高效抗逆转录病毒治疗对74例艾滋病初治患者三年疗效观察

目的 观察我国AIDS初治患者接受高效抗逆转录病毒治疗(HAART)的疗效,为规范HAART提供依据.方法 对74例初治AIDS患者给予HAART并进行定期随访,分析随访3年来的疗效、毒副反应及耐药情况.结果 74例患者男46例,女28例,平均年龄42岁.治疗前HIV病毒载量为(2.2±2.0)×105拷贝/ml,CD4+T淋巴细胞计数(62±71)个/μl;接受HAART后3、6、12、18、24、30、36个月,HIV病毒载量小于50拷贝/ml的百分率分别为:71.6%、83.8%、75.7%、77.0%、82.4%、81.1%、79.7%;CD4+T淋巴细胞计数分别为:(167±105)、(177±129)、(238±137)、(290±158)、(304±191)、(331±175)、(352±202)个/μl;各观察时段CD4+T淋巴细胞计数增加幅度不同,以0～3个月时明显,显著高于其余时段的改变(P＜0.01).74例患者中发生肝功能损害52例(70.3%),血脂升高52例(70.3%),骨髓造血功能抑制33例(44.6%),外周神经炎32例(43.2%),外周脂肪萎缩26例(35.1%).9例患者出现临床耐药并检测到相关耐药基因位点突变.结论 我国AIDS初治患者接受HAART后病毒学及免疫学应答效果好,临床耐药较低,但毒副反应较大.

Abstract：

Objective To evaluate the therapeutic effect of highly active anti-retroviral therapy (HAART) in treatment-na(i)ve Chinese patients with AIDS, to provide evidences for standardizing HAART.Methods Seventy-four treatment-naive AIDS patients were initiated with HAART and followed up regularly for 3 years. The clinical and laboratory data, side effects and drug resistance were observed and analyzed during the follow-up period. Results Of the 74 patients, 46 were males and 28 were females, with the average age being 42 years. The mean HIV viral load was ( 2. 2 ± 2.0 ) × 105 copies/ml and the baseline mean CD4+ T lymphocyte count was (62 ± 71 )cells/μl before treatment. After treatment for 3, 6, 12, 18,24, 30 and 36 months, the percentage of undetectable HIV viral road (less than 50 copies/ml ) was 71.6%, 83.8%, 75.7%, 77.0%, 82.4%, 81.1% and 79.7% respectively, and CD4+T lymphocyte count ascended to ( 167 ± 105), ( 177 ± 129), (238 ± 137), (290 ± 158), (304 ± 191 ), (331 ± 175) and ( 352 ± 202 ) cells/μl. The increase in amplitude of CD4+ T lymphocyte count in different periods examined was different, with the period of 0-3 months post-treatment demonstrating the most obvious augmentation ( P ＜ 0. 01 ) . The most common adverse reactions were liver function injury ( 52/74,70. 3% ), hyperlipemia (52/74, 70. 3%), hematopoietic inhibition of the bone marrow (33/74, 44. 6% ),peripheral neuritis (32/74, 43.2% ) and lipoatrophy (26/74, 35. 1%). Clinical drug resistance were found in nine patients and HIV gene mutations were detected in these patients. Conclusions Chinese treatment-naive AIDS patients have achieved good virological and immunological response to generic-drugpredominant HAART regimes with low drug resistance, but relatively more side effects.     

Risk analysis of lymph node metastasis in 285 patients with superficial esophageal squamous cell carcinoma

<正>Objective To identify risk factors of lymph node metastasis in superficial esophageal squamous cell carcinoma(ESCC),and to provide evidence for treatment choice under endoscope.Methods From January 2007 to December 2011,285 patients with pathologically diagnosed ESCC who received surgery and had clear record of lymph nodes resection were enrolled.The clinical pathological data of these patients were analyzed,including     

Factors associated with CD4~+/CD8~+T lymphocyte ratio normalization in acquired immunodeficiency syndrome patients after antiretroviral therapy

正Objective To investigate the factors associated with CD4~+/CD8~+T lymphocyte ratio normalization in acquired immunodeficiency syndrome (AIDS) patients after antiretroviral therapy (ART).Methods The data of 1 188human immunodeficiency virus (HIV)/AIDS patients     

