池州市艾滋病患者机会性感染与CD4+T细胞计数间的关系

目的探讨池州市HIV／AIDS（acquired immunede ficiency syndrome,AIDS）患者机会感染特点及其与CD4＋T细胞计数间的关系。方法回顾性分析池州市2005年1月—2012年2月65例HIVAIDS患者临床资料,总结患者机会感染特点、不同CD4’T细胞计数水平发生机会感染的差异;分析机会感染特点与CD4＋T细胞计数间的关系,统计学采用PearsonChi-Square检验。结果65例患者中发生机会性感染36例,感染率55．38％（36／65）。CIM＋T细胞≥200个／L的4例（19．05％）（4／21）;100〈CIM＋T细胞〈200个／L的7例（53．85％）（7／13）;50／L〈CD4＋T细胞≤100个／L的14例（53．85％）（14／20）;CD4＋r细胞≤50个／L,11例（100．00％）（11／11）。CD4＋T细胞〉100个／L,感染部位多数为2个或2个以下;而CIM＋T细胞≤100个时,多发生2个以上部位感染。常见机会感染有肺孢子菌肺炎（Pneumocystis pneumonia,PCP）、肺结核、结核性胸膜炎、肠结核、巨细胞病毒视网膜炎、淋巴瘤、消化道真菌感染、隐球菌性脑膜炎、带状疱疹和败血症。结论池州市HIV／AIDS患者机会感染发病率高,多部位感染、混合感染常见;随着CD4＋T细胞数量减少,机会感染的发病率、累及部位增加     

HIV感染者CD4细胞计数与结核菌素试验结果分析

目的了解HIV感染者CD4细胞计数、结核菌素（PPD）反应及两者的相互影响情况。方法抽取2032例HIV感染者进行CD4细胞计数和5U的PPD试验。结果CD4细胞计数随患者年龄的增加而明显下降，CD4计数小于等于200个/mm^3者占25％，大于等于500个/mm^3者21．4％，位于两者之间者53．6％；PPD反应阳性率14．7％，随年龄的增加而呈上升趋势；CD4细胞计数与PPD反应呈负相关，但无统计学意义（P〉0．05）。结诊HIV感染者中PPD反应阳性率较低；PPD反应与CD4细胞计数呈负相关但无统计学意义（P＞0.05）。     

HIV／AIDS合并肺结核患者血T—SPOT．TB结果分析

目的 对HIV／AIDS合并肺结核患者T—SPOT．TB结果 进行分析,讨论HIV／AIDS合并肺结核患者CD4水平对T—SPOT．TB结果 的影响。方法 采用T—SPOT．TB对确诊且未进行抗结核治疗的51例HIV／AIDS合并肺结核患者和58例肺结核患者的外周血进行检测。结果 T—SPOT．TB在全部HIV／AIDS合并肺结核患者组、CD4〉200／山组、CD4≤〈200／止组、肺结核患者组中的阳性检出率分别是74．5％（38／51）、83．3％（15／18）、69．7％（23／33）、91．4％（53／58）。各组之间阳性检出率比较,肺结核组高于HIV／AIDS合并肺结核组（P〈0.05）,肺结核组高于CD4≤200／μl组（P〈0.05）,肺结核组高于CD4〉200／μl组（P〉0.05）,HIV／AIDS合并肺结核组低于CD4〉200／μl组（P〉0.05）,HIV／AIDS合并肺结核组高于CD4≤200／μl组（P〉0．05）,CD4〉200／μl组高于CD4≤200／μl组（P〉0．05）。结论 HIV／AIDS合并肺结核患者CD4水平对T—SPOT．TB结果 有一定的影响,当CD4≤200／μl时,T—SPOT．TB在HIV／AIDS合并肺结核中的阳性检出率明显降低,对结核感染的诊断存在一定困难,值得临床关注。     

