antibiotic use in the intervention group was 10.5 d, which was less than 13.0 d in the control group(P<0.05). The survival analysis results showed that the survival time without reinfection was longer in the intervention group than in the control group(P<0.05). Conclusions Treatment of granulocytopenia(deficiency) during the initial immunoreconstructive period in the first 6 months of HARRT has a positive effect on reducing reinfection rates in patients with advanced AIDS.