一期根治术治疗肛周脓肿对HIV感染者细胞免疫的影响

目的探讨一期根治术治疗肛周脓肿对不同免疫缺陷程度的人免疫缺陷病毒（Human immunodeficiency virus,HIV）感染者的临床疗效以及对细胞免疫功能的影响。方法 54例HIV阳性（HIV＋）与同期随机48例HIV阴性（HIV-）共102例需行一期根治术治疗肛周脓肿的患者,检测其术前1 d（D0）、术后第7天（D7）、术后第30天（D30）外周静脉血T淋巴细胞亚群CD4和CD8计数（单位cell/μl）及CD4/CD8,各自计算D7、D30两次CD4计数相对于D0百分比D7/D0（%）、D30/D0（%）,并根据术前1 d（D0）CD4计数分层（组）,Ⅰ≥500〉Ⅱ≥200〉Ⅲ≥0,SPSS 19.0软件包分析每组内前后差异以及各层组之间差异。结果 102例肛周脓肿均获得一次性治愈或好转,治愈率为97.1%。两组患者在术后肛瘘、肛周脓肿复发、肛门狭窄,平均创口愈合时间等方面比较差异均无统计学意义（P〉0.05）。各组内部手术前后三次检测各项目均数差异中,淋巴细胞计数、CD4计数、CD4/CD8有统计学意义（P〈0.05）,不同组别之间的差异也有统计学意义（P〈0.05）,时间与组别两个因素之间有交互效应（F=4.52、7.703、3.11,P〈0.05）。结论一期根治术治疗肛周脓肿对以CD4为主的细胞免疫功能有＂先抑制后恢复＂的影响过程,HIV感染者免疫缺陷程度越重,其免疫抑制越明显,正确把握手术适应证以及恰当的围术期处理前提下,合并HIV感染的肛周脓肿患者施行手术可以取得与非HIV感染者类似满意的临床疗效。

Impact of primary radical operation for treatment of perianal abscess on cellular immunity in HIV-infected patients

Objective To observe the impact of primary radical operation for treatment of perianal abscess on the clinical efficacy and cellular immunity in HIV-infected patient with different levels immunodeficiency.Methods We select 102 patients with perianal abscess who need a primary radical surgery, which including 54 cases of HIV-positive（HIV＋） and 48 randomized cases of HIV-negative（HIV-）, then detect the peripheral venous blood and count the number of T lymphocyte subsets CD4（cell/μl）, CD8（cell/μl） and CD4/CD8 on preoperative day 1（D0）, postoperative day 7（D7） and postoperative day 30（D30）. Then we calculated twice the ratio of CD4 number of D7 to D0and D30 to D0respectively： D7/D0（%） and D30/D0（%）, and stratified according to the count of CD4 on D0, Ⅰ≥500Ⅱ≥200Ⅲ≥0. The differences of the preoperative and postoperative count in each group and the differences of count between each group were analyzed with SPSS（V19.0）. Results All 102 cases have received a one-time perianal abscess cured or improved, and the cure rate was 97.1%. The difference was not statistically significant on the postoperative fistula, perianal abscess recurrence, anal stenosis, and the average wound healing time of patients from both group,（P0.05）. In the three preoperative and postoperative detections for each group, the difference was statistically significant in pair-wise comparison of three times＇ lymphocyte count, CD4 count, CD4/CD8 inside each group（P0.05）;There were also statistically significant differences among different groups（P0.05）. And there were interaction effect between time and groups（F=4.52, 7.703, 3.11, P0.05）. Conclusion Primary radical operation of perianal abscess had an impact on CD4 based cellular immunity with the process from suppression to restoration. The more severe the immune defects in HIV-infected patients, the more obvious immunosuppression were. Based on the correct operation indications and appropriate perioperative management, the HIV-in