32例AIDS中晚期患者CD^＋4淋巴细胞水平与病毒载量关系分析

目的了解CD^＋4淋巴细胞计数〈200个／mm^3的中晚期艾滋病（AIDS）患者的CD^＋4淋巴细胞水平与病毒载量关系。方法应用流式细胞仪检测CD^＋4淋巴细胞水平;用罗式荧光定量核酸检测仪检测HIV血浆病毒载量（VL）。结果CD^＋4淋巴细胞计数〈50个／mm^3时,HIV血浆病毒载量VL（Log10）为4.974±0.309;50-100个／mm^3时,VL（Log10）为4.091±0.485;100-200个／mm^3时,VL（Log10）为4.086±0.401,各组间比较P〉0.05,差异无统计学意义。结论32例CD^＋4淋巴细胞计数〈200个／mm^3的中晚期AIDS患者,CD^＋4淋巴细胞水平与病毒载量（VL）无相关性。     

流式细胞术检测外周血T淋巴细胞亚群在NHL中的意义研究

目的应用流式细胞术检测非霍奇金淋巴瘤（NHL）患者外周血T淋巴细胞亚群绝对值计数并分析其临床意义。方法采集NHL组（n=62）与正常对照组（n=30）空腹外周血2ml,采用流式细胞术检测外周血T淋巴细胞各亚群包括CD3＋、CD4＋、CD8＋细胞的绝对值计数,并可计算出CD4＋／CD8＋比值;两组数值之间进行比较。结果与对照组相比,NHL组CD3＋、CD4＋细胞数明显降低[CD3＋细胞数（823．3±211．5）、CD4＋细胞数（423．8±234．8）]（P〈0．05）,CD8＋细胞数（861．2±634．1）升高（P〈0．05）,CD4＋／CD8＋降低（0．5±0．3）（P〈0．05）。结论NHL患者细胞免疫功能下降,应用流式细胞术进行外周血T淋巴细胞亚群绝对值计数的检测对NHL的诊断、治疗和预后判断有意义。     

化疗对结核病大鼠T细胞亚群变化的影响

目的探讨CD4^＋CD8^＋双阳（DP）T细胞与结核病相关性。方法60只PPD皮试阴性SD大鼠随机分成（1）结核病化疗组、（2）感染对照组、（3）健康对照组。化疗组和感染组大鼠均于观察开始接受结核菌标准株H37Rv（TB）攻击，攻毒1个月后化疗组接受抗TB化疗；三组动物均于感染结核分枝杆菌前和感染后1、2、3、5个月末检测外周血中CD3^＋、CD4^＋．CD8^＋,DPT细胞含量。结果5个月全程观察中，感染后1个月内化疗组、感染对照组各死亡2例（10％）；2—5个月内化疗组死亡率5．6％（1／18），不化疗组同期死亡率38．9％（7／18），P〈0．05；健康对照组动物无死亡。开始观察时3组之间各对应参数对比差异无显著性，P〉0．05；对照组观察期内各参数的改变差异亦无显著性，乃O．05：感染1个月后，化疗组、感染对照CD4^＋单阳（SP）细胞数、CD4^＋/CD8^＋T细胞比率降低，而CD8^＋、DPT细胞数升高。P〈0．05或P〈0．01。不化疗的感染对照组在感染后1个月时与其后2—5个月各参数差异无显著性。P〉0．05。化疗组化疗1个月后各参数恢复到结核感染前相近水平，与对照组各对应参数差异已无显著性，P〉0．05。TB感染后．CD4^＋单阳、CD4^＋／CD8＋比率降低，而DP、CD8^＋T细胞升高呈负相关。结论CD4^＋CD8^＋双阳（DP）T细胞是抗结核保护性免疫相关细胞。     

HIV感染者和AIDS患者及正常人CD_4与CD_8细胞计数对照研究

目的研究正常人与艾滋病（AIDS）患者、人类免疫缺陷病毒（HIV）感染者之间免疫指标CD4细胞计数、CD8细胞计数及CD4/CD8比值的差异。方法使用BD公司CD4T细胞检测试剂对我院体检的43份正常人全血样本（正常组）,与随访检查的199例HIV感染者（感染组）及49例AIDS患者（患者组）的全血样本进行检测。结果正常组与患者组及感染组CD4细胞计数、CD8细胞计数、CD4/CD8比值之间差异有统计学意义（P〈0.05）,患者组、感染组CD4细胞计数、CD4/CD8比值显著低于正常组（P〈0.05）,CD8细胞计数显著高于正常组（P〈0.05）;患者组与感染组CD4细胞计数、CD4/CD8比值、CD8细胞计数差异无统计学意义（P〉0.05）。结论 HIV感染者、AIDS患者的CD4细胞计数、CD4/CD8细胞计数降低,而CD8细胞计数升高。     

