广东地区762例住院人类免疫缺陷病毒感染患者机会性感染分析

目的 探讨广东地区HIV/AIDS患者机会性感染的特点及其与外周血CD4+T淋巴细胞计数(CD4+)之间的关系.方法 对762例HIV/AIDS住院患者机会性感染发生情况及其外周血CD4+进行分析.结果 762例患者中,704例(92.39%)发生机会性感染,共发生感染1428例次,其中真菌、细菌、病毒感染分别占38.38%、36.20%和7.77%.以肺部、口腔、皮肤、消化道感染、败血症及其他全身播散性疾病为主,分别占33.05%、26.89%、10.29%、8.96%、6.58%和9.94%.CD4+≥2001μ1的患者机会性感染率为75.74%(103/136),而CD4+<200/μ1的患者则为96.01%(601/626),两组比较差异有统计学意义(P<0.01).所有的AIDS指征性机会性感染均发生在CD4+<200/μ1患者,其中81.97%的耶氏肺孢子茵肺炎(PCP)、71.43%的巨细胞病毒(CMV)视网膜炎及所有的隐球菌脑膜炎、播散性隐球菌病、播散性组织胞浆病、播散性鸟型分枝杆菌病(MAC)、播散性青霉病及弓形虫脑病均发生在CD4+<50/μ1的患者.结论 广东地区HIV/AIDS患者机会性感染主要病原为真菌、细菌、病毒等,以肺部、口腔、皮肤、胃肠道和全身播散性感染为主.CD4+水平越低,机会性感染特别是指征性机会性感染越常见,CD4+对机会性感染发生的预测、预防和早期诊断与治疗有重要的指导意义.

An analysis of opportunistic infection in 762 inpatients with human immunodeficiency virus infection in Guangdong areas

Objective To analyze the characteristics of opportunistic infection (OI) in patients with HIV/AIDS in Guangdong and the relationship between OI and the change in blood CD4+ T lymphocyte count (CD4+ ).Methods Seven hundred and sixty two patients with HIV/AIDS admitted were analyzed. Results Among all the 762 patients, 704 (92.39% ) had more than one kind of OI, with 1428 episodes totally.Etiologically, fungus infection (38.38% ) was most common, followed by bacteria (36.20% ), and virus (7.77% ) infection. Most OI occurred in the lungs (33.05% ), mouth (26.89% ), skin (10.29% ) and gastro-intestine (8.96% ).Septicemia and other systemic disseminated diseases accounted for 6.58% and 9.94% respectively.The incidence of OI in patients with CD4+= 200/μ1 (103/136, 75.74%) was significantly lower than that in patients with CD4+ <200/μ1 (601/626, 96.01%), P<0.01.All the AIDS defining OI were found in patients with CD4+ <200/μ1 Among them, 81.97% of patients with pneumonia carinii pneumonia (PCP), 71.43% of patients with cytomegalovirus retinitis and all the patients with cryptococcal meningitis, disseminated cryptococosis, disseminated histoplasmosis, mycobacterium avium intracellular complex (MAC), disseminated penicilliosis mameffei and toxoplasma cerebritis had the CD4+ less than 50/ μ1.Conclusions The most common OI in patients with AIDS in Guangdong area are fungi, bacterial and viral infections.Lung, mouth, skin, gastro-intestine and systemic disseminated infections are the most prevalent infections.As the CD4+ decreased, the incidence of OI especially AIDS defining OI increased. Dynamic detection of CD4+ will be of great help for the prediction, prevention, early diagnosis and treatment of OI in patients with AIDS.