深圳市HIV/AIDS患者口腔念珠菌检出状况及相关因素研究

目的 了解深圳市HIV/AIDS病人口腔念珠菌检出情况,系统分析其可能的相关因素和意义.方法 采集571例HIV/AIDS患者的口腔粘膜拭子,采用CHROMagar念珠菌显色培养基培养,API-20C-AUX鉴定系统鉴定到种,同时通过国家艾滋病综合防治信息系统查找相关流行病学、治疗、检测等信息进行单因素和多因素分析.结果 571例HIV/AIDS患者中有174例(30.5％)检出口腔念珠菌,所分离到的念珠菌188株以白色念珠菌(70.7％)和克柔念珠菌(10.1％)为主；单因素和多因素分析发现,该人群口腔念珠菌检出在CD4计数、病毒载量以及感染途径这三项上差异有统计学意义(P＜0.01).其中,CD4计数＜200个/ml者和病毒载量＞10 000 copies/ml者检出率明显高于同项其他组;不同感染途径中经吸毒和母婴途径感染者检出率较高,男男同性恋人群口腔念珠菌检出率低于经异性感染者.此外,还发现抗病毒治疗＜30 d者其口腔念珠菌检出率最高,随着抗病毒治疗时间的延长,检出率逐渐降低.结论 口腔念珠菌检出率与CD4计数、病毒载量高度相关,与治疗时间也有关联;检出率可能对HIV/AIDS患者判断临床病毒学及免疫学预后有一定参考价值;其受不同感染途径的影响较大,尤其是本研究中在男男同性恋人群偏低的原因值得进一步研究.

Identification and Associated Factor Analysis of Oral candidas Isolated from 571 Case of HIV/AIDS Patients Lived in Shenzhen

Objective To study the strain distribution of Oral candida among HIV/AIDS patients lived in Shenzhen, and analysis the relationship between presence of Oral candida and its possible associated factors. Methods 571 samples of oral cotton swab collected from HIV/AIDS patients were cultured,and 188 strain of Candida were identified with CHROMagar medium and API-20C-AUX strip. Information including age,gender,route of HIV infection,CD4 lymphocyte counts, viral load, duration of anti-retroviral therapy （ART） and proteinase inhibitor （PI） usage were taken from the medical records and China information system for disease control and prevention. All data reserved for single factor analysis and multiple logistic analysis. Results The percentage of HIV/AIDS patients with Oral candida was 30.5%. Most of these oral Candida species were Candida albicans （70.7%） and Candida krusei （10.1%）. In both multiple logistic regression analysis and single factor analysis, Oral candida showed a statistically significant association with low CD4＋ lymphocyte count （〈 200 cell/ml）, high viral load （〉10 000 copies/ml）, and route of HIV infection. The ratio of Oral candida positive in homosexual group was found to be lower than heterosexual group. Besides,along with the prolongation of treatment time （〉30 d）, the rising presence of Oral candida was found to show a trend of fallback. Conclusion These findings suggest that Oral candida might be a valuable marker for HIV/AIDS patients to estimate their viral or immune prognosis.The mechanism of routes of HIV infection affecting Oral candidosis needs to be investigated.