HIV感染合并肺结核患者CD4^＋细胞计数与胸部影像特征的相关性研究

目的分析HIV感染合并肺结核患者外周血CD4^＋T淋巴细胞计数与其胸部影像特征的相关性。方法选取220例经Westernblot确诊为HIV感染并合并肺结核患者,抽取外周血进行CD4淋巴细胞计数,同时行正位X胸片或CT检查及PPD实验。结果220例患者中CD4细胞计数〈200者占30％,PPD阳性反应仅2例患者阳性;200～500者占49％,PPD阳性率为28．7％;〉500者占21％,PPD阳性率为80．4％。胸部影像检查显示当CD4细胞数〉500时,肺部病变与普通患者相似,空洞、钙化灶等多见;CD4细胞数在200—500时渗出性实变较多,52％的患者可出现纤维化病灶、空洞等典型症像;CD4细胞数〈200时,以弥漫性的渗出性病变为主。结论HIV感染合并肺结核患者随着机体免疫系统受损,影像表现以渗出性病变为主,有必要与肺部其他病变相鉴别。     

血液CD3＋CD4＋／CD3＋CD8＋T细胞水平对肺部真菌感染的影响

目的探讨血液CD3＋CD4＋／CD3＋CD8＋T淋巴细胞水平对非HIV感染患者发生侵袭性肺部真菌感染的影响。方法根据入选标准及诊治规范,入选IPFI组患者61例,非IPFI肺炎组患者47例及同期健康对照组体检者30例。收集记录上述患者的临床资料,观察3组病例CD3CD;T淋巴细胞百分比,CD3＋CD8＋T淋巴细胞百分比及CD3＋CD4＋／CD3＋CD8＋T淋巴细胞比值情况。结果白色念珠菌仍是最常见的致病真菌,占总检出菌株数的46．03％,同时本研究曲霉菌（30．16％）感染也占有相当高的比例。CD3＋CD4＋T淋巴细胞百分比及CD3＋CD4＋／CD3＋CD8＋T细胞比值水平,IPFI组较非IPFI肺炎组（t=5．910,P〈0．05;t=7．395,P〈0．05）及健康对照组（t=6．443,P〈0．05;t=7．428,P〈0．05）均明显下降。结论血液CD4＋／CD8＋T淋巴细胞水平测定有助于早期发现肺部真菌感染的发生。     

HIV/AIDS患者口腔真菌分布及药物敏感性分析

目的探讨HIV／AIDS患者口腔真菌感染状况和耐药性分析。方法选择该院门诊随访的166例HIV／AIDS患者,同期在体检中心体检的310例健康体检者作为对照。通过真菌培养和酵母菌药物敏感性试验分析感染状况和耐药性。结果HIV／AIDS患者口腔真菌定植率（50．0％）明显高于同期健康体检者（29．0％）（P〈0．05）;CD4细胞计数与是否接受HAART治疗是HIV／AIDS患者口腔真菌定植的高危因素;HIV／AIDS组口腔真菌对唑类抗真菌药物的耐药率均高于健康体检组（P〉0．05）;接受HAART治疗的HIV／AIDS患者口腔真菌对唑类抗真菌药物的耐药率均低于非HAART治疗患者,其中氟康唑、伊曲康唑的耐药率差异显著（P〈0．05）。HIV／AIDS组患者中口腔酸碱度pH值为6、6．5、7的比例与健康人群组差异显著（P〈0．05）。结论HIV／AIDS患者口腔真菌定植以白色念珠菌居多,但非白念珠菌比例有所上升,HAART治疗可明显降低分离的白念珠菌菌株耐药率。     

Serum pepsinogen and gastrin levels in HIV-positive patients: relationship with CD4+ cell count and Helicobacter pylori infection

