HIV/AIDS患者机会性感染特点分析

目的探讨HIV／MDS患者机会性感染疾病谱及其与CD4^＋及CD8^＋T细胞间的关系,从而为临床防治机会性感染提供依据。方法对北京佑安医院感染科2002—2005年收治的181例HIV／AIDS患者的临床资料进行回顾性分析。结果181例患者中,有104例发生了机会性感染,部分患者同时有多种机会性感染。本组最常见的机会性感染是口腔念珠菌感染（52．9％）,其他依次为卡氏肺孢子菌肺炎（PCP）（31．7％）、结核（21．2％）、食管或肠道真菌感染（15．4％）、疱疹病毒感染（12．5％）及肺部感染（6．7％）等;各种机会性感染中,结核组与PCP组间CD4／CD8比值差异具有统计学意义;按同时伴有机会性感染的种类数分组,机会性感染各组的平均CD4^＋、CD8^＋T细胞计数及CD4／CD8比值均显著低于无机会性感染组;随着机会性感染种类的增加,CD4^＋T细胞数逐渐降低,CD4／CD8比值亦逐渐降低。结论HIV／MDS患者机会性感染多见于消化和呼吸系统,发生频率与CD4^＋T细胞计数及CD4／CD8比值有着非常密切的关系,CD4^＋T细胞计数小于200个／μl、CD4／CD8比值小于0．20,机会性感染明显增加,且随着病情进展同时发生多种机会性感染的几率也明显增加,此可作为开展机会性感染预防的参照指标。

The characteristics of opportunistic infections in 181 HIV/AIDS patients in China

OBJECTIVE: To investigate the spectra of opportunistic infections (OIs) in HIV/AIDS patients in China and evaluate the relation between OIs and CD(4)(+), CD(8)(+) T cell counts so as to suggest when the prophylaxis for OIs should begin. METHODS: The clinical and immunological characteristics of 181 patients with HIV/AIDS admitted into the Department of Infectious Disease, Beijing Youan Hospital from 2002 to 2005 were retrospectively analyzed. RESULTS: One hundred and four of the 181 HIV-positive patients experienced at least one HIV-related opportunistic infection. The most common opportunistic infections were as follows: oral candidal pharyngitis (52.9%), Pneumocystis carinii pneumonia (PCP) (31.7%), tuberculosis (21.2%), systemic mycosis (15.4%), viral herpes (12.5%) and other respiratory infections (6.7%), etc. The medians of CD(4)(+), CD(8)(+) T cell counts and CD(4)/CD(8) ratios in the patients with OIs were lower as compared with those in the patients without OIs. The patients who experienced OIs had similar CD(4)(+) T cell count with no statistical difference, no matter there was one or more than one OIs. The CD(+)(4) T cell counts lowered in accordance with increase of the number of OIs. The similar results were found in the CD(4)/CD(8) ratios. There was significant difference between CD(4)/CD(8) in patients with tuberculosis and those with PCP. CONCLUSIONS: HIV-related OIs are easily encountered in digestive and respiratory systems of HIV/AIDS patients and it is shown that a close correlation exists between CD(4)(+) T cell count, CD(4)/CD(8) ratio and opportunistic infections. Patients with CD(4)(+) T cell count below 200 cells/microl, CD(4)/CD(8) less than 0.20 especially are at higher risk of developing opportunistic infections and they generally have diverse OIs. Our findings are helpful to predict the initiation both primary and secondary prophylaxis for OIs in HIV/AIDS patients in China.