艾滋病合并巨细胞病毒血症患者临床特点分析

目的 了解AIDS合并CMV血症患者的临床特征.方法 回顾性分析2008年10月至2009年11月北京地坛医院住院的249例AIDS患者的临床资料,对其中43例确诊为CMV血症患者的临床症状、脑脊液检查结果、气管镜、胃镜和肠镜检查等资料通过Excel软件建立数据库,并利用统计软件SPSS12.0分析细胞免疫功能和CMV DNA水平的相关性.结果 在249例AIDS患者中,43例经过CMV pp65抗原和CMV DNA检测确诊为CMV血症;14例患者眼底镜检查提示视网膜渗出或视网膜出血;4例出现眼底视网膜渗出或出血后机化;通过气管镜肺泡灌洗液病理检查发现1例确诊CMV肺炎;低水平CD4+T淋巴细胞和CMV DNA阳性具有相关性.结论 对CD4+T淋巴细胞＜100×106/L的AIDS患者应进行CMV DNA或pp65抗原的筛查,并予以全身抗CMV治疗;眼底镜和气管镜肺泡灌洗液病理检查是确诊CMV视网膜炎和肺炎的有效方法.

Abstract：

Objective To understand the clinical features of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) complicated by cytomegalovirus (CMV)viremia.Methods The clinical data of 249 cases of HIV/AIDS patients hospitalized in Beijing Ditan Hospital from Oct 2008 to Nov 2009 were analyzed retrospectively,in which 43 HIV/AIDS patients were diagnosed with CMV viremia.The symptoms and signs,cerebrospinal fluid (CSF)tests,and pathological detections by bronchoscope,gastroscope and fibercoloscope were collected.The database was set up using Excel software.The association between cellular immunity and CMV DNA level was determined by SPSS12.0 software.Results Forty-three patients (17.3%)were diagnosed with CMV viremia by positive results of CMV pp65 antigen and CMV DNA tests; 14 patients manifested retinal bleeding or infiltration and 4 patients displayed retinal fibrosis; 1 patient was diagnosed with CMV pneumonitis by pathological results of bronchoalveolar lavage fluid.Low level of CD4+ T lymphocytes and CMV DNA levels were positively correlated.Conclusions CMV pp65 antigen and CMV DNA should be detected in HIV/AIDS patients with CD4+ T lymphocytes less than 100 × 106/L and anti-CMV treatment should be given according to the results.Ophthalmologic examination and bronchoalveolar lavage fluid pathological detection are effective methods in diagnose of CMV retinitis and pneumonitis.     

Toxoplasma gondii and human immunodeficiency virus co-infection in western Iran: A cross sectional study

Objective: To determine Toxoplasma gondii(T. gondii) as a cause of morbidity and mortality in human immunodeficiency virus(HIV) infected patients by ELISA method and to investigate toxoplasmosis-associated risk factors. Methods: This cross sectional study was conducted with 385 patients with HIV/AIDS referred to the behavior disease consultation center in Kermanshah, Iran between May 2012 and June 2013. Anti-Toxoplasma IgG and IgM antibodies were measured by using the ELISA method. Also, the relationship between the infection and age, gender, education, occupation, antiretroviral status, CD4+ cell counts and some other factors of the patients were assessed. P0.05 was considered statistically significant. Results:Among the HIV-positive patients, 40.8%(157/358) and 2.6%(10/358) patients were positive for anti-T. gondii IgG and IgM antibodies, respectively. The mean CD4+ count in the patients with HIV was 327 cells/μL. A significant correlation was observed between the toxoplasmosis infections with the age group(P0.05). Nevertheless, no statistically significant difference was found between gender, living area, educational level, occupational, marital status, antiretroviral status, prophylaxis, CD4+ cell count and toxoplasmosis. Conclusions: This study revealed that the patients with HIV infection were at the high risk of developing toxoplasmosis disease especially those patients who do not receive antiretroviral therapy and prophylaxis. The development and use of the effectiveness-based guidelines for controlling and the prevention reactivation of the latent T. gondii infection is required.     

