艾滋病相关肺孢子菌肺炎复合感染状况与CD_4^+ T细胞数的关系  

Correlation between composite infections in acquired immune deficiency syndrome patients complicated with pneumocystis pneumonia and counts of CD_4^+ T cell

作　　者：叶宁[1] 李茜茜[1] 朱明利[1] 师金川[1] 叶荣夏[1] 喻剑华[1] 刘寿荣[1] 徐纪茹[2] 

机构地区：[1]浙江中医药大学附属杭州西溪医院杭州市西溪医院,浙江杭州310023 [2]西安交通大学医学部病原生物学与免疫学系,陕西西安710061

出　　处：《中华医院感染学杂志》2017年第10期2161-2164,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2015KYB321);杭州市社会发展基金资助项目(20160533B54)

摘　　要：目的分析获得性免疫缺陷综合征(AIDS)相关肺孢子菌肺炎(PCP)患者复合感染的情况及与CD_4^+ T细胞数的相关性。方法选取2012-2016年在杭州市西溪医院感染二科住院的AIDS患者147例,其中AIDS合并PCP感染患者60例,AIDS未合并PCP感染患者87例;将AIDS合并PCP患者中复合感染组与无复合感染组CD_4^+ T细胞数、CD_8^+ T细胞数以及CD_4^+ T/CD_8^+ T细胞比值进行比较,并进一步分析不同CD_4^+ T细胞数水平发生复合感染情况。结果 60例PCP患者中有47例发生复合感染,感染率为78.33%;其主要的复合感染是口腔念珠菌病、巨细胞病毒感染、细菌性肺炎、梅毒、乙型病毒性肝炎,感染率分别为41.67%、31.67%、31.67%、30.00%、11.67%;AIDS相关PCP患者CD_4^+ T细胞数均<200×10~6/L,且绝大多数≤50×10~6/L;复合感染组CD_4^+ T细胞数、CD_4^+ T/CD_8^+ T细胞比值显著低于无复合感染组(P<0.01,P<0.05);CD_4^+ T细胞数≤50×10~6/L组患者复合感染率为90.91%,显著高于CD_4^+ T细胞数51~100×10~6/L组(57.14%)、101~200×10~6/L组(33.33%),差异有统计学意义(P<0.017)。结论 AIDS相关PCP患者复合感染率高,AIDS合并PCP患者感染的病原体多种多样,且CD_4^+ T细胞数与AIDS合并PCP患者复合感染关系密切,随着CD_4^+ T细胞水平降低,机体免疫力下降,合并多种机会性感染的可能性进一步增加。OBJECTIVE To observe the correlation between the opportunistic infections in acquired immune deficiency syndrome （AIDS） patients complicated with pneumocystis pneumonia （PCP） and the CD4＋ T cell counts.METHODS A total of 147 AIDS patients who were hospitalized in Hangzhou Xixi Hospital from 2012 to 2016 were enrolled in the study,including 60 AIDS patients complicated with PCP and 87 AIDS patients without PCP.The CD4 ＋ T cell counts,CD8 ＋ T cell counts,and ratio of CD4 ＋ T cell to CD8 ＋ T cell were observed and compared between the opportunistic infection group and the non-opportunistic infection group;the prevalence of opportunistic infections in the patients with different levels of CD4 ＋ T cell was further analyzed.RESULTS Of the 60 patients,47 had the opportunistic infections,with the infection rate 78.33 %;the oral candidiasis,cytomegalovirus infection,bacterial pneumonia,syphilis,and hepatitis B were dominant among the opportunistic infections,accounting for 41.67%,31.67%,31.67%,30.00%,and 11.67%,respectively.The CD4＋ T cell counts of the AIDS patients complicated with PCP were less than 200 × 10^6/L,most of whom were no more than 50 × 10^6/L.The CD4 ＋ T cell counts and ratio of CD4 ＋ T cell to CD8 ＋ T cell were remarkably lower in the opportunistic infection group than in the non-opportunistic infection group （P〈0.01,P〈0.05）.The incidence of opportunistic infection of the patients with the CD4 ＋ T cell counts no more than 50× 10^6/L was 90.91%,significantly higher than 57.14% of the patients with the CD4 ＋ T cell counts ranged between 51 and 100 × 10^6/L and 33.33 % of the patients with the CD4 ＋ T cell counts ranged between 101 and 200 × 10^6/L（P〈0.017）.CONCLUSION The incidence of opportunistic infections is high in the AIDS patients complicated with PCP,there are a great diversity of pathogens causing the infections in the AIDS patients complicated with PCP,and the CD4 ＋ T cell count is closely associated with the opportunistic infection in the AIDS

关 键 词：获得性免疫缺陷综合征 肺孢子菌肺炎 机会性感染 CD4+ T细胞 

分 类 号：R512.91[医药卫生—内科学]