人类免疫缺陷病毒,艾滋病病毒1型艾滋病患者CD4+T淋巴细胞水平与机会感染及病毒载量的相关性分析

Correlation of CD4+ T lymphocyte level with opportunistic infections and viral load in AIDS patients infected with HIV-1

摘要:

目的  分析人类免疫缺陷病毒,艾滋病病毒-1（HIV-1）型艾滋病（AIDS）患者体内CD4+T淋巴细胞水平与艾滋病病毒载量及机会性感染的相关性。方法  通过Real-time PCR OBASAmpliPrep/COBAS TaqMan全自动病毒载量仪（Roche公司）和流式细胞仪（FACSCOUNT）绝对计数法对95例HIV-1型AIDS患者定量检测血浆中HIV-1 RNA和CD4+T淋巴细胞数。结果  低文化程度的35～50岁已婚男性农民是HIV-1型AIDS患者的多见人群，主要通过性传播途径感染；机会感染最常见部位是呼吸系统感染90例次（51.5％）；机会感染发病率最多的是细菌性肺炎48例次（27.4％）；根据CD4+T淋巴细胞计数分层水平分为5组，细菌性肺炎、卡氏肺孢子虫肺炎、肺结核、口腔念珠菌感染、隐球菌脑膜炎、感染性腹泻及单纯疱疹各自在5组间比较差异有统计学意义（P <0.05），其余机会感染各自在5组间比较差异无统计学意义（P >0.05）；CD4+T细胞计数低于200个/μl时，机会感染发生例次率为97.7%；病毒量<103拷贝/ml的AIDS中，以CD4+T细胞数在200～399个/μl的个体较多（75%），病毒量≥105拷贝/ml的AIDS中，CD4+T细胞数在<200个/μl的个体45例（73.8%）；CD4+T淋巴细胞值与病毒载量对数值呈负相关（r =-0.34，P <0.01）。结论  AIDS患者机会性感染的发生率高，随病毒载量上升CD4+T淋巴细胞数呈现不同程度的下降趋势，CD4+T细胞计数是AIDS患者发生机会性感染的独立危险因素，加强对患者CD4+T细胞计数观察是预测机会性感染的重要手段。

Abstract:

 Objective To analyze the correlation of CD4+ T cell level with HIV load and opportunistic infections in AIDS patients with type 1 human immunodeficiency virus(HIV-1). Methods The plasma load of HIV-1 RNA was detected using real-time PCR OBASAmpliPrep/COBAS TaqMan automatic viral load meter (Roche), and CD4+ T lymphocytes were counted by flow cytometry (FACSCOUNT) absolute counting method for 95 patients with AIDS of HIV-1 infection. Results The majority of the patients with HIV-1 type AIDS were mainly married male farmers with low education level at the age of 35-50 years. They got the infection mainly through sexual transmission. Opportunis tic infections most commonly occurred in the respiratory system (90 times, 51.5%) and bacterial pneumonia accounted for the highest incidence (48 times, 27.4%). Based on CD4+ T lymphocyte count level the opportunistic infections were divided into 5 groups. Bacterial pneumonia, Pneumoaystis carrii pneumonia, pulmonary tuberculosis, oral Candida infection, cryptococcal meningitis, infectious diarrhea and herpes simplex were significantly different among the 5 groups (P < 0.05). When CD4+ T cell count was less than 200/μl, the incidence of opportunistic infections was 97.7%. Among the AIDS patients with virus load < 103 copies/ml, most of the individuals had CD4+ T cell count of 200-399/μl (75%); while the virus load ≥ 105 copies/ml, most of the patients had CD4+ T cell count < 200/μl (45 cases, 73.8%). CD4+ T lymphocyte count and viral load were in a negative correlation (r = -0.34, P < 0.01). Conclusions The incidence of opportunistic infection is high in AIDS patients. As the viral load increases, CD4+ T lymphocyte count declines to various degree. CD4+ T cell count is the independent risk factor for opportunistic infection in AIDS patients. Close monitoring CD4+ T cell count in ADIS patients is an important means of predicting opportunistic infections.