艾滋病恐惧症46例临床分析

目的 总结艾滋病恐惧症患者临床特征,初步提出艾滋病恐惧症的临床诊断依据.方法 收集艾滋病恐惧症患者临床资料,分析研究对象的一般人口学、临床表现及实验室检测结果.结果 艾滋病恐惧症患者临床特点包括:(1)可存在或不存在感染HIV的高危行为;(2)反复要求进行实验窒相关检查验证,怀疑或坚信感染HIV,影响正常工作与生活;(3)临床主诉繁多,主诉症状多以头痛、咽痛等流感样症状(15例)及肌肉震颤、皮肤蚁走感、关节疼痛(12例)、乏力(12例)、发热(但测量体温正常,12例)为主,体检除舌苔发白厚腻外未见明显阳性体征;(4)症状大多出现在高危行为后的0～3个月,期间重复HIV抗体检测呈阴性;(5)23例患者进行了T淋巴细胞哑群的检测,其中19例(82.6%)CD4+T淋巴细胞计数大于50个/μl,其余4例患者在300～500个/μl,最低者307个/μl,个别有CD4+/CD8+T淋巴细胞比例倒置情况,但CD8+T淋巴细胞均无异常激活表现.结论 艾滋病恐惧症是一种复杂的躯体心理疾病,其诊断与治疗还需进一步探讨.

Abstract：

objective To summarize the clinical characteristics of AIDS phobia patients and establish the preliminary clinical diagnostic criteria.Methods The clinical information of 46 AIDS phobia patients was collected and summarized.General demographic data,clinical manifestations and laboratory results were analyzed.Results The clinical characteristics of AIDS phobia patients include:(1)With or without high-risk behavior of HIV-1 infection;(2)Patients repeatedly demanded HIV/AIDS related laboratory tests,suspected or believed in HIV-1 infection with daily life affected;(3)The main complaints were non-specific including influenza-like symptoms(headache,sore throat and so on),fasciculation,formication,arthrodynia,fatigue and complaint of fever with normal body temperature;physical examination did not reveal any positive physical sign except white coated tongue;(4)Symptoms mainly appeared 0-3 months after the high-risk behavior while HIV-1 antibody kept negative;(5)T lymphocyte subsets test was carried out in 23 patients and showed 19(82.6%)with CD4+ T lymphocyte count>500/μl,the remaining 4 were 300-500/μl,with the lowest count of 307/μl.Few patients had inversed CD4+/CD8+ ratio but without excessive CD8+T lymphocyte activation.Conclusion AIDS phobia is a complicated physical and mental disease,whose diagnosis and treatment still need further investigation.     

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.     

Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer

AIM: The study of immune response of open versus laparoscopical total mesorectal excision with anal sphincter preservation in patients with rectal cancer has not been reported yet. The dissected retroperitoneal area that contacts directly with carbon dioxide is extensive in laparoscopic total mesorectal excision with anal sphincter preservation surgery. Tt is important to clarify whether the immune response of laparoscopic total mesorectal excision with anal sphincter preservation (LTME with ASP) in patients with rectal cancer is suppressed more severely than that of open surgery (OTME with ASP). This study was designed to compare the immune functions after laparoscopic and open total mesorectal excision with anal sphincter preservation for rectal cancer.METHODS: This study involved 45 patients undergoing laparoscopic (n=20) and open (n=25) total mesorectal excisions with anal sphincter preservation for rectal cancer.Serum interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor α (TNFα) were assayed preoperatively and on days 1 and 5 postoperatively. CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ natural killer cell (NK)count and immunoglobulin (IgG/IgM/IgA) were assayed preoperatively and on day 5 postoperatively. The numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells were counted using flow cytometry. An enzyme-linked immunosorbent assay (ELISA) was used for IL-2, TL-6 and TNFα determination. And IgG, IgM, and IgA were assayed using immunonephelometry.RESULTS: The demographic data of the two groups had no difference. The preoperative levels of CD3+ and CD56+ T lymphocyte count, CD3- and CD56+ NK count, serum IgG,IgM, IgA, IL-2, IL-6 and TNFα also had no significant difference in the two groups (P＞0.05). The CD3+ and CD56+ T lymphocyte counts had no obvious changes after surgery in laparoscopic (d=-0.79±3.83 %) and open (d=0.42±2.09 %)groups. The CD3- and CD56+ NK counts were decreased postoperatively in both laparoscopic (d=-7.23±11.33 %) and open (d=-9.21±13.93 %) groups. The differences of the determined values of serum IgG, IgM and IgA on the fifth day after operation subtracted those before operation were -2.56±2.14 g/L, -252.35±392.94 mg/L, -506.15±912.24 mg/L in laparoscopic group, and -1.81±2.10 g/L, -282.72±356.75mg/L, -252.20±396.28 mg/L in open group, respectively. The levels of IL-2 were decreased after operation in both groups.However, the levels of IL-6 were decreased after laparoscopic surgery (d1=-23.14±263.97 ng/L and d5=-40.08±272.03 ng/L),and increased after open surgery (d1=27.38±129.14 ng/L and d5=21.67±234.31 ng/L). The TNFα levels were not elevated after surgery in both groups. There were no significant differences in the numbers of CD3+ and CD56+ T lymphocytes and CD3- and CD56+ NK cells, the levels of IgG, IgM, IgA,IL-2, IL-6 and TNFα between the two groups (P＞0.05).CONCLUSION: There are no differences in immune responses between the patients having laparoscopic total mesorectal excision with anal sphincter preservation and those undergone open surgery for rectal cancer.     

Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner

AIM:To investigate the number,size,and status of lymph nodes within the mesorectum and to explore the prognostic significance of lymph node micrometastases in patients with rectal cancer. METHODS:Thirty-one patients with rectal cancer undergone total mesorectal excision between October 2001 and October 2002 were included.Mesorectal nodes retrieved from the resected specimens were detected with a combination of haematoxylin and eosin(HE)staining and immunohistoch- emistry(IHC).The relations between lymph node metastases, micrometastases and postoperative recurrence were analyzed. RESULTS:A total of 548 lymph nodes were harvested, with 17.7±8.2 nodes per case.The average number of metastatic nodes in HE-positive patients and micrometastatic nodes in IHC-positive patients was 5.2±5.1 per case and 2.2±1.3 per case,respectively.The mean size of all nodes and metastatic nodes was 4.1±1.8 mm and 5.2±1.7 mm in diameter,respectively.The mean size of micrometastatic nodes was 3.9±1.4 mm in diameter.The size of the majority of mesorectal nodes(66.8%),metastatic nodes(52.6%),and micrometastatic nodes(79.5%)was less than 5 mm in diameter. During a median follow-up period of 24.6±4.7 too,5 patients (16.7%)had recurrence,of them 2 died and 3 survived. Another case died of tumor unrelated cause and was excluded. All 5 recurrent cases had 3 or more nodes involved,and one of them developed only lymph node micrometastases.The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent groups(P<0.01 and P=0.01,respectively). CONCLUSION:The majority of lymph nodes,metastatic, and micrometastatic lymph nodes within the mesorectum are smaller than 5 mm in diameter.The nodal status and the number of lymph nodes involved with tumor metastases and micrometastases are related to the rapid postoperative recurrence.     

HIV/AIDS患者浅表淋巴结肿大与其CD＋4T淋巴细胞计数的相关性分析

目的 探讨HIV/AIDS患者肿大浅表淋巴结的病理改变与其CD＋4T淋巴细胞计数的相关性.方法 对81例HIV/AIDS患者肿大的浅表淋巴结组织进行病理学检查,并检测其外周血CD＋4T淋巴细胞计数.结果 CD＋4T淋巴细胞＜100cells/ul有58例,100～200cells/ul有17例,＞200cells/ul有6例.主要病理改变结核病48例,艾滋病相关淋巴结病15例,淋巴结反应性增生14例.合并浅表淋巴结肿大的结核病患者的CD＋4T淋巴细胞计数比较差异有统计学意义（P=0.008）.合并淋巴结反应性增生患者的CD＋4T淋巴细胞计数比较差异有统计学意义（P=0.018）.结论 检测外周血CD＋4T淋巴细胞计数对出现浅表淋巴结肿大的HIV/AIDS患者的临床诊断具有重要的参考价值.     

