人免疫缺陷病毒感染者/艾滋病患者浅表淋巴结肿大与CD4＋T淋巴细胞计数的相关性  

Clinicopathologic correlation between CD4-positive T lymphocyte counts and superficial lymphadenopathy in HIV-positive/AIDS patients

作　　者：卢祥婵[1] 邓建宁[1] 黄爱春[1] 李雪琴[1] 牟敏红[2] 欧汝志[1] 黄磊[3] 赵敏[1] 

机构地区：[1]南宁市第四人民医院感染科,530023 [2]南宁市第四人民医院病理科,530023 [3]解放军第三○二医院感染性疾病诊疗与研究中心

出　　处：《中华病理学杂志》2011年第9期622-625,共4页Chinese Journal of Pathology

基　　金：国家自然科学基金（30771897）;都医学发展科研基金（2007-3036）;2010年南宁市科学研究与技术开发计划、创新计划项目科研课题（201003047C-1）

摘　　要：目的 探讨人免疫缺陷病毒感染者/艾滋病患者（简称HIV感染者/AIDS患者）浅表淋巴结肿大的病理改变及其与CD4＋T淋巴细胞计数的相关性。方法 对1066例HIV感染者/AIDS患者浅表淋巴结肿大的发生情况及其外周血CD4＋T淋巴细胞计数进行分析；并对浅表淋巴结肿大患者行淋巴结活检。结果 在1066例HIV感染者/AIDS患者中有126例出现浅表淋巴结肿大，发生率为11.8％，其中17例检出合并有两种类型的病理改变。CD4＋T淋巴细胞计数＜100个/μl有69例，包括结核病37例，淋巴结反应性增生8例，艾滋病相关淋巴结病18例，青霉病12例，真菌感染5例，非结核分枝杆菌感染1例；CD4＋T淋巴细胞计数（100～200）个/μl有26例，包括结核病12例，淋巴结反应性增生8例，艾滋病相关淋巴结病6例，青霉病2例，非霍奇金淋巴瘤1例；CD4＋T淋巴细胞计数＞200个/μl有31例，包括结核病11例，淋巴结反应性增生12例，艾滋病相关淋巴结病3例，青霉病1例，非霍奇金淋巴瘤4例。合并浅表淋巴结肿大的结核病、艾滋病相关淋巴结病及青霉病患者的CD4＋T淋巴细胞计数比较差异有统计学意义（x2 =8.861,P=0.O12）。另外，浅表淋巴结肿大的发生率与CD4＋T淋巴细胞计数存在相关性（X2=375.41，P=0.000）。结论 导致HIV感染者/AIDS患者浅表淋巴结肿大的最常见疾病为结核病，其次为淋巴结反应性增生、艾滋病相关淋巴结病、青霉病。CD4＋T淋巴细胞计数越低，发生浅表淋巴结肿大的几率越高，合并机会性感染的风险也越大，测定外周血CD4＋T淋巴细胞计数对HIV感染者/AIDS患者浅表淋巴结肿大的早期诊断与治疗有指导意义。Objective To explore the clinicopathological correlation between CD4＋ T lymphocyte count and superficial lymphadenopathy HIV/AIDS patients. Methods A total of 1066 HIV/AIDS patients were included in this study. The incidence of superficial lymphadenopathy, peripheral blood CD4＋ T lymphocyte counts and histological features of superficial lymphadenopathy were analyzed. Results Among 1066 patients, 126 cases （11.8%） presented with superficial lymphadenopathy. Of the 126 cases, there were 69 cases with CD4＋ T lymphocyte counts 〈 100/μl and clinical diagnoses including tuberculosis （37 cases）, reactive hyperplasia （8 cases）, AIDS-related lymphadenopathy （18 cases）, penicillium diseases （12 cases）, fungal infection （5 cases） and non-tuberculous mycobacterial infection （1 case）.Twenty-six cases had CD4 ＋ T lymphocyte counts between 100/μl to 200/μl and clinical diagnosis including tuberculosis （ 12 cases ）, reactive hyperplasia （ 8 cases ）, AIDS-related lymphadenopathy （ 6 cases ）,penicillium disease （2 cases） and non-Hodgkin lymphoma （ 1 case ）. Twenty-nine cases had CD4 ＋ T lymphocyte counts 〉 200/μl and clinical diagnoses including tuberculosis （ 11 cases）, reactive hyperplasia （ 12 cases）, AIDS-related lymphadenopathy （ 3 cases）, Penicillium diseases （ 1 case） and non-Hodgkin lymphoma （4 cases）. The CD4 ＋ T lymphocyte counts among patients with tuberculosis, AIDS-related lymphadenopathy and Penicillium diseases were significantly different （x2 =8. 861, P =0. 012 ）. A significant correlation between the incidence of superficial lymphadenopathy and CD4 ＋ T lymphocyte counts was found （x2 =375.41, P =0.000 ）. ConclusionsThe most common cause of superficial lymphadenopathy in HIV/AIDS patients is tuberculosis, followed by lymph node reactive hyperplasia, AIDSrelated lymphadenopathy and Penicillium disease. Low CI4 ＋ T lymphocyte count correlates with an increased incidence of superficial lymphadenopathy and the risk of o

关 键 词：获得性免疫缺陷综合征 活组织检查 CD4阳性T淋巴细胞 

分 类 号：R51[医药卫生—内科学]