CAJ | 학술논문

目的探讨先占性抗巨细胞病毒(CMV)治疗对艾滋病合并CMV血症患者预后的影响.方法 2011年7月1日至2013年6月30日住院的伴CMV血症的男性艾滋病患者共69例,按患者意愿,非随机对照分为2组,即治疗组(抗CMV组)57例、对照组(非抗CMV组)12例,治疗组采用更昔洛韦或膦甲酸钠静脉注射,CMV-DNA阴转后1周停药,3周末行抗高效逆转录病毒治疗(HAART);对照组仅行HAART及其他对症治疗,评价入组时两组CMV-DNA载量、HIV-RNA载量、CD4+T细胞计数、卡氏肺孢子菌肺炎(PCP)以及活动性结核的合并感染率有无差异.观察期12月,评价观察期末两组CD4+T细胞计数、CMV视网膜炎的发生率、再住院率以及死亡率的差异.结果入组时两组CMV-DNA载量、HIV-RNA载量、CD4+T细胞计数差异无统计学意义(P＞0.05);两组PCP、活动性结核的合并感染率差异无统计学意义(P＞0.05).与对照组相比,抗CMV组12个月时CD4+T细胞计数及再住院率明显得到改善(t=-3.850,P＜0.05;x2=6.078,P＜0.05).观察期内两组均无CMV视网膜炎发生.两组死亡率差异无统计学意义(P＞0.05).结论先占性抗CMV治疗有利于艾滋病合并CMV血症患者的CD4+T细胞计数增长及减少再住院率,并阻止了CMV视网膜炎的发生,有利于细胞免疫重建及改善艾滋病患者的生存质量.
목적 탐토선점성항거세포병독(CMV)치료대애자병합병CMV혈증환자예후적영향.방법 2011년7월1일지2013년6월30일주원적반CMV혈증적남성애자병환자공69례,안환자의원,비수궤대조분위2조,즉치료조(항CMV조)57례、대조조(비항CMV조)12례,치료조채용경석락위혹련갑산납정맥주사,CMV-DNA음전후1주정약,3주말행항고효역전록병독치료(HAART);대조조부행HAART급기타대증치료,평개입조시량조CMV-DNA재량、HIV-RNA재량、CD4+T세포계수、잡씨폐포자균폐염(PCP)이급활동성결핵적합병감염솔유무차이.관찰기12월,평개관찰기말량조CD4+T세포계수、CMV시망막염적발생솔、재주원솔이급사망솔적차이.결과 입조시량조CMV-DNA재량、HIV-RNA재량、CD4+T세포계수차이무통계학의의(P＞0.05);량조PCP、활동성결핵적합병감염솔차이무통계학의의(P＞0.05).여대조조상비,항CMV조12개월시CD4+T세포계수급재주원솔명현득도개선(t=-3.850,P＜0.05;x2=6.078,P＜0.05).관찰기내량조균무CMV시망막염발생.량조사망솔차이무통계학의의(P＞0.05).결론 선점성항CMV치료유리우애자병합병CMV혈증환자적CD4+T세포계수증장급감소재주원솔,병조지료CMV시망막염적발생,유리우세포면역중건급개선애자병환자적생존질량.
Objective To explore the effect of preemptive anti-cytomegalovirus therapy on prognosis of patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) viraemia.Methods A non-random prospective study of male hospitalized patients were carried out who were newly diagnosed as AIDS during July 1,2011 to June 30,2013 in the First Affiliated Hospital of China Medical University.There were 69 patients who were divided into treatment group (57 cases) and control group (12cases).The duration of anti-cytomegalovirus therapy was a week after plasma CMV-DNA becoming undetectable.Baseline age,CMV-DNA,human immunodeficiency virus (HIV)-RNA,CD4+T cells,the rate of pneumocystis carinii pneumonia (PCP) and tuberculosis were evaluated between two groups.After 12-month follow-up,CD4 + T cells,the rate of rehospitalization,CMV retinitis,and mortality were evaluated.Results There were no difference in CMV-DNA,HIV-RNA,CD4 + T cells,the rate of PCP,and tuberculosis(P ＞ 0.05).At the end of 12 months,there were higher CD4 +T cells and lower rehospitalization rate in treatment group than control group(t =-3.850,P ＜ 0.05;x2 =6.078,P ＜ 0.05).CMV retinitis was not found.The mortality was not different between two groups(P ＞0.05).Conclusions Anticytomegalovirus therapy was beneficial to the increment of CD4 +T cells and decrement of rehospitalization,and prevention from CMV retinitis.