【摘要】：目的探討高效抗反轉(zhuǎn)錄病毒治療(HARRT)HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素,并觀察改用洛匹那韋利托那韋(LPV/r)的療效。方法選取2006年7月—2013年3月在柳州市人民醫(yī)院進(jìn)行免費抗病毒治療且跟蹤隨訪的HIV感染者和AIDS患者510例為研究對象,經(jīng)HARRT 12個月后,174例患者發(fā)生不和諧反應(yīng),其中70例同意更換為含LPV/r的二線治療方案。收集患者一般資料,記錄治療時及治療后3、6、12個月時HIV RNA、CD+4T細(xì)胞計數(shù)、CD+8T細(xì)胞計數(shù)、淋巴細(xì)胞計數(shù)、白細(xì)胞計數(shù)、血紅蛋白、血小板計數(shù),記錄更換治療方案者和未更換治療方案者第2年CD+4T細(xì)胞計數(shù)的增長量。結(jié)果多因素Logistic回歸分析顯示年齡〔OR=1.037,95%CI(1.012,1.062),P=0.004〕、治療時CD+4T細(xì)胞計數(shù)〔OR=0.988,95%CI(0.982,0.995),P0.001〕、治療后3個月CD+4T細(xì)胞計數(shù)〔OR=0.991,95%CI(0.985,0.997),P=0.001〕、治療后6個月CD+4T細(xì)胞計數(shù)〔OR=0.993,95%CI(0.988,0.998),P=0.009〕、治療后6個月淋巴細(xì)胞計數(shù)〔OR=0.433,95%CI(0.230,0.816),P=0.010〕進(jìn)入回歸方程,是HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素。未更換治療方案患者CD+4T細(xì)胞計數(shù)增長70.5(119.5)個/μl,更換治療方案患者CD+4T細(xì)胞計數(shù)增長147(155.2)個/μl,差異有統(tǒng)計學(xué)意義(Z=-5.386,P0.05)。未更換治療方案患者不和諧反應(yīng)發(fā)生率為53.8%(56/104),更換治療方案患者為22.8%(16/70),不和諧反應(yīng)率比較差異有統(tǒng)計學(xué)意義(χ2=11.413,P0.05)。結(jié)論年齡、治療時CD+4T細(xì)胞計數(shù)等是HARRT患者發(fā)生不和諧反應(yīng)的影響因素,且發(fā)生不和諧反應(yīng)后改用含LPV/r的方案治療,可改善患者免疫功能,降低不和諧反應(yīng)發(fā)生率。
[Abstract]:Objective to investigate the influencing factors of discordant reaction between (HARRT) HIV infected patients and AIDS patients with highly effective antiretroviral therapy and to observe the efficacy of Lopinowilitonavir (LPV/r). Methods from July 2006 to March 2013, 510 cases of HIV infected persons and AIDS patients who were treated with free antiviral therapy in Liuzhou people's Hospital and followed up were selected as the subjects. 174 patients with HARRT 12 months later had disharmonious reaction. Seventy of them agreed to replace it with a second-line therapy with LPV/r. The general data of the patients were collected, and the HIV RNA,CD 4T cell count, CD8T cell count, lymphocyte count, white blood cell count, hemoglobin and platelet count were recorded at the time of treatment and at 12 months after treatment. The increase of CD 4 T cell count in the second year was recorded between the patients who changed the treatment regimen and those who did not. Results Multivariate Logistic regression analysis showed that age (OR=1.037,95%CI (1.012 鹵1.062) / P 0.004), CD 4T cell count (OR=0.988,95%CI (0.9820.995) / P0.001), CD 4T cell count (OR=0.991,95%CI (0.9850.997) / P0. 001) and CD 4T cell count (OR=0.993,95%CI (0.9880.998) / P 0.009) at 6 months after treatment. The lymphocyte count (OR=0.433,95%CI (0.230 鹵0.816) entered the regression equation 6 months after treatment, which was the influencing factor of disharmonious reaction between HIV infected patients and AIDS patients. The number of CD 4T cells increased by 70.5 (119.5) / 渭 l in patients with no replacement treatment regimen and 147( 155.2) / 渭 l by CD _ 4T cells in patients with replacement treatment regimen. The difference was statistically significant (P 0.05). The rate of disharmonious reaction was 53.8% (56 / 104) in patients without replacement treatment regimen and 22.8% (16 / 70) in patients with alternative treatment regimen. The difference was statistically significant (蠂 2 11.413 P 0.05). Conclusion Age and CD 4T cell count are the influencing factors of disharmonious reaction in patients with HARRT. The treatment with LPV/r regimen after disharmonious reaction can improve the immune function of patients and reduce the incidence of dissonant reactions.
【作者單位】： 廣西柳州市人民醫(yī)院感染病科;
【基金】：廣西壯族自治區(qū)衛(wèi)生廳自籌經(jīng)費科研課題(Z2012561) 柳州市應(yīng)用技術(shù)研究與開發(fā)計劃項目(2011J0302021) 廣西自然科學(xué)基金資助項目(2013GXNSFAA019213)
【分類號】：R512.91

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本文編號：2210613