血清乳酸脱氢酶检测在获得性免疫缺陷综合征患者合并机会感染中的临床价值  

Clinical value of lactate dehydrogenase detection in early diagnosis of opportunistic infections in patients with acquired immune deficiency syndrome

作　　者：周泱[1] 孙丽琴[1] 吕德良[2] 程林[1] 李莎茜[1] 徐六妹[1] 王辉[1] Zhou Yang;Sun Liqing;Lv Deliang;Cheng Lin;Li Shaxi;Xu Liumei;Wang Hui(Division of Infectious Diseases,Shenzhen the Third People＇s Hospital,Shenzhen 518112,China;Shenzhen Center for Chronic Diseases Control,Shenzhen 518020,China)

机构地区：[1]广东省深圳市第三人民医院感染科,深圳市518112 [2]广东省深圳市慢性病防治中心健康与慢病管理科,深圳市518020

出　　处：《中华实验和临床感染病杂志（电子版）》2018年第4期341-347,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金："十三五"艾滋病和病毒性肝炎等重大传染病防治科技重大专项(No.2017ZX10202101-002-004);深圳"医疗卫生三名工程"项目(No.深卫计发[2016]23);深圳市科技创新项目(No.深科技创新[2016]148号)

摘　　要：目的探讨血清乳酸脱氢酶(LDH)在获得性免疫缺陷综合征(AIDS)患者合并机会感染疾病中的临床应用价值。方法选取2010年1月至2015年12月深圳市第三人民医院所收治的708例初诊住院AIDS患者,收集AIDS患者入院时临床特征和血清LDH水平,分析AIDS患者各种机会感染疾病的血清LDH水平。根据LDH水平(LDH> 250 U/L和≤250 U/L)将入组患者分成两组,即LDH升高组245例和LDH正常组463例。结果 708例初诊住院AIDS患者中,女性132例、男性576例,合并机会感染者182例(Waldχ~2=29.675、P<0.001),合并肺部感染者162例(Waldχ~2=69.328、P<0.001)。Logistic回归单因素分析结果显示,低CD4+T细胞计数水平(Waldχ~2=60.646、P<0.001)、高HIV RNA载量(Waldχ~2=25.305、P <0.001)、合并真菌感染(Waldχ~2=67.264、P <0.001)、卡氏肺孢子(PCP)感染(Waldχ~2=101.892、P<0.001)更易导致AIDS患者LDH升高,差异均有统计学意义;而合并分枝杆菌感染(Waldχ~2=0.137、P=0.711)的患者不易出现血清乳酸脱氢酶升高,差异无统计学意义(P> 0.05)。Logistic回归多因素分析结果显示,HIV RNA载量> 107拷贝/μl(Waldχ~2=5.175、P=0.023)、肺部感染(Waldχ~2=5.096、P=0.024)、血流感染(Waldχ~2=9.443、P=0.002)、PCP(Waldχ~2=57.216、P <0.001)和真菌感染(Waldχ~2=6.064、P=0.014)均影响LDH水平,差异均有统计学意义。结论 AIDS合并机会感染者LDH升高提示肺部感染和血流感染,感染病原体倾向于PCP和真菌感染,具有一定早期临床诊断价值。Objcetive To investigate the clinical value of lactate dehydrogenase in diagnosis of opportunistic infections in patients with HIV infection. Methods Total of 708 patients with HIV infection admitted for the first time during January 2010 to December 2015 in Shenzhen the Third People＇s Hospital were analyzed, retrospectively. The clinical characteristics and levels of serum lactate dehydrogenase（LDH） were collected after admission. According to the reference value of serum LDH（LDH 250 U/L and ≤ 250 U/L）, the patients were divided into two groups： elevated LDH group（245 cases） and normal LDH group（463 cases）. Results Among the 708 patients with AIDS who were admitted to hospital for the first time, there were 132 female cases and 576 male cases. In LDH elevated group, there were 182 cases with opportunistic infection（Waldχ^2 = 29.675, P 0.001）, and 162 cases with pulmonary infection（Waldχ^2 = 69.328, P 0.001）. The results of Logitic regression single factor analysis showed that lower CD4＋ T counts（Waldχ^2 = 60.646, P 0.001）, higher HIV loads（Waldχ^2 = 25.305, P 0.001）, fungal infections（Waldχ^2 = 67.264, P 0.001） and pneumocystis pneumonia（Waldχ^2 = 101.892, P 0.001） were more likely to lead to elevated LDH in patients with AIDS, with significant differences. In patients with Mycobacterium infection, the level of serum lactate dehydrogenase was not easy to increase, without significant difference（Waldχ^2 = 0.137, P = 0.711）. The results of Logitic regression multi-factor analysis showed that HIV RNA viral load 107 copies/ml（Waldχ^2 = 5.175, P = 0.023）, pulmonary infection（Waldχ^2 = 5.096, P = 0.024）, blood stream infections（Waldχ^2 = 9.443, P = 0.002）, pneumocystis pneumonia（Waldχ^2 = 57.216, P 0.001）, fungal infections（Waldχ^2 = 6.064, P = 0.014） were associated with LDH elevation, with significant differences. Conclusions The increase of LDH in patients with AIDS indicated that the infection site tends to be pulmonary infection a

关 键 词：获得性免疫缺陷综合征 机会感染 乳酸脱氢酶 临床价值 

分 类 号：R512.91[医药卫生—内科学]