HIV感染者外周浅表淋巴结中CD4~+T淋巴细胞计数与胶原沉积的关系研究

目的通过对不同感染阶段HIV感染者外周浅表淋巴结中CD4+T淋巴细胞、胶原蛋白、白细胞介素(interleukin,IL)-7的检测,以及CD4+T淋巴细胞计数与胶原沉积的相关性分析,探讨HIV感染后胶原沉积对CD4+T淋巴细胞的影响。方法选择HIV感染者43例,分为HIV感染无症状组和AIDS组,留取外周浅表淋巴结活体组织检查(活检)组织;另外选择非HIV感染者12名为健康对照组,同样留取其外周浅表淋巴结活检组织。利用免疫组织化学方法检测研究对象淋巴结中CD4+T淋巴细胞、Ⅰ型胶原蛋白和IL-7定量及分布情况。结果 1随着病程进展,HIV感染者外周浅表淋巴结中胶原沉积逐渐增加,AIDS组高于无症状组,无症状组高于健康对照组,差异均有统计学意义(P均0.05);2HIV感染无症状组外周浅表淋巴结中CD4+T淋巴细胞计数与健康对照组相比差异无统计学意义(P0.05),而AIDS组则显著减少(P0.01);3HIV感染者外周浅表淋巴结中CD4+T淋巴细胞计数与胶原沉积量呈负相关(R2=0.724,P=0.000),与外周血中CD4+T淋巴细胞计数呈正相关(R2=0.702,P=0.000);43组IL-7的表达水平差异无统计学意义(P0.05),而AIDS组部分患者淋巴结中IL-7呈局部聚集性分泌。结论 HIV感染后外周浅表淋巴结中胶原沉积逐渐增加导致结构破坏,可能是CD4+T淋巴细胞进行性减少的一个重要原因,虽然IL-7有随病程进展而分泌增加的趋势,但仍不足以弥补淋巴结结构破坏对CD4+T淋巴细胞的影响。     

AIDS合并结核病患者HIV RNA定量和CD4+T淋巴细胞计数特点分析

目的 总结AIDS合并结核病的临床特点,进一步提高对AIDS合并结核病的认识.方法 将AIDS合并结核病患者分为肺内结核组、肺内结核并肺外结核组和肺外结核组,比较和分析3组之间HIV RNA定量、CD4+T淋巴细胞计数的差异.结果 肺内结核组的HIV RNA定量明显低于肺内并肺外结核组和肺外结核组(P均＜0.05).肺内结核组的CD4+T淋巴细胞计数明显高于肺内并肺外结核组和肺外结核组(P均＜ 0.05).结论 患者的HIV RNA载量越高、CD4+T淋巴细胞计数越低,免疫功能越差,越易发生肺外结核和肺内并肺外结核,越易导致结核分枝杆菌播散性传播.     

伴浅表淋巴结肿大的HIV/AIDS病人的临床与病理特征

目的探讨淋巴结穿刺及病理组织检查,对伴浅表淋巴结肿大的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人的早期诊断的指导意义。方法对43例伴浅表淋巴结肿大的HIV/AIDS病人的临床表现、实验室检查、影像学及内镜检查、淋巴结活检病理学检查、治疗和转归情况进行分析。结果①男女比例9.8∶1,平均年龄33.6岁。②76.7%(33/43)病人淋巴结肿大发生在高效抗反转录病毒治疗(HAART)之前,20.9%(9/43)发生在HAART开始后5个月内。③临床表现:发热占88.4%(38/43),消瘦占48.8%(21/43),伴咳嗽咳痰和盗汗各占39.5%(17/43);90.7%(39/43)的病人肿大的淋巴结位于头颈部,86.0%(37/43)为多发,86.0%(37/43)淋巴结直径1～5cm,65.1%(28/43)伴深部淋巴结肿大。④实验室检查:81.4%(35/43)的病人伴有贫血,48.8%(21/43)CD4+T淋巴细胞计数<50个/μL,7.0%(3/43)CD4+T淋巴细胞计数50～100个/μL;86.0%(37/43)病人血沉增快。⑤影像学及内镜检查:65.1%(28/43)的病人伴深部淋巴结肿大,37.2%(16/43)为肺部炎症,32.6%(14/43)伴有肝大和/或脾大,30.2%(13/43)为肺结核。⑥淋巴结病理学检查:分枝杆菌感染占58.1%(25/43),马尔尼菲青霉病(PSM)和AIDS相关淋巴瘤(ARL)各11.6%(5/43)。⑦预后:多数病人预后良好,ARL预后较差。结论伴有浅表淋巴结肿大的HIV/AIDS病人,其临床表现复杂多样,以分枝杆菌感染、真菌感染和肿瘤多见。及时行淋巴结穿刺或活检进行病理检查,对早期诊断和治疗意义重大。     

