張 鵬，蔣忠勝，溫小鳳，韋靜彬，覃 川

?

·論著·

高效抗反轉(zhuǎn)錄病毒治療HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素及改用洛匹那韋利托那韋的療效研究

張 鵬，蔣忠勝，溫小鳳，韋靜彬，覃 川

獲得性免疫缺陷綜合征；HIV RNA；CD4陽性T淋巴細(xì)胞；洛匹那韋利托那韋

張鵬，蔣忠勝，溫小鳳，等.高效抗反轉(zhuǎn)錄病毒治療HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素及改用洛匹那韋利托那韋的療效研究[J].中國(guó)全科醫(yī)學(xué)，2015，18(20)：2426-2429.[www.chinagp.net]

Zhang P,Jiang ZS,Wen XF,et al.Influencing factors for discordant responses to highly active antiretroviral therapy on HIV-infected and AIDS patients and efficacy of LPV/r[J].Chinese General Practice，2015，18(20)：2426-2429.

1 對(duì)象與方法

1.1 研究對(duì)象 選取2006年7月—2013年3月在柳州市人民醫(yī)院進(jìn)行免費(fèi)抗病毒治療且跟蹤隨訪的HIV感染者和AIDS患者510例為研究對(duì)象，其中男322例，女188例；年齡(42.1±12.5)歲。納入標(biāo)準(zhǔn)：(1)經(jīng)HIV初篩確診陽性；(2)治療前未使用抗HIV藥物；(3)未妊娠者；(4)未因藥物毒副作用、機(jī)會(huì)性感染及其他因素導(dǎo)致停藥。

1.4 統(tǒng)計(jì)學(xué)方法 采用SPSS 17.0軟件進(jìn)行統(tǒng)計(jì)分析，不符合正態(tài)分布的計(jì)量資料以M(QR)表示，組間比較采用非參數(shù)檢驗(yàn)；計(jì)數(shù)資料以相對(duì)數(shù)表示，組間比較采用χ2檢驗(yàn)；采用單因素和多因素Logistic回歸分析發(fā)生不和諧反應(yīng)的影響因素。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

表1 HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)影響因素的單因素Logistic回歸分析

Table 1 Unvariable Logistic regression analysis on influencing factors for discordant responses in HIV-infected and AIDS patients

變量β值SEWaldχ2值OR值(95%CI)P值性別-07530205134640471(0315，0704)<0001年齡0016000745921016(1001，1031)0032HIV分期 Ⅳ期---1- Ⅲ期-0858028789130424(0241，0745)0003 Ⅱ期-1482055571380227(0077，0674)0008 Ⅰ期-20710236767650126(0079，0200)<0001肺外結(jié)核-16840345237720186(0094，0365)<0001肺部真菌感染-15530377169540212(0101，0443)<0001肺孢子菌肺炎-1094036291390335(0165，0681)0003巨細(xì)胞病毒感染-1160057840290313(0101，0973)0045馬爾尼菲青霉菌病-16910456137510184(0075，0451)<0001機(jī)會(huì)性感染11890166511283283(2370，4548)<0001治療時(shí)CD+4T細(xì)胞計(jì)數(shù)-002000021069350980(0976，0984)<0001治療時(shí)CD+8T細(xì)胞計(jì)數(shù)-00010274070999(0998，0999)<0001治療時(shí)淋巴細(xì)胞計(jì)數(shù)-13850183575270250(0175，0358)<0001治療時(shí)白細(xì)胞計(jì)數(shù)-02860058240930751(0670，0842)<0001治療時(shí)血紅蛋白-00210004256970979(0971，0987)<0001治療后3個(gè)月CD+4T細(xì)胞計(jì)數(shù)-002000021139020981(0977，0984)<0001治療后3個(gè)月淋巴細(xì)胞計(jì)數(shù)-08520179225510426(0400，0606)<0001治療后6個(gè)月CD+4T細(xì)胞計(jì)數(shù)-002000021162920980(0976，0983)<0001治療后6個(gè)月淋巴細(xì)胞計(jì)數(shù)-09260183256720396(0277，0567)<0001

注：-無此數(shù)據(jù)

表2 HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)影響因素的多因素logistic回歸分析

Table 2 Multivariate Logistic regression analysis on influencing factors for discordant responses in HIV-infected and AIDS patients

變量β值SEWaldχ2值OR值(95%CI)P值年齡0036003283561037(1012，1062)0004治療時(shí)CD+4T細(xì)胞計(jì)數(shù)-00120003121640988(0982，0995)<0001治療后3個(gè)月CD+4T細(xì)胞計(jì)數(shù)-00090003101920991(0985，0997)0001治療后6個(gè)月CD+4T細(xì)胞計(jì)數(shù)-0007000367730993(0988，0998)0009治療后6個(gè)月淋巴細(xì)胞計(jì)數(shù)-0837032367120433(0230，0816)0010

3 討論

實(shí)施抗HIV治療后，我國(guó)艾滋病患者整體病死率有所下降，但發(fā)生不和諧反應(yīng)的患者由于其免疫功能重建不全，其疾病惡化風(fēng)險(xiǎn)較免疫功能重建良好患者增加1倍,死亡風(fēng)險(xiǎn)也相應(yīng)增加[2-3]。因此研究此類患者發(fā)生不和諧反應(yīng)的影響因素，對(duì)降低患者病死率有重要意義。

[1]中華醫(yī)學(xué)會(huì)感染病學(xué)分會(huì)艾滋病學(xué)組.艾滋病診療指南[J].中華傳染病雜志，2006，24(2):133-144.

