2008-2018年某院167例丙型肝炎病毒合并人类免疫缺陷病毒感染者的临床特征及治疗  

Clinical features and treatment of 167 patients with hepatitis C virus and human immunodeficiency virus coinfection in a hospital from 2008 to 2018

作　　者：赵凤丛[1] 马合木热·艾则孜 努斯来提[1] 张永萍[1] 成军[3] Zhao Fengcong;Mahemure Aizezi;Nusilaiti;Zhang Yongping;Cheng Jun(Department of Infectious Diseases,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Division of 2nd Department of Infectious Diseases,the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830013,China;Center of Hepatology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]新疆维吾尔自治区人民医院感染性疾病科,乌鲁木齐市830001 [2]新疆维吾尔自治区第六人民医院感染二科,乌鲁木齐市830013 [3]首都医科大学附属北京地坛医院肝病中心,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第6期453-460,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：新发突发传染病研究北京市重点实验室开放课题资助项目(No.DTKF201802)。

摘　　要：目的探讨丙型肝炎病毒(HCV)合并人类免疫缺陷病毒(HIV)感染者的临床特征及治疗现状,为HIV/HCV共感染的治疗提供科学指导。方法基于医院信息系统真实世界数据,提取2008年5月至2018年5月新疆维吾尔自治区第六人民医院(传染病医院)和新疆维吾尔自治区人民医院收治的167例HIV/AIDS患者的病历资料。依据医嘱记录,对HIV/HCV共感染者按照抗HCV方案分为聚乙二醇化干扰素α-2b(PegIFNα-2b)联合利巴韦林(RBV)治疗组(PegIFN组、62例),普通干扰素联合RBV治疗组(IFN组、46例)与直接抗病毒药物(DAAs)治疗组(DAAs组、59例);分析3组患者CD4+T淋巴细胞、丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)的变化、病毒学应答及不良反应发生率。结果共收集659例HIV/AIDS感染者的临床资料,其中合并HCV感染共计167例,合并感染率为25.34%。HCV基因型别主要为:3b型43例、3a型41例、1b型32例、6a型21例、未分出亚型25例、2a型5例,以3型最多,占50.29%(84/167)。其中经静脉吸毒感染占29.40%(142/483),性传播占14.20%(23/162),其他占14.29%(2/14)。125例患者无明显症状,42例患者出现虚弱、发热、盗汗、肝硬化、淋巴结肿大等症状。肝功能检查发现:肝功能正常者56例(56/167、33.53%),肝功能异常者111例(111/167、66.47%),其中12例为肝硬化代偿期,7例为肝硬化失代偿期。HIV/HCV共感染率自2008年的37.25%下降至2018年的15.00%,且呈逐年下降,趋势卡方检验显示差异有统计学意义(χ^2=263.190、P<0.001)。HIV/HCV共感染者CD4+T细胞计数显著高于单纯HIV/AIDS患者(t=7.203、P<0.001),总胆红素(TBil)(t=29.101、P<0.001)、ALT(t=25.382、P<0.001)、AST(t=30.984、P<0.001)、HIV RNA(t=9.190、P<0.001)均显著低于单纯HIV/AIDS患者,差异均有统计学意义。各组患者治疗后CD4+T淋巴细胞数均较治疗前升高,且DAAs组患者高于PegIFN组和IFN组;3组患者治疗后ALT、AST水平均较治疗前降低,且DAAs组患�Objective To investigate the clinical characteristics and treatment status of patients with hepatitis C virus(HIV)and human immunodeficiency virus(HIV)infection,and to provide scientific guidance for HIV/HCV co-infection treatment.Methods Based on real-world data from hospital information system,medical records of 167 patients with HIV/acquired immune deficiency syndrome(AIDS)from the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region(Infectious Diseases Hospital)and Xinjiang Uygur Autonomous Region People’s Hospital were collected from May 2008 to May 2018.According to medical records,patients with HIV/HCV co-infection were divided into polyethylene glycol interferon-α-2 b(PegIFNα-2 b)and ribavirin(RBV)treatment group(PegIFN group:62 cases),common IFN and RBV treatment group(IFN group:46 cases)and direct acting antivirals(DAAs)treatment group(DAAs group:59 cases).The changes of CD4+T lymphocytes,alanine transaminase(ALT),aspartate transaminase(AST),virological response and adverse reactions in the three groups were analyzed,respectivly.Results Total of 659 cases with HIV/AIDS were collected,among which,167 cases were complicated with HCV infection,the complicated infection rate was 25.34%.The main HCV genotypes were type 3 b(43 cases),type 3 a(41 cases),type 1 b(32 cases),type 6 a(21 cases),undifferentiated subtype(25 cases),type 2 a(5 cases);among which type 3 was the most,accounting for 50.29%(84/167).Among them,intravenous drug use accounted for 29.40%(142/483),sexual transmission accounted for 14.20%(23/162)and others accounted for 14.29%(2/14).Total of 125 patients had no obvious symptoms,and 42 patients had symptoms such as weakness,fever,night sweats,liver cirrhosis and lymphadenopathy.Liver function detection showed that 56 cases(56/167,33.5%)were with normal liver function,111 cases(111/167,66.5%)with abnormal liver function,including 12 cases with cirrhosis in compensatory stage,7 cases with degeneration of cirrhosis repayment period.The HIV/HCV coinfection rate dropped from 37.25%in 200

关 键 词：肝炎病毒 丙型 人免疫缺陷病毒 临床特征 治疗现状 

分 类 号：R512.63[医药卫生—内科学] R512.91[医药卫生—临床医学]