BACKGROUND: The relationship between serum parameters of gastric function and Helicobacter pylori infection in human immunodeficiency virus (HIV)-positive patients is almost unknown. AIMS: To investigate in HIV-infected patients: (i) the relationship between serum gastrin and serum pepsinogens over the progressive phases of HIV-related disease; (ii) the impact of H. pylori infection on gastrin and pepsinogen serum levels and its relation to antral histology; (iii) the prevalence of parietal cell autoantibodies. METHODS: Fifty-nine HIV-positive patients were studied by upper endoscopy plus gastric antral biopsy. Serum samples were tested for gastrin, pepsinogen A, pepsinogen C and parietal cell autoantibodies. RESULTS: In patients without overt acquired immunodeficiency syndrome (AIDS), or with a CD4+ count of > 100 x 10(6) cells/L, mean serum levels of gastrin and pepsinogen C were higher than in subjects with AIDS or with a CD4+ count of < 100 x 10(6) cells/L (P < 0.01). Only one patient was found to be positive for parietal cell autoantibodies. H. pylori infection was associated with increased values of gastrin and pepsinogen C only in HIV-positive patients without AIDS or with a CD4+ count of > 100 x 10(6) cells/L. Atrophy was more frequent in patients with overt AIDS than in those without overt AIDS (57% vs. 33%, P=N.S.), and/or in patients with a CD4+ count of < 100 x 10(6) cells/L than in those with a CD4+ count of > 100 x 10(6) cells/L (62% vs. 26%, P < 0.05). CONCLUSIONS: HIV-positive patients without overt AIDS have increased serum levels of gastrin and pepsinogen C compared with HIV-positive patients with overt AIDS.     

The natural history of untreated HIV infection in Lima, Peru: implications for clinical trial endpoints for HIV vaccines

Most candidate HIV vaccines are directed at priming memory T cell responses and are being evaluated on their effects on post acquisition viremia and/or disease progression. These vaccines are being studied in areas of high HIV-1 prevalence. As such, we evaluated the frequency of CD4+ T cell decline and time course of opportunistic infections of patients presenting at a major metropolitan hospital in Lima, Peru, an area where such candidate vaccines are being tested. We examined 92 patients with untreated HIV-1 in calendar year 2002: 35% presented with CD4+ T cell counts of <200, 25% between 201 and 400, and 17% with >400 cells/mm3, 30 of 92 patients presented with overt AIDS, 6 were without an AIDS defining OI but CD4 counts <200. Over the course of follow-up, CD4 count decreased by a mean of 31 cells/mm3/year in women and 28 in men (p>0.5). Among persons presenting with CD4 counts >250 cells/mm3, the median time to first OI was 3.5 years. If clinical endpoints are required to evaluate the clinical effectiveness of T cell based vaccines, extended clinical follow-up of subjects enrolled in such trials will be required.     

AIDS并发隐球菌脑膜炎103例脑脊液分析和CD4关系的研究

目的通过对艾滋病(AIDS)合并新生隐球菌脑膜炎患者的脑脊液情况分析,探讨该病的脑脊液变化及和外周血CD4+T淋巴细胞计数(以下简称CD4)的关系,为采取进一步预防措施和停药时机寻找依据。方法回顾总结103例AIDS合并新生隐球菌脑膜炎患者的实验室资料和临床特征,以及其脑脊液变化和CD4的关系等。结果 AIDS患者合并新生隐球菌脑膜炎时颅内压升高显著,脑脊液变化显著,病死率高(20.39%),几乎所有患者CD4都小于200/mm3,外周血HIV-RNA460000-1600000copies/ml。结论 AIDS并发新生隐球菌脑膜炎患者CD4低下,外周血HIV病毒复制活跃,颅内压显著升高、脑脊液蛋白显著升高、糖和氯显著降低,死亡率高,预后不良。对于CD4小于100/mm3患者持续采取二级预防治疗是必要的。     

艾滋病患者机会性感染与CD4^＋T细胞计数的关联分析

目的观察艾滋病患者治疗6个月内的机会性感染与CD4^＋ T细胞计数之间的关系。方法对136例患者在治疗6个月内机会性感染与CD^4＋ T细胞计数进行回顾性调查分析。结果治疗3个月内有87.5%（119/136）的患者CD4^＋ T细胞数≤200个/μl,治疗6个月内41.9%（57/136）的患者CD4^＋T细胞数≤200个/μl。初始治疗时CD4^＋ T细胞数≤200个/μl的136例中发生多种机会性感染82例,感染率为60.3%;治疗6个月时而CD4^＋ T细胞计数〉200个/μl的79例患者中,只有3例发生了机会性感染,其感染率3.8%。结论艾滋病患者在CD4^＋ T细胞数≤200个/μl时机会性感染出现频率较少,CD4^＋ T细胞数〈200个/μl〈200个/μl时机会性感染的频率明显增加;初始治疗时全部患者CD4^＋ T细胞数〈200个/μl,很容易发生各种机会性感染。     

