赣州市2010-2014年新发HIV/AIDS病例首次CD4~+ T淋巴细胞检测结果分析

目的了解赣州市HIV/AIDS患者免疫水平及疾病进展情况,为其抗病毒治疗提供参考依据。方法将入选的564例HIV/AIDS病例首次血液标本采用流式细胞仪(FACScont)进行CD4~+T淋巴细胞绝对值检测。结果 564例HIV/AIDS患者的CD4~+T淋巴细胞中位数(四分位数间距)为256.00(277.75)个/μl,CD4~+T淋巴细胞绝对值≤200个/μL者占35.28%,201~350个/μL者占32.09%,351~500个/μL者占18.26%,500个/μL者占14.36%。不同性别HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异无统计学意义(P0.05),不同年龄和样本来源HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异有统计学意义(P0.05)。结论赣州市多数HIV/AIDS患者CD4~+T淋巴细胞免疫水平偏低,HIV感染者已经进入发病高峰期,应加强防控措施。     

浙江省桐乡市2005-2019年HIV/AIDS患者CD4~+T淋巴细胞检测情况分析

目的了解桐乡市艾滋病感染者/艾滋病患者CD4~+T淋巴细胞检测情况及影响因素分析。方法利用目前我国的晚发现定义标准回顾性分析2005年1月1日-2019年12月31日桐乡市报告至全国传染病监测系统的HIV/AIDS病例数据资料,描述统计CD4~+T淋巴细胞检测结果低于200个/μL的影响因素,用Kaplan-Meier法估计生存时间,Cox比例风险模型分析与生存状态有关的影响因素,并采用Log Rank、Breslow和Tarone-Ware三种检验方法分析治疗组与非治疗组的生存率是否存在组间差别,并绘制生存曲线。结果 2005-2019年桐乡市累计报告HIV病例531例,首次随访检测CD4~+T淋巴细胞503例。其中,晚发现患者128例,平均年龄(47.32±12.63)岁,以小学及以下文化、异性传播、已婚有配偶及非浙江省户籍的男性为主,单因素分析显示,是否治疗、年龄、婚姻状况、文化程度及感染途径,是检测CD4~+T淋巴细胞晚发现的影响因素,差异有统计学意义(P0.05)。非治疗组的死亡风险高于治疗组(95%CI:7.818～356.526),首次CD4~+T淋巴细胞计数检测水平50个/μL组死亡风险高于50～200个/μL组(95%CI:1.843～61.030)。病例报告来源于术前检测(95%CI:0.005～0.641)、其他体检人群检测(95%CI:0.121～0.016)为保护因素。未治疗组平均生存时间为(60.137±19.092)个月,治疗组的生存时间为(151.470±5.013)个月,差异有统计学意义(P0.05)。结论桐乡市2005-2019年晚发现比例低于平均水平,治疗是提高患者生存的保护因素,应进一步扩大对重点人群的艾滋病主动检测,提高检测力度,提早发现HIV感染者并积极纳入治疗体系。     

HIV/AIDS患者抗病毒治疗效果评估及基因型耐药分析

目的对人类免疫缺陷病毒(HIV)携带者和艾滋病(AIDS)患者(简称HIV/AIDS患者)抗病毒治疗效果进行评估并分析其基因型耐药情况。方法选取2018年6月至2020年6月无锡市第二人民医院收治的81例HIV/AIDS患者作为研究对象。对所有患者进行抗病毒治疗,测定CD4~+T淋巴细胞计数与病毒载量,分析抗病毒失败患者基因型耐药情况。结果 81例HIV/AIDS患者中95.06%患者服药依从性较好,92.59%患者临床症状明显减轻,坚持服药患者中97.40%患者病情好转,未坚持服药患者无病情好转现象,差异具有统计学意义(P0.05)。81例HIV/AIDS患者最近一次CD4~+T淋巴细胞计数高于开始治疗前CD4~+T淋巴细胞计数(P0.05),治疗后免疫学成功率达到85.19%,HIV病毒抑制率达到92.59%。抗病毒失败患者核苷类反转录酶抑制剂(NRTI)、非核苷类反转录酶抑制剂(NNRTI)耐药突变率分别为40.00%、80.00%,其中1例(20.00%)患者出现NNRTI、NRTI双重耐药,主要以3TC/FTC/EFV耐药为主。结论 HIV/AIDS患者抗病毒治疗效果明显,但需要患者保持良好服药依从性,治疗失败患者耐药率较高,建议临床加大病毒载量及基因型耐药分析,及时调整治疗方案。     

