HIV/AIDS患者CD4+T淋巴细胞数水平与巨细胞病毒感染分析

目的 分析住院及门诊人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染者/获得性免疫缺陷综合征（acquired immunodeficiency syndrome, AIDS）患者（简称HIV感染者/AIDS患者）不同免疫状态下合并巨细胞病毒（human cytomegalovirus, HCMV）感染率情况,进一步了解HIV/AIDS合并HCMV感染的相关影响因素。方法 用流式细胞术进行HIV/AIDS体内CD4⁺T淋巴细胞亚群的计数,采用聚合酶链-荧光法进行HIV/AIDS尿液中HCMV-DNA检测,采用χ²检验分析HIV/AIDS不同来源、不同免疫状态下合并HCMV感染率差异。采用Logistic回归分析HIV/AIDS患者合并HCMV感染的相关因素。结果 817例HIV/AIDS患者合并HCMV感染阳性率21.5%（147/817）。HIV/AIDS患者的年龄、性别在是否合并HCMV感染中差异无统计学意义。CD4⁺T细胞≤50个/μL、合并梅毒感染为HIV/AIDS患者合并HCMV感染危险因素（P<0.001,OR=6.410,95%CI=4.141~9.922;P<0.05,OR=1.790,95%CI=1.206~2.657）,门诊和住院HIV/AIDS患者合并HCMV感染率差异有统计学意义（χ²=36.042,P<0.001）。以患者来源为分层因素进行CD4⁺T淋巴细胞计数与HCMV感染率分析,住院HIV/AIDS患者CD4⁺T细胞≤50个/μL时为合并HCMV危险因素（P<0.001,OR=4.796,95%CI=2.998~7.668）;门诊HIV/AIDS患者,CD4⁺T细胞≤50个/μL时为HIV/AIDS患者合并HCMV危险因素（P<0.001,OR=18.468,95%CI=6.668~51.154）。结论 AIDS期患者应及时筛查有无巨细胞病毒合并感染, AIDS CD4⁺T细胞数≤50个/μL、合并梅毒感染为HIV/AIDS患者合并HCMV感染的危险因素,门诊AIDS患者CD4⁺T细胞≤50个/μL其合并HCMV感染可能性为CD4⁺T细胞>50个/μL的18.468倍,应予以重视,尽早治疗,获得更好预后。

CD4+T lymphocyte level and cytomegalovirus infection in HIV/AIDS patients

Objective To analyze the different immune status of inpatients and outpatients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients (referred to as HIV-infected/AIDS patients) with human cytomegalovirus (HCMV) infection rate, further understand the related factors of HIV/AIDS patients with HCMV infection. Methods Flow cytometry was used to count the CD4⁺T lymphocyte subsets in HIV/AIDS patients, polymerase chain-fluorescence method was used to detect HCMV-DNA in the urine of HIV/AIDS patients, and the chi-square test was used to analyze the HCMV infection rate in AIDS patients from different sources and different immune states.Logistic regression was used to analyze the related factors of HIV/AIDS patients with HCMV infection. Results The positive rate of 817 HIV/AIDS patients with HCMV infection was 21.5% (147/817). The age and gender of HIV/AIDS patients were not statistically different in whether they were combined with HCMV infection. CD4⁺T cells ≤50/μL, syphilis infection were risk factors for HIV/AIDS patients with HCMV infection (P<0.001, OR=6.410, 95%CI=4.141-9.922; P<0.05, OR=1.790, 95% CI=1.206-2.657). There was a statistically significant difference in the HCMV infection rate between outpatient and inpatient HIV/AIDS patients (χ²=36.042, P<0.001). In hospitalized patients, CD4⁺T cells ≤50/μL was a risk factor for HIV/AIDS patients with HCMV (P<0.001, OR=4.796 ,95%CI=2.998-7.668); Outpatient HIV/AIDS patients, CD4⁺T cells≤50/μL was a risk factor for HIV/AIDS patients with HCMV (P<0.001, OR=18.468, 95%CCI=6.668-51.154). Conclusions AIDS patients should be screened for cytomegalovirus infection in time, especially for advanced AIDS CD4⁺T cells≤50/μL, syphilis infection is a risk factor for HIV/AIDS patients with HCMV infection, outpatient AIDS patients CD4⁺T cells≤50/μL, the possibility of combined HCMV infection is 18.468 times that of CD4⁺T cells>50/μL. It should be paid attention to and treated as soon as possible to obtain a better prognosis.