艾滋病患者高效抗病毒治疗后免疫重建及预后影响因素的研究  

Influencing factors for immune reconstruction and prognosis of AIDS patients after highly active antiretroviral therapy

作　　者：陈国春[1] 卫峥[1] 马波[1] 黄和冲[1] 崔曼曼[1] CHEN Guo-chun;WEI Zheng;MA Bo;HUANG He-chong;CUI Man-man(The Third People＇s Hospital of Changzhou,Changzhou,Jiangsu 213001,China)

机构地区：[1]常州市第三人民医院感染科,江苏常州213001

出　　处：《中华医院感染学杂志》2018年第22期3414-3417,3421,共5页Chinese Journal of Nosocomiology

基　　金：江苏省基础研究计划基金资助项目(BK2011341)

摘　　要：目的探究艾滋病患者行高效抗病毒治疗后免疫重建及预后关系因素。方法选取2010年1月-2017年6月我院收治的艾滋病患者180例作为研究对象,按照患者的预后情况分为预后良好组与预后不良组;统计两组患者的基本临床资料,测定基线CD_4^+T淋巴细胞、白蛋白、血红蛋白、白细胞、血小板及血清中C-反应蛋白(CRP)等,动态观察治疗前、治疗后1个月、3个月及6个月外周血中CD_4^+T淋巴细胞含量,评价免疫重建情况;分析预后相关因素;评价CRP基线水平对预后的预测效果。结果与预后良好组相比,预后不良组年龄较大,临床分期为3期和4期,CD_4^+T淋巴细胞<100个/μL、白蛋白<35g/L、血红蛋白<100g/L、白细胞<4.0×10~9/L及CRP≥5mg/L的患者显著增加(P<0.05);较大年龄、临床分期、CD_4^+T淋巴细胞基线值、低血红蛋白、低白细胞及高CRP均为影响预后的危险因素;CD_4^+T淋巴细胞基线值、治疗后1个月、3个月及6个月的CD_4^+T淋巴细胞显著减少(P<0.05);CRP最佳截断为5mg/L,对不良预后预测的敏感度、特异性、准确率、阳性预测率及阴性预测率高于70.00%。结论艾滋病患者CD_4^+T淋巴细胞的基线水平与抗病毒治疗后免疫重建效果有一定的相关性;CRP基线水平对患者的预后效果有一定的预测作用。OBJECTIVE To explore the related factors for immune reconstruction and prognosis of AIDS patients after highly active antiretroviral therapy（HAAT）.METHODS A total of 180AIDS patients who were treated in the hospital from Jan 2010to Jun 2017were recruited as the study objects and divided into the favorable prognosis group and the poor prognosis group according to the status of prognosis.The baseline clinical data of the two groups of patients were statistically analyzed.The baseline CD4＋T lymphocyte,albumin,hemoglobin,white blood cell（WBC）,blood platelet and serum CRP were determined,the peripheral CD4＋T lymphocyte level was dynamically observed before the treatment and after the treatment for 1,3and 6months,and the status of immune reconstruction was evaluated.The related factors for prognosis were analyzed,and the effect of the baseline level of CRP on prediction of prognosis was evaluated.RESULTS The patients were older in the poor prognosis group than in the favorable prognosis group;the patients with clinical stage 3and 4,CD4＋T lymphocyte less than100/μL,albumin less than 35g/L,hemoglobin less than 100g/L,WBC less tan 4.0×10^9/L and CRP no less than 5mg/L were significantly increased（P〈0.05）.The old age,clinical stage,baseline value ofCD4＋T lymphocyte,low level of hemoglobin,low level of WBC and high level of CRP were the risk factors for the prognosis.The baseline value of CD4＋T lymphocyte and the CD4＋T lymphocyte counts after the treatment for 1,3and 6months were significantly reduced（P〈0.05）.The optimal cutoff value of CRP was 5mg/L,and the sensitivity,specificity,positive predictive rate and negative predictive rate were more than 70.00%in prediction of the poor prognosis.CONCLUSIONS The baseline level of CD4＋T lymphocyte of the AIDS patients is,to some extent,associated with the effect of immune reconstruction after the antiviral therapy,and the baseline level of CRP has certain effect on prediction of prognosis of the patients.

关 键 词：艾滋病 CD4+T淋巴细胞 C-反应蛋白 高效抗病毒治疗 免疫重建 预后 

分 类 号：R512.91[医药卫生—内科学]