HIV／AIDS患者血浆病毒载量及外周血T淋巴细胞亚群的变化

目的：观察国内HIV／AIDS患者血浆病毒载量和外周血CD4^ 、CD8^ T淋巴细胞的变化，探讨这些变化的临床意义。方法：选择未经抗病毒治疗的HIV／AIDS患者124例，用bDNA法检测血浆病毒载量，并用流式细胞仪检测外周血CD4^ 、CD8^ T淋巴细胞。结果：AIDS患者的血浆病毒载量明显高于HIV感染者，血浆病毒载量与CD4^ 细胞计数呈显著负相关，但其最高峰位于CD4^ 细胞计数100／μl处，然后随着CD4^ 细胞计数的下降而减少。CD4^ T细胞计数为AIDS组＜HIV组＜正常对照组：HIV感染者的CD8^ T细胞计数显著高于正常组和AIDS组，而AIDS患者CD8^ T细胞数则随着CD4^ T细胞减少而下降。结论：血浆病毒载量随着疾病进展而显著升高，但在疾病晚期则有所降低。外周血CD4^ T细胞计数随着疾病的进展而进行性减少；CD8^ T细胞计数在感染早期显著升高，进入晚期则减少。在评价HIV感染者和AIDS患者病情时，应结合病毒载量、CD4^ 、CD8^ T细胞计数综合分析。     

人类免疫缺陷病毒感染后不同疾病阶段的胃黏膜病理改变

目的 评价胃黏膜中CD4~+T淋巴细胞群与外周血CD4~+T淋巴细胞及病毒载量的相关性.探讨HIV感染后不同疾病阶段患者的胃黏膜病理改变.方法 选取HIV感染者36例,根据全血CD4~+T淋巴细胞计数和临床症状,将研究对象分为HIV感染无症状者和AIDS患者两组,免疫组织化学方法检测CD4~+T淋巴细胞在胃黏膜中的表达,以直线回归分析、Spearman等级相关分析进行统计.结果 随着疾病的进展,HIV感染者胃黏膜腺体萎缩和间质增生逐渐加重,而黏膜中浸润炎性细胞及淋巴细胞进行性减少,并普遍存在淋巴细胞噬黏膜腺体现象.HIV感染者血清病毒载量与胃黏膜内CD4~+T淋巴细胞呈负线性相关(r=-0.336,P=0.01),全血CD4~+T淋巴细胞与胃黏膜中CD4~+T淋巴细胞呈正相关(r=0.5762,P<0.01).结论 HIV感染后,患者胃黏膜组织出现多种病理改变,并随着病程阶段的进展而加重,胃黏膜中CD4~+T淋巴细胞群与全血CD4~+T淋巴细胞计数和病毒载量的相关性即是这种改变的具体体现.     

艾滋病合并结核病与CD4 T淋巴细胞计数的相关性研究

目的　通过对AIDS合并结核病例的回顾性分析,探讨AIDS合并结核病临床特征与CD4 T淋巴细胞计数的相关性。方法 对95例AIDS并发结核感染的病例CD4 T淋巴细胞计数进行检测,同时选择30例近期入院的HIV阴性肺结核病人CD4 T淋巴细胞计数的检测,AIDS合并结核病与HIV阴性肺结核病CD4 T淋巴细胞水平对比分析;AIDS合并结核中PPD、结明试验、结核分型与CD4 T不同水平进行相关性分析。结果 AIDS合并结核病与HIV阴性结核病CD4 T淋巴细胞水平相比,二者有显著性差异;CD4 T淋巴细胞计数与艾滋病合并结核病的影象学表现;PPD、结明试验、痰涂片抗酸染色阳性率、结核病分型有相关性,CD4<100/mm³与CD4>100/mm³相比,影象学中斑片实变影、多发空洞、多发结节、纵隔和(或)腋下淋巴结肿大有显著性差异;单发空洞,胸腔积液的机率,无显著性差异。CD4<100/mm³与CD4>100/mm³相比,PPD、结明试验、痰涂片抗酸染色阳性率相比均有显著性差异;Ⅱ、Ⅴ型结核发生率有明显差异。结论 AIDS患者合并结核病发病率高,尤其以肺外结核和血型播散性结核多见,CD4 T淋巴细胞计数低于100/mm³时,临床表现不典型,胸部影象学表现多样化及结核菌素试验、结核抗体试验、痰涂片抗酸染色阳性率低。     

