摘要
目的探讨住院艾滋病(AIDS)合并巨细胞病毒(CMV)感染患者的临床表现及T细胞亚群特点。方法收集2010年1月至2017年8月北京协和医院住院首次诊治的48例AIDS合并CMV感染患者的临床资料,回顾性分析其临床表现、免疫功能特点。单纯人类免疫缺陷病毒(HIV)感染/AIDS(HIV/AIDS)组为北京协和医院2009年4月至2016年8月招募并纳入前期研究的57例HIV/AIDS患者。结果48例均为AIDS C3期合并CMV感染,CD4^+T淋巴细胞≤50个μl者35例,51~100个/μl者7例,101~200个/μl者3例,>200个/μl者3例;AIDS合并CMV感染的疾病构成谱中,CMV DNA血症31例,CMV脑炎1例,CMV肠炎1例,CMV肺炎5例,CMV视网膜炎9例:其他机会性感染包括卡氏肺孢子菌肺炎(PCP)16例、结核菌感染9例、梅毒5例,消化道真菌感染18例,肺部真菌感染8例,EB病毒(EBV)感染2例,H1V脑病/进行性多灶性脑白质病变(PML)2例.隐球菌脑膜炎3例,弓形虫病1例;AIDS合并CMV感染组CD4^+/CD8^+比例倒置100%,CD8^+CD38^+T细胞异常激活比例(CD8^+CD38^+/CD8^+)为61.6%~98.8%,中位数91.2%, 48例中收集到的40例中均有异常激活;人类白细胞抗原(HLA)-DR^+CD8^+T细胞异常激活比例(HLA-DR^+CD8^+/CD8^+)为25.5%~98.0%,中位数60.3%, 48例中收集到的44例中均有激活;同时有CD8^+CD38^+、HLA-DR^+CD8^+T细胞异常激活的36例;不同性别、不同年龄组B细胞、自然杀伤(NK)细胞、T细胞亚群中CD4^+T细胞计数、CD8^+T细胞计数及激活亚群情况差异无统计学意义(P值均>0.05)。 AIDS合并CMV感染组血清HIV病毒载量与HLA-DR^+CD8^+/CD8^+、CD38^+CD8^+/CD8^+、CD4^+T细胞计数、CD4^+/CD8^+之间的相关性不明显(r值分别为0.180,0.134,-0.147和0.273,P值均>0.05)血清 CMV 病毒载量与HLA-DR^+CD8^+/CD8^+、CD38^+CD8^+/CD8^+、CD4^+T细胞计数。CD4^+/CD8^+相关性亦不明显(r值分别为0.139、0.266、-0.046和-0.106. P值均>0.05);而单纯HIV/AIDS组血清HIV病毒载量与HLA-DR^+CD8^+/CD8^+、CD38^+CD8^+/CD8^+、CD4^+T细胞计数、CD4^+/CD8^+之间存在显著相关性(r值分别为0.473 ,0.575 .-0.767和-0.678,P值均<0.05)。结论CMV感染多发生在晚期AIDS患者,可使AIDS患者T淋巴细胞亚群产生变化,可引起多器官、多系统病变,严重威胁AIDS患者的生命,尤其CD4^+T细胞<50个/μl的患者,应注意筛查CMV IgM、pp65抗原、CMV DNA指标协助临床早期诊疗。
Objective To investigate the c-linical features and T lymphocytes subsets in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) infection. Methods A total of 48 hospitalized patients with human immunodeficiency virus (HIV)-l/AIDS and CMV infections were recruited at Peking Union Medical College Hospital from Jan 2010 to Aug 2017. Their clinical features and immune function were retrospectively analyzed. Patients with only HIV/AIDS in previous study were recruited as controls. Results All 48 patients were at C3 stage, including 36 men and 12 women. Five of them were younger than 30 years old, 33 cases within 31-50 years old, and 10 cases older than 50 years old. Thirty-five patients had CD4^+T lymphocytes ≤50 cells/μl,7 cases with CD4^+T cells 51~100/μl. 3 cases with 101-200 cells/μl, and 3 cases over 200 cells/μl. As to CMV infections, there were 31 cases of CMV viremia. 1 case of CM V encephalitis, 1 case of CMV enteritis, 5 cases of CMV pneumonia, and 9 cases of CMV retinitis. Other opportunistic infections were also common including 16 cases of pneumocystis pneumonia, 9 cases of tuberculosis, 5 cases of syphilis, 18 cases of digestive tract fungal infections, 8 cases of pulmonary fungal infections, 2 cases of EB virus infections. 2 cases of HIV encephalopathy / progressive multifocal leukoencephalopathy (PML), 3 cases of cryptococcal meningitis, 1 case of toxoplasma infection, In group of both CMV and HIV/AIDS infections, 100% patients had inverted CD4^+/CD8^+ ratio. The immune activation marker CD8^+CD38^+/CD8^+ was higher (61.6%-98.8%) with a median value of 91.2% in 40 patients. HLA-DR^+CD8^+/CD8^+, another marker for T cell activation, was 25.5%-98.0% in 44 patients with a median value of 60.3%. Thirty-six patients had both immune activation markers positive. There was no significant difference in counts of B cells, natural killer cells. CD4^+T cells, CD8^+T cells and immune activation subsets stratified by gender and age (P>0.05). Meanwhile, neither serum HIV viral load nor serum CMV viral load was correlated with HLA-DR^+CD8^+/CD8^+, CD8^+CD38^+/CD8+,CD4^+T cell counts, and CD4^+/CD8^+ratio in the CMV and HIV/AIDS co-infectio n group (all P>0.05), while HIV viral load in HIV/AIDS only group was significantly correlated with HLA-DR^+CD8^+/CD8^+, CD8^+CD38^+/CD8+,CD4^+T cell counts, CD4^+CD8^+ ratio (r=0.473, 0.575.-0.767 and -0.678, respectively, all P<0.05). Conclusions CMV infections develop in HIV patients with advanced stage. CMV infection can cause life-threatening multiple organ lesions, especially in those with CD4^+T cells less than 100 cells/μl. It is of great importance to screen CMV-IgM. pp65 antigen. CMV DNA to make early diagnosis and treatment.
作者
贾春辉
王磊
荆凡辉
谢静
邱志峰
李太生
吕玮
Jia Chunhui;Wang Lei;Jing Fanhui;Xie Jing;Qiu Zhifeng;Li Taisheng;LV Wei(Department of Infections Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Infectious Diseases, the Third Hospital of Qinhuangdao, Qinhuangdao 066000,China)
出处
《中华内科杂志》
CAS
CSCD
北大核心
2019年第3期191-197,共7页
Chinese Journal of Internal Medicine
