176例人类免疫缺陷病毒合并肺部感染者呼吸道病原体特点与免疫学特征

Characteristics of respiratory pathogens and immunological features of 176 patients W ith human im m unodeficiency virus and pulmonary infection

目的探讨人类免疫缺陷病毒(HIV)合并肺部感染者呼吸道病原体特点、免疫学特征及其相关影响因素。方法采用回顾性队列研究方法,收集2018年1月至2020年12月首都医科大学附属北京地坛医院诊断为HIV感染合并肺部感染共176例患者的支气管肺泡灌洗液和临床资料。通过多重实时荧光聚合酶链式反应(PCR)进行病原学检测,根据有无病原体检出将病例分为检出组(118例)和未检出组(58例),分析病原体单检出率、合并检出率并比较两组患者临床指标和免疫学指标,采用多因素Logistic回归分析探讨HIV合并肺部感染的影响因素。结果HIV合并肺部感染者中118例(67.0%)检出有1种或1种以上呼吸道病原体。其中,检出最多病原体为耶氏肺孢子菌(95/149,63.76%)。此外,29例(16.5%)病例检测到2种或2种以上呼吸道病原体。检出组与未检出组患者CD4+T淋巴细胞计数水平(U=2267、P=0.001)、HIV病毒载量(U=2277、P=0.001)和是否接受抗病毒治疗(χ^(2)=18.557、P=0.001)差异均有统计学意义。多因素Logistic回归分析显示,年龄≥37.5岁(OR=1.15、95%CI:1.00~1.23、P=0.038)为HIV感染者发生肺部感染独立危险因素,CD4^(+)T淋巴细胞计数≥112cells/μl为保护因素(OR=0.89、95%CI:0.84~0.95、P=0.001)。结论HIV合并肺部感染者中呼吸道病原体阳性检出率较高。明确HIV感染者的呼吸道病原体感染特点和患者的CD4^(+)T淋巴细胞计数水平等免疫学特征对其肺部感染诊疗具有重要意义。与临床诊断相比,多重实时荧光PCR检测具有更高的灵敏性和特异性,可为HIV合并肺部感染诊断提供更多病原学依据。

Objective To investigate the characteristics of respiratory pathogens,immunological features and related risk factors of patients with human immunodeficiency virus(HIV)and pulmonary infection.Methods The bronchoalveolar lavage fluid and clinical data from 176 HIV-infected patients complicated with respiratory symptoms who were admitted to Beijing Ditan Hospital,Capital Medical University from January 2018 to December 2020 were collected,retrospectively.Pathogen were detected with multiplex real-time PCR,all cases were divided into detected group(118 cases)and undetected group(58 cases)based on the presence of pathogens.The single detection rate and complicated detection rate of pathogens were analyzed,and clinical and immunological indicators of the two groups were compared.Multivariate Logistic regression analysis was used to explore the risk factors for HIV combined with pulmonary infection.Results Total of 118(67.0%)patients with HIV complicated with pulmonary infection were found to have one or more respiratory pathogens.The most commonly detected pathogen was Pneumocystis jiroveci(95/149,63.76%).Additionally,29(16.5%)patients were found to have two or more respiratory pathogens.The positive of pathogen varied significantly with the level of CD4^(+)T-lymphocyte count(U=2267,P=0.001),HIV viral load(U=2277,P=0.001)and received highly active antiretroviral therapy or not(χ^(2)=18.557,P=0.001).Multivariate Logistic analysis revealed that age was an independent risk factors for pulmonary infection in HIVinfected patients(OR=1.15,95%CI:1.00-1.23,P=0.038)and CD4^(+)T-lymphocyte count≥112 cells/μl was a protective factor(OR=0.89,95%CI:0.84-0.95,P=0.001).Conclusions The positive detection rate of respiratory pathogens are higher in HIV-infected patients with pulmonary infection.Clarifying respiratory pathogen infection characteristics and immunological characteristics such as CD4^(+)T-lymphocyte count of HIV-infected people is of great significance for the diagnosis and treatment of lung infections.In addition,compared with clinical diagnosis,multiplex real-time PCR detection has higher sensitivity and specificity,which can provide more pathogenic evidence for the diagnosis of HIV complicated with pulmonary infection.