CAJ | 학술논문

目的：探讨一期根治术治疗肛周脓肿对不同免疫缺陷程度的人免疫缺陷病毒(Human immunodefi-ciency virus，HIV)感染者的临床疗效以及对细胞免疫功能的影响。方法54例HIV阳性(HIV+)与同期随机48例HIV阴性(HIV-)共102例需行一期根治术治疗肛周脓肿的患者,检测其术前1 d (D0)、术后第7天(D7)、术后第30天(D30)外周静脉血T淋巴细胞亚群CD4和CD8计数(单位cell/μl)及CD4/CD8，各自计算D7、D30两次CD4计数相对于D0百分比D7/D0(%)、D30/D0(%)，并根据术前1 d (D0) CD4计数分层(组)，Ⅰ≥500＞Ⅱ≥200＞Ⅲ≥0，SPSS 19.0软件包分析每组内前后差异以及各层组之间差异。结果102例肛周脓肿均获得一次性治愈或好转，治愈率为97.1%。两组患者在术后肛瘘、肛周脓肿复发、肛门狭窄，平均创口愈合时间等方面比较差异均无统计学意义(P>0.05)。各组内部手术前后三次检测各项目均数差异中，淋巴细胞计数、CD4计数、CD4/CD8有统计学意义(P<0.05)，不同组别之间的差异也有统计学意义(P<0.05)，时间与组别两个因素之间有交互效应(F=4.52、7.703、3.11，P<0.05)。结论一期根治术治疗肛周脓肿对以CD4为主的细胞免疫功能有“先抑制后恢复”的影响过程, HIV感染者免疫缺陷程度越重,其免疫抑制越明显，正确把握手术适应证以及恰当的围术期处理前提下，合并HIV感染的肛周脓肿患者施行手术可以取得与非HIV感染者类似满意的临床疗效。
목적：탐토일기근치술치료항주농종대불동면역결함정도적인면역결함병독(Human immunodefi-ciency virus，HIV)감염자적림상료효이급대세포면역공능적영향。방법54례HIV양성(HIV+)여동기수궤48례HIV음성(HIV-)공102례수행일기근치술치료항주농종적환자,검측기술전1 d (D0)、술후제7천(D7)、술후제30천(D30)외주정맥혈T림파세포아군CD4화CD8계수(단위cell/μl)급CD4/CD8，각자계산D7、D30량차CD4계수상대우D0백분비D7/D0(%)、D30/D0(%)，병근거술전1 d (D0) CD4계수분층(조)，Ⅰ≥500＞Ⅱ≥200＞Ⅲ≥0，SPSS 19.0연건포분석매조내전후차이이급각층조지간차이。결과102례항주농종균획득일차성치유혹호전，치유솔위97.1%。량조환자재술후항루、항주농종복발、항문협착，평균창구유합시간등방면비교차이균무통계학의의(P>0.05)。각조내부수술전후삼차검측각항목균수차이중，림파세포계수、CD4계수、CD4/CD8유통계학의의(P<0.05)，불동조별지간적차이야유통계학의의(P<0.05)，시간여조별량개인소지간유교호효응(F=4.52、7.703、3.11，P<0.05)。결론일기근치술치료항주농종대이CD4위주적세포면역공능유“선억제후회복”적영향과정, HIV감염자면역결함정도월중,기면역억제월명현，정학파악수술괄응증이급흡당적위술기처리전제하，합병HIV감염적항주농종환자시행수술가이취득여비HIV감염자유사만의적림상료효。
Objective To observe the impact of primary radical operation for treatment of perianal ab-scess on the clinical efficacy and cellular immunity in HIV-infected patient with different levels immunodeficiency. Methods We select 102 patients with perianal abscess who need a primary radical surgery, which including 54 cases of HIV-positive (HIV+) and 48 randomized cases of HIV-negative (HIV-), then detect the peripheral venous blood and count the number of T lymphocyte subsets CD4 (cell/μl), CD8 (cell/μl) and CD4/CD8 on preoperative day 1 (D0), postop-erative day 7 (D7) and postoperative day 30 (D30). Then we calculated twice the ratio of CD4 number of D7 to D0 and D30 to D0 respectively:D7/D0 (%) and D30/D0 (%), and stratified according to the count of CD4 on D0,Ⅰ≥500>Ⅱ≥200>Ⅲ≥0. The differences of the preoperative and postoperative count in each group and the differences of count between each group were analyzed with SPSS (V19.0). Results All 102 cases have received a one-time perianal ab-scess cured or improved, and the cure rate was 97.1%. The difference was not statistically significant on the postopera-tive fistula, perianal abscess recurrence, anal stenosis, and the average wound healing time of patients from both group, (P>0.05). In the three preoperative and postoperative detections for each group, the difference was statistically significant in pair-wise comparison of three times' lymphocyte count, CD4 count, CD4/CD8 inside each group (P<0.05);There were also statistically significant differences among different groups (P<0.05). And there were interaction effect between time and groups (F=4.52, 7.703, 3.11, P<0.05). Conclusion Primary radical operation of perianal abscess had an impact on CD4 based cellular immunity with the process from suppression to restoration. The more severe the immune defects in HIV-infected patients, the more obvious immunosuppression were. Based on the correct operation indications and appropriate perioperative management, the HIV-infected patients with perianal abscess can get a clini-cal efficacy as satisfactory as one with non-HIV-infected.