温脾补肾法联合高效抗逆转录病毒治疗对HIV/AIDS患者免疫功能影响的研究

目的 探讨温脾补肾法联合高效抗逆转录病毒疗法（HAART）对HIV/AIDS患者免疫功能的影响.方法 将30例HIV/AIDS患者分为中西医结合治疗组（治疗组）14例,西医治疗组（对照组）16例.对照组采用HAART疗法,治疗组在此基础上联合以温脾补肾法为组方原则的中药艾可清优化处方治疗,共治疗6个月.监测全部患者治疗前、后的卡洛夫斯基积分、临床症状、外周血T淋巴细胞亚群CD4＋计数及CD4＋/CD8＋比值、血常规及肝肾功能等,并综合比较两组的临床疗效.结果 ①治疗后治疗组、对照组的临床受益率分别100.0％和87.5％,两组比较差异有统计学意义（P＜0.05）;②治疗后治疗组卡洛夫斯基积分、体重有所改善（P＜0.05）,在改善中医临床症状乏力、纳呆及总积分方面也优于对照组（P＜0.05）;③治疗后治疗组CD4＋细胞计数、白细胞计数分别为（264.97±52.94）个/mm^3和（6.94±0.97）×109/L,优于对照组的（238.73±50.13）个/mm^3和（5.57±1.29）×10^9/L （P＜0.05）;④两组在治疗期间未出现明显不良反应.结论温脾补肾法联合HAART治疗HIV/AIDS患者可明显地改善临床症状,并能增强机体的免疫功能和提高生活质量,对于实现本病的功能性治愈可起到一定的作用.     

人类免疫缺陷病毒/获得性免疫缺陷综合征患者高效抗逆转录病毒治疗中发生骨髓抑制相关因素分析

目的:探讨HIV/AIDS患者高效抗逆转录病毒治疗(HAART)过程中出现骨髓抑制的高危因素。方法:回顾性分析432例HIV/AIDS患者HAART治疗资料,分别对患者的性别、年龄、HIV感染途径、体质量、是否肝、肾功能损害、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、是否合并机会性感染、是否联合应用具有骨髓抑制作用药物等与骨髓抑制的发生进行相关性分析。结果:骨髓抑制的发生与患者HIV感染途径、体质量无相关性(P> 0.05);与患者年龄、性别、肝、肾功能损害、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、联合应用具有骨髓抑制作用药物相关(P< 0.05)。结论:老年、女性、肝、肾功能损害者、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、合并机会性感染、联合应用具有骨髓抑制作用药物是患者治疗期间发生骨髓抑制的高危因素。     

Differential course of HIV-1 infection and apolipoprotein E polymorphism

We studied the course of infection with human immunodeficiency virus type 1 (HIV-1) in relation to apolipoprotein E (APOE) polymorphism found for 209 Italians treated at Infectious Disease Clinics in Rome and Modena. Clinically, patients were classified into four groups according to the yearly rate of decline in CD4+ cell count (LTNP: long-term non-progression; SLOW, ’NORMAL’ or RAPID). Patients at both extremes of the clinical spectrum, i.e. those who rapidly progressed to AIDS and those with stable high CD4 cell counts, had few APOE ɛ4 and ɛ2 alleles (P = 0.04). Detailed clinical information was then used to construct four model-based clinical profiles using grade-of-membership analysis (GoM), predictive of APOE genotypic frequencies: 1. The clinical profile associated with good long-term prognosis lacked ɛ2 (P=0.01); 2. Disease progression to AIDS was associated with ɛ4 and ɛ2, most evident for zidovudine-lamivudine regimens without a protease inhibitor (P = 0.03); and, 3. AIDS patients had low ɛ4 and ɛ2 frequencies, consistent with a high mortality rate among ɛ4+ and ɛ2+ AIDS patients. These findings suggest allele-specific immunomodulatory effects involving inherited APOE isoform important enough to alter the clinical course of HIV infection and, possibly, drug efficacy. They imply a connection between lipid metabolism and immunity potentially relevant to common disorders.     

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.