未抗病毒治疗的HIV/AIDS患者CD4~+T淋巴细胞快速下降和显著下降比例及相关因素

目的探讨云南省玉溪市新报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS)在未抗病毒治疗的情况下其CD4~+T值快速下降及显著下降情况,分析其相关因素。方法收集未抗病毒治疗HIV/AIDS历次CD4~+T淋巴细胞计数值、人口学特征、样本来源和可能感染途径等,计算快速下降率和显著下降率并分析相关因素。结果 1 480例HIV/AIDS其CD4~+T值快速下降率和显著下降率分别为42.64%(631/1 480)、52.23%(773/1 480),单因素分析结果显示,CD4~+T值快速下降与性别、文化、年龄、职业、婚姻状况、传播途径、首次CD4~+T值以及首末次检测时间间隔有关,CD4~+T值显著下降与文化、民族、传播途径、首次CD4~+T值以及首末次检测时间间隔有关;经多因素Logistic回归分析表明,女性(OR=1.271,95%CI:1.044~1.674)、已婚(OR=1.460,95%CI:1.093~1.949)、传播途径注射吸毒(OR=1.365,95%CI:1.016~1.833)、首次CD4~+T值500cell/μL,更容易出现CD4~+T值快速下降,首末次检测时间间隔18个月更不容易出现CD4~+T值快速下降;传播途径注射吸毒(OR=1.286,95%CI:1.018~1.625)、首次CD4~+T值500 cell/μL、首末次检测时间间隔≥6个月,更容易出现CD4~+T值显著下降,传播途径为男男性行为(OR=0.426,95%CI:0.199~0.914)更不容易出现CD4~+T值显著下降。结论 HIV/AIDS患者CD4~+T值快速下降和显著下降与性别、婚姻状况、传播途径等因素有关,需加强对女性、已婚、注射吸毒人群的定期随访,及时启动抗病毒治疗。     

人免疫缺陷病毒阳性带状疱疹27例临床分析

目的探讨感染人免疫缺陷病毒(HIV)带状疱疹患者的临床特征。方法回顾性分析2013年1月—2014年10月收治的HIV感染并发带状疱疹27例患者临床资料。结果 27例HIV感染者所有疼痛评分均3分(6.07±2.05)分,住院天数为(9.5±2.0)d,均出现了CD4+T淋巴细胞计数降低(343±49)个/μl。结论 HIV感染并发带状疱疹患者与普通带状疱疹患者相比,常常侵犯多神经支配区域,疼痛明显,临床表现更为严重,治疗时间相对较长,CD4+T淋巴细胞计数降低可能是带状疱疹的发生及复发的重要因素。     

杭州市萧山区HIV/AIDS患者抗病毒治疗情况及影响因素

目的探讨现阶段萧山区HIV/AIDS患者抗病毒治疗情况及影响因素。方法采用回顾性研究的方法,将2004年1月-2017年12月在杭州市萧山区疾病预防控制中心登记的所有HIV/AIDS患者的报告卡和随访记录表资料进行筛选,对符合入选标准的数据采用χ~2检验分析人口学特征、艾滋病相关特征、高危行为、社会支持差异,并对患者抗病毒治疗情况进行Logistic回归分析,探索HIV/AIDS患者抗病毒治疗情况的影响因素,并计算OR(95%CI)值。结果共815例纳入研究,其中男671例(82.3%),年龄分布在20～39岁之间的453例(55.6%),中等学历(初中、高中及中专)的有498例(61.1%),732例(89.8%)的HIV/AIDS患者接受了抗病毒治疗,496例(60.9%)患者处于HIV感染阶段。多元Logistic回归分析显示:已婚(OR=5.750,95%CI:2.332～14.182)、过去3个月每次性行为都使用避孕套(OR=3.577,95%CI:1.966～6.411)的HIV感染者更有可能接受抗病毒治疗(OR1);病程阶段为HIV感染(OR=0.012,95%CI:0.003～0.050)、CD4~+T淋巴细胞数为0～200个/μL(OR=0.026,95%CI:0.007～0.097)、CD4~+T淋巴细胞数为201～350个/μL(OR=0.377,95%CI:0.194～0.732)、过去3个月每次性行为未使用避孕套(OR=0.267,95%CI:1.966～6.411)的HIV感染者接受抗病毒治疗可能性更低(OR1)。结论杭州市萧山区HIV/AIDS患者整体具有良好的抗病毒治疗情况,但尚未达到90-90-90目标,各部门仍需继续努力。且抗病毒治疗情况易受到相关高危行为及社会支持的影响,应给予综合干预。     