[2]Gutiérrez F,Padilla S,Masiá M,et al.Patients′ characteristics and clinical implications of suboptimal CD4T-cell gains after 1year of sucessful antiretroviral therapy[J].Curr HIV Res,2008,6(2):100-107.

[3]Tan R,Westfall AO,Willig JH,et al.Clinical outcome of HIV infected antiretroviral naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy[J].J Acquir Immune Defic Syndr,2008,47(5):553-558.

[4]Collazos J，Asensi V，Cartón JA，et al.Factors associated with poor immunologic responses despite viral suppression in markedly immunosuppressed patients [J].AIDS Patient Care STDS，2007，21(6):378-384.

[5]Sun QY,Xiong HY,Wang L,et al.The epidemiological and clinical characteristics of 48 older HIV/AIDS patients in Chongqing[J].The Chinese Journal of Dermatovenereol,2011,25(4):286-288.(in Chinese) 孫慶云,熊鴻燕,王林,等.老年HIV/AIDS住院患者48例流行病學(xué)及臨床特征分析[J].中國(guó)皮膚性病學(xué)雜志,2011,25(4):286-288.

[6]中國(guó)疾病預(yù)防控制中心性病艾滋病預(yù)防控制中心.國(guó)家免費(fèi)艾滋病抗病毒藥物治療手冊(cè)[M].3版.北京:人民衛(wèi)生出版社，2012:15-17.

[7]Zhang Y,Liu CX,He H,et al.The study of immunologic reconstitution in HIV/AIDS highly active antiretroviral therapy[J].Journal of Clinical Internal Medicine,2009,26(5):305-307.(in Chinese) 張勇,劉存旭,何晗,等.300例艾滋病患者高效抗逆轉(zhuǎn)錄病毒治療后免疫重建規(guī)律探討[J].臨床內(nèi)科雜志,2009,26(5):305-307.

[8]Sharma SK,Mohan A,Kadhiravan T.HIV-TB co-infection:epidemiology,diagnosis and management[J].Indian J Med Res,2005,121(4):550-567.

[9]Obirikorang C，Quaye L,Acheampong I.Total lymphocyte count as a surrogate marker for CD4count in resource-limited settings[J].BMC Infecti Dis，2012，12:128.

[10]Wang YY,Zheng YT.HIV protease inhibitors and apoptosis[J].Chinese Pharmacology Bulletin,2004,20(2):141-145.(in Chinese) 王媛媛，鄭永唐.HIV蛋白酶抑制劑與細(xì)胞凋亡[J].中國(guó)藥理學(xué)通報(bào),2004,20(2):141-145.

[11]李重熙,劉俊,田波,等.AIDS病人改用克力芝后免疫重建不良的免疫學(xué)療效觀察[J].中國(guó)艾滋病性病,2013,19(12):856-858.

[12]Zhao Y,Liu AW,Tang ZR,et al.The immunological response after switching to protease inhibitor based regimen among suboptimal immunologic responders[J].Chinese Journal of Experimental and Clinical Infectious Diseases：Electronic Edition,2012,6(5):419-422.(in Chinese) 趙燕,劉愛文,唐志榮,等.蛋白酶抑制劑對(duì)免疫重建不良艾滋病患者的免疫學(xué)影響[J].中華實(shí)驗(yàn)和臨床感染病雜志：電子版，2012,6(5):419-422.

[13] Jiang ZS,Jiang JN.The research of prognosis risk factors in recent period for HIV-infected individuals and acquired immunodeficiency syndrome patients [J].The Chinese Journal Dermatovenereology,2014,8(3):279-281.(in Chinese) 蔣忠勝,江建寧.HIV感染者/AIDS患者近期預(yù)后危險(xiǎn)因素的分析[J].中國(guó)皮膚與性病學(xué)雜志,2014,8(3):279-281.

[14]Yu F,Liang FL,He YY,et al.Relationship between C-reactive protein level and prognosos of HIV/AIDS patients after antiretroviral therapy[J].Chinese Journal of Nosocomiology,2013,23(19):4616-4618.(in Chinese) 余豐,梁飛立,何艷英,等.C-反應(yīng)蛋白水平與HIV/AIDS患者抗病毒治療預(yù)后關(guān)系的研究[J].中華醫(yī)院感染學(xué)雜志,2013,23(19):4616-4618.

(本文編輯：吳立波)

Influencing Factors for Discordant Responses to Highly Active Antiretroviral Therapy on HIV-infected and AIDS Patients and Efficacy of LPV/r

ZHANGPeng,JIANGZhong-sheng,WENXiao-feng,etal.

DepartmentofInfectiousDisease,LiuzhouPeople′sHospital,Liuzhou545006,China

Acquired immunodeficiency syndrome；HIV RNA；CD4-positive T-lymphocytes；Lopinavir and ritonavir

廣西壯族自治區(qū)衛(wèi)生廳自籌經(jīng)費(fèi)科研課題(Z2012561)；柳州市應(yīng)用技術(shù)研究與開發(fā)計(jì)劃項(xiàng)目(2011J0302021)；廣西自然科學(xué)基金資助項(xiàng)目(2013GXNSFAA019213)

545006廣西柳州市人民醫(yī)院感染病科

蔣忠勝，545006廣西柳州市人民醫(yī)院感染病科；E-mail：jiangzs1111@126.com

R 512.91

A

10.3969/j.issn.1007-9572.2015.20.016

2014-12-26；

2015-03-18)