87例CD4+T淋巴细胞低水平AIDS患者机会性感染临床分析

目的分析CD4^＋T淋巴细胞低水平AIDS患者机会性感染的临床特点及治疗效果,以提高临床诊疗水平。方法收集我院感染科就诊的87例CD4^＋T淋巴细胞低于100／td的AIDS患者的临床资料,回顾性分析其机会性感染谱及预后情况。结果87例中67例发生机会性感染,主要临床表现为：发热、咳嗽、消瘦、乏力、口腔白斑、头晕、呕吐、气短、腹泻、皮疹、淋巴结肿大等;主要机会性感染依次为：细菌性肺炎、口腔念珠菌感染、肺结核、带状疱疹、肺孢子菌肺炎等。总共发生107例次机会性感染,在接受对症治疗的70例次中,治愈或好转59例次,治疗无效8例次;3例因机会性感染死亡。发生过多种机会性感染的患者与未发生机会性感染患者相比,有较低的CD4＋T淋巴细胞水平及较高的病毒载量,但并未显示出统计学差异。结论CD4＋T淋巴细胞低水平的AIDS患者易发各种机会性感染,发生率为77．01％,临床症状复杂多样。早期发现、早期诊断、早期治疗机会性感染对降低AIDS患者的病死率,提高其生活质量尤为重要。     

艾滋病合并肺结核的影像学特征及其与CD4+T淋巴细胞的相关性

目的探讨艾滋病合并肺结核病的影像学特征及其与CD+4 T淋巴细胞的相关性.方法回顾性对照分析26例艾滋病晚期合并肺结核患者与60例单纯性肺结核患者的胸部X线表现、CD+4 T淋巴细胞的检测结果.结果 (1) 胸片结果显示艾滋病合并肺结核患者较单纯性肺结核患者出现较多淡片状模糊阴影(53.8%与8.3%;P<0.01)、粟粒结节影(23.1%与5.0%;P< 0.05)、胸内淋巴结肿大(34.6%与8.3%;P< 0.01)及肺外结核(23.1%与3.3%;P< 0.05),较少表现为上肺野或肺尖部病变(23.1%与76.7%;P<0.01)、实变或密度不均匀增高影(11.5%与71.7%;P< 0.01)、合并空洞影(7.7%与30.0%;P< 0.05);二者胸腔积液差异无统计学意义(11.5%与20.0%;P>0.05).(2)CD+4T淋巴细胞检测结果显示26例艾滋病合并肺结核患者与31例单纯性肺结核患者的CD+4 T淋巴细胞相对数分别为(5.0±6.4)%与(65.3±1.5)%,两者比较差异有统计学意义(P<0.01);26例艾滋病合并肺结核患者中,CD+4 T淋巴细胞计数<50个/μl的15例患者均为不典型肺结核,CD+4 T淋巴细胞计数为50～100个/μl的4例中,有3例为不典型肺结核,而4例CD+4T淋巴细胞计数为>100～200个/μl与2例>200个/μl的病例中,不典型肺结核分别为2与0例.结论艾滋病晚期患者影像表现多不典型,这与CD+4T淋巴细胞计数明显减低有关.因此了解艾滋病合并肺结核的影像特征与CD+4T淋巴细胞的相关性,对于艾滋病患者的早诊断、早治疗、早隔离具有重要的意义.     

126例HIV/结核分枝杆菌合并感染临床观察

目的 观察治疗HIV/结核分枝杆菌(Mycobacterium tuberculosis, MTB)合并感染的临床疗效. 方法 分析126例HIV/MTB合并感染者的临床疗效,统计高效抗反转录病毒治疗(highly active antiretroviral therapy, HAART)后1年内免疫重建炎症反应综合征(immune reconstitution inflammatory syndrome, IRIS)发病率及CD4+T淋巴细胞上升水平. 结果 126例均完成了抗结核治疗,HAART 1年内无死亡及复发结核病例. HAART后CD4+T淋巴细胞计数逐渐升高,以12周时上升幅度最大.治疗过程中37 例(29.37%)出现IRIS.CD4+ T 淋巴细胞计数＜200 个/mm3组IRIS 发病率高于≥200 个/mm3组（χ2=6.206,P=0.013）,且在HAART 后12 周及48 周CD4+ T 淋巴细胞上升幅度低于≥200 个/mm3组（P＜0.05）.结论HIV/MTB 合并感染者在CD4+ T 淋巴细胞≥200 个/mm3时接受HAART,IRIS 发病率低,免疫重建良好.