HIV/AIDS抗病毒治疗前CD4^+ T淋巴细胞计数自然变化与治疗后免疫恢复及死亡率的相关性  

Trends of CD4^+ T cell count among HIV/AIDS patients prior to antiretroviral therapy initiation and its association with immunological recovery and mortality after treatment

作　　者：董文斌[1] 李世福[1] 赵金仙[1] 苏舒 陈黎跃[1] 蔡英[1] 朱永芬 刘小春[1] 鲁建波[1] 李顺祥[1] 许杰[1] 李泽 吴强[1] DONG Wen-bin;LI Shi-fu;ZHAO Jin-xian;SU Shu;CHEN Li-yue;CAI Ying;ZHU Yong-fen;LIU Xiao-chun;LU Jian-bo;LI Shun-xiang;XU Jie;LI Ze;WU Qiang(Division of HIV/AIDS and STD control,Centre for Disease Control and Prevention,Yuxi 653100,China;Department of Epidemiology and Preventive Medicine,School of Public Health,Monash University,Melbourne 999029,Australia)

机构地区：[1]玉溪市疾病预防控制中心性病艾滋病控制科,云南玉溪653100 [2]莫纳什大学公共卫生学院流行病学和预防医学系,澳大利亚墨尔本999029

出　　处：《中华疾病控制杂志》2018年第12期1229-1233,共5页Chinese Journal of Disease Control & Prevention

基　　金：云南省中青年学术技术带头后备人才培养项目(2016HB052)

摘　　要：目的 探讨云南省玉溪市艾滋病病毒感染者/艾滋病病人(human immunodeficiency virus/acquired immunodeficiency syndrome,HIV/AIDS)获得抗病毒治疗(antiretroviral therapy,ART)前CD4^+ T淋巴细胞(简称CD4)自然变化与ART后免疫恢复及死亡率的相关性。方法 将HIV/AIDS获得ART前CD4自然变化分为四组,描述不同组间ART后免疫恢复情况,应用非条件Logistic回归进行单因素和多因素分析HIV/AIDS病例ART后免疫无应答(immune non-responses,INRs)的相关因素,采用Kaplan-Meier法绘制不同组间ART后生存曲线。结果 777例HIV/AIDS中ART前快速上升组、平缓上升组ART后CD4月均上升速率慢于ART前快速下降组,差异均具有统计学意义(均有P <0. 05)。多因素Logistic回归分析发现:ART前CD4自然变化为上升(OR=2. 416,95%CI:1. 264~4. 616,P=0. 008; OR=1. 997,95%CI:1. 067~3. 737,P=0. 031)、基线CD4值> 500 cell/μL(OR=6. 550,95%CI:3. 315~12. 941,P <0. 001)、ART时年龄≥50岁(OR=4. 276,95%CI:1. 761~10. 3865,P=0. 001)的病例ART后更容易出现INRs。ART前平缓上升组ART后累计生存率低于ART前平缓下降组和快速下降组(χ^2=8. 979,P=0. 003;χ^2=4. 158,P=0. 041),在基线CD4值<200 cell/μl层,ART前平缓上升组在ART后累计生存率低于ART前平缓下降组和ART前快速下降组,差异均有统计学意义(均有P <0. 05)。结论 HIV/AIDS患者ART前CD4自然变化与ART后免疫恢复、INRs及死亡率存在一定关联。Objective To examine the association between the natural trends of CD4 + T cell prior to antiretroviral therapy (ART) initation and immunological recovery and mortality after ART among HIV/AIDS patients in Yuxi Prefec-ture,Yunnan. Methods The natural changes of the CD4 + T cell before ART were divided into four groups among HIV/ AIDS patients,the immunologic recovery was described and Kaplan-Meier method were used to describe survival curve a- mong different groups of patients initiated ART. Multivariate logistic regression were used to analyse factors associated with immune non-responses. Results Among 777 HIV/AIDS patients,the natural changes of CD4^+ T cell after ART was significantly lower in gently and rapidly increased groups than rapidly decline groups among ART-nave HIV/AIDS patients. Multivariate logistic regression analysis indicated that patients with natural increase of CD4 + T cell counts before ART initia- tion (OR =2. 416,95% CI:1. 264 - 4. 616,P = 0. 008;OR = 1. 997,95% CI:1. 067 - 3. 737,P = 0. 031),with baseline CD4^+ T cell counts more than 500cell/Μl (OR =6. 550,95% CI: 3. 315 -12. 941,P <0. 001) and those older than 50 years old at ART initiaiton (OR =4. 276,95%CI: 1. 761-10. 3865,P =0. 001) were more likely to have immune non-re- sponses after ART. The cumulative survival rate was significantly lower in gently increased groups than the gently and rapid decline groups (χ^2 =8. 979,P =0. 003;χ^2 =4. 158,P =0. 041),further stratified analysis showed that those with baseline CD4 counts less than 200 cell/μl,as well (all P <0. 05). Conclusions An association was identified between the natu- ral changes of CD4 + T cell before ART and the immunologic recovery after ART,INRs and mortality.

关 键 词：HIV/AIDS CD4^+T淋巴细胞 抗病毒治疗 生存分析 相关性分析 

分 类 号：R512.91[医药卫生—内科学]