HIV/HBV合并感染者的HBeAg状态与免疫重建的关系

目的了解人类免疫缺陷病毒(HIV)/乙型肝炎病毒(HBV)合并感染者的HBeAg状态与高效抗反转录病毒治疗(HAART)后患者免疫重建的关系。方法 69例HIV/HBV合并感染者按HBeAg的状态分为HBeAg阳性组(26例)和HBeAg阴性组(43例);分别对两组患者治疗后1年、2年、3年的CD4~+ T淋巴细胞的增长值进行比较。结果两组患者在接受HAART治疗3年后,外周血HIV RNA载量均低于检测下限(20拷贝/mL)。两组患者基线CD4~+ T淋巴细胞计数的比较差异无统计学意义。HBeAg阴性组合并感染者接受HAART治疗后1年、2年、3年的CD4~+ T细胞计数的增长值均明显低于HBeAg阳性组合并感染者,差异具有统计学意义(P0.05)。结论 HBeAg的状态可能影响HIV/HBV合并感染者接受HAART治疗后的免疫重建。     

未治疗HIV/AIDS中CD4~+T淋巴细胞计数与机会性感染的相关性分析

目的探讨未抗病毒治疗HIV感染者/艾滋病病人(HIV/AIDS)CD4~+T淋巴细胞计数及其自然变化与机会性感染(OIs)1年内发生率之间的关联,为临床防治OIs提供依据。方法对新报告的739例HIV/AIDS开展为期1年、每3个月一次随访的队列研究,了解其1年内OIs出现情况,获取OIs出现与未出现者基线与末次CD4~+,CD8~+T淋巴细胞计数数据,描述并比较其末次与基线T淋巴细胞计数自然变化速率。结果 739例研究对象中207例(28.01%)1年内出现OIs,50岁及以上年龄组1年内OIs发生率(79.69%)较50岁以下年龄组(23.11%)高(P0.05),随着基线CD4~+T淋巴细胞计数的降低,1年内OIs发生率由8.97%上升至69.02%(P0.05);OIs各组的CD4~+,CD8~+T淋巴细胞计数值及CD4/CD8比值均显著低于无OIs组(P0.05);CD4~+T淋巴细胞计数快速、平缓下降组OIs出现构成比分别为48.72%和25.18%,而CD4~+T淋巴细胞计数平缓、快速上升组OIs出现构成比分别为18.45%和9.01%,差异有统计学意义(P0.05)。结论 CD4~+T淋巴细胞计数水平越低OIs增加越明显,无论基线CD4~+T淋巴细胞计数水平是高是低,CD4~+T淋巴细胞计数快速下降均对应着OIs出现几率的明显提高,CD4~+T淋巴细胞计数水平及其下降速率对OIs发生的预测、预防有重要的指导意义。     

HIV/AIDS患者外周血CD4~+ T淋巴细胞水平与巨细胞病毒感染相关性分析

目的:了解HIV/AIDS患者外周血CD4+T淋巴细胞水平与巨细胞病毒(CMV)感染的相关性。方法:采集300例HIV/AIDS患者外周血,进行CD4+T淋巴细胞水平和巨细胞病毒DNA检测。结果:300例HIV/AIDS患者中CMV DNA呈阳性者26例,阳性率为8.67%。CMV阳性患者中,有18例CD4+T淋巴细胞低于200个/μL,占CMV阳性者的69.23%。当CD4+T淋巴细胞计数低于200个/μL时,CMV感染率明显升高,与CD4+T淋巴细胞计数高于200个/μL时比较差异具有统计学意义(x2=18.42,P<0.05)。不同性别间CMV阳性率差异无统计学意义(x2=0.05,P=0.824)。年龄越小,CMV阳性率越高,各年龄组间差异具统计学意义(x2=7.93,P=0.042)。结论:在HIV/AIDS患者CD4+T淋巴细胞低于200个/μL时,应加强CMV监测。     

高效抗反转录病毒疗法治疗HIV/AIDS患者的临床研究

目的探讨艾滋病免费抗病毒药物治疗的临床疗效、安全性、免疫重建和影响因素。方法对203例艾滋病患者应用国家免费抗病毒药物治疗,采用科学的督导管理模式,定期随访观察临床疗效、药物副作用,并做血常规、肝肾功、血糖、血脂、CD4~+、病毒载量等检测。结果服药依从性在95%～100%之间,平均98.7%。所有患者临床症状均有不同程度改善,无死亡和严重不良事件发生。治疗满18个月的169例患者有89.8%CD4~+上升,总体CD4~+平均上升127.8个/μL,132例做病毒载量(HIV RNA)检测,结果患者HIV RNA持续下降,6个月、12个月、18个月时有78.8%、81.1%和85.6%的患者HIVRNA检测不出。结论高效联合抗反转录病毒治疗(HAART)对艾滋病患者有确切疗效,1年半抗病毒治疗有效率为85.6%。95%以上的依从性是治疗成功的关键因素。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.