HIV/AIDS患者并发EBV和HCMV感染临床免疫学特征及影响因素分析  

Clinical Immunological Characteristic and Influencing Factors Analysis of HIV/AIDS Patients Infected with EBV and HCMV

作　　者：周林颖 刘兴 伍勇 胡金伟 ZHOU Linying;LIU Xing;WU Yong;HU Jinwei(Department of Clinical Laboratory,the First Hospital of Changsha,Changsha 410005,China)

机构地区：[1]长沙市第一医院检验科,长沙410005

出　　处：《现代检验医学杂志》2024年第2期91-95,共5页Journal of Modern Laboratory Medicine

基　　金：湖南省卫健委湖南省自然科学基金(2023JJ40066):虚拟筛选以Ltas蛋白为靶点的活性小分子抑制耐甲氧西林金黄色葡萄球菌的相关研究;长沙市卫健委长沙市自然科学基金(kq2208455):高通量筛选小分子化合物并探究其对耐甲氧西林金黄色葡萄球菌的抗菌作用。

摘　　要：目的调查人类免疫缺陷病毒/获得性免疫缺陷综合征(human immunodeficiency virus/acquired immune deficiency syndrome,HIV/AIDS)患者感染EB病毒(Epstein-Barr virus,EBV)和人类巨细胞病毒(human Cytomegalovirus,HCMV)的情况,检测相关临床免疫学指标,分析其影响因素。方法选取2022年1~12月在长沙市第一医院住院并接受EBV和HCMV筛查的1093例HIV/AIDS患者。流式细胞术检测CD4^(+)T淋巴细胞数量;荧光定量PCR检测HIVRNA载量、EBV-DNA载量和HCMV-DNA载量。采用SPSS 27.0统计学软件进行统计分析,并通过Logistic回归分析HIV/AIDS患者并发病毒感染的危险因素。结果1093例HIV/AIDS患者中,EBV-DNA阳性率为48.22%(527/1093),HCMV-DNA阳性率为19.03%(208/1093)。随着CD4^(+)T淋巴细胞数量增加,EBV-DNA和HCMV-DNA的阳性率下降(χ^(2)=39.50,143.0,均P<0.001);随着HIV-RNA载量增加,EBV-DNA和HCMV-DNA的阳性率增加,差异具有统计学意义(χ^(2)=46.18,124.3,均P<0.001)。另外,患者接受抗逆转录病毒治疗(antiretroviral therapy,ART)也可明显降低EBV-DNA和HCMV-DNA的阳性率,差异具有统计学意义(χ^(2)=30.60,96.59,均P<0.001)。CD4^(+)T淋巴细胞数量和HIV-RNA载量有显著的负相关关系(r=-0.49,P<0.001)。Logistic回归分析显示CD4^(+)T淋巴细胞数量<200个/μl(OR=1.46,95%CI:1.02~2.08,P=0.037),HIV-RNA载量>200 copies/ml(OR=1.70,95%CI:1.18~2.44,P=0.004),年龄>30岁(OR=2.15,95%CI:1.44~3.19,P<0.001)是HIV/AIDS患者并发EB病毒感染的危险因素;未持续接受ART(OR=1.83,95%CI:1.10~3.02,P=0.019),HIV-RNA载量>200 copies/ml(OR=2.56,95%CI:1.50~4.35,P<0.001),CD4^(+)T淋巴细胞数量<200个/μl(OR=4.61,95%CI:2.57~8.28,P<0.001)是HIV/AIDS患者并发HCMV感染的危险因素。结论在艾滋病的治疗与管理中,当CD4^(+)T淋巴细胞数量下降(<200个/μl),HIV-RNA载量升高(>200 copies/ml)或者年龄>30岁时,应加强对病毒的监测和ART,减少HIV/AIDS患者机会性感染的可能。Objective To investigate the basic information of human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS)patients who infected with Epstein-Barr virus(EBV)or human Cytomegalovirus(HCMV),collect the relevant clinical immunological data and analyze the influencing factors.Method A total of 1093 HIV/AIDS patients treated in the First Hospital of Changsha from January to December 2022 and underwent EBV and HCMV screening were collected.Flow cytometry was used to detect the CD4^(+)T lymphocytes.Fluorescence quantitative PCR was applied for HIV-RNA,EBV-DNA,and HCMV-DNA testing.Statistical analysis was carried out by using SPSS 27.0,and logistic regression was used to analyze the risk factors of HIV/AIDS patients complicated with viral infection.Results Among 1093 HIV/AIDS patients,the positive rates of EBV-DNA and HCMV-DNA were 48.22%(527/1093)and 19.03%(208/1093),respectively.As the number of CD4^(+)T lymphocytes increased,the positive rates of EBV-DNA and HCMV-DNA decreased,and the differences was statistically significant(χ^(2)=39.50,143.0,all P<0.001).As the level of HIV-RNA increased,the positive rates of EBV-DNA and HCMV-DNA increased,and the differences were statistically significant(χ^(2)=46.18,124.3,all P<0.001).The patients receiving antiretroviral therapy(ART)significantly decreased the positive rates of EBV-DNA and HCMV-DNA(χ^(2)=30.60,96.59,all P<0.001).There was a significant negative correlation between the number of CD4^(+)T lymphocytes and the level of HIV-RNA(r=-0.49,P<0.001).Logistic regression analysis showed that the CD4^(+)T lymphocyte count<200/μl(OR=1.46,95%CI:1.02~2.08,P=0.037),HIV-RNA load>200 copies/ml(OR=1.70,95%CI:1.18~2.44,P=0.004)and the age>30 years old(OR=2.15,95%CI:1.44~3.19,P<0.001)were risk factors for HIV/AIDS patients infected with EBV.Without regularly receiving ART(OR=1.83,95%CI:1.10~3.02,P=0.019),HIV-RNA load>200 copies/ml(OR=2.56,95%CI:1.50~4.35,P<0.001)and the CD4^(+)T lymphocyte count<200/μl(OR=4.61,95%CI:2.57~8.28,P<0.001)were risk factors for HCMV in

关 键 词：人类免疫缺陷病毒 EB病毒 巨细胞病毒 T淋巴细胞 艾滋病病毒载量 抗逆转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学] R373[医药卫生—临床医学]