CAJ | 학술논문

目的：探讨人类免疫缺陷病毒(human immunodeficiency virus，HIV)阳性患者高效抗逆转录病毒治疗血液学指标变化，与临床疾病的关系。方法我院2013年11月-2014年12月收治的100例HIV阳性患者，随机分为两组，55例高效抗逆转录病毒(highly active antiretroviral therapy，HAART)治疗组(On HAART)和45例未进行该治疗的HIV患者为对照组(HAART na?ve)，分别采用流式细胞术(flow cytometry，FCM)检测外周血T淋巴细胞亚群百分比、细胞计数，采用核酸荧光染料和FCM检测白细胞计数(white blood cell，WBC)、红细胞计数(red blood cell，RBC)、血色素(hemoglobin，Hgb)、红细胞压积(hematocrit，HCT)、平均RBC体积(mean corpuscular volume，MCV)、平均RBC血红蛋白(mean corpuscular hemoglobin，MCH)、平均血红蛋白浓度(mean corpuscular hemoglobin concentration，MCHC)、RBC分布宽度(red blood cell volume distribution width，RDW)、血小板计数(platelets，PLT)、血小板容积(plateletcrit，PCT)、血小板分布宽度(platelet distribution width，PDW)和血小板平均体积(mean platelet volume，MPV)等，采用免疫比浊法检测凝血酶原时间(prothrombin time，PT)、凝血酶原活动度(prothrombin activity，PTA)水平，并采用荧光定量PCR法检测患者HIV病毒载量(HIVRNA)。观察HIV阳性患者经高效抗逆转录病毒治疗血液学指标变化特点。结果治疗组与对照组在治疗前血液学指标差异无统计学意义(P＞0.05)。治疗后治疗组Hgb、MCV、MCH、MCHC、CD4和CD8+ T淋巴细胞数(14.2 g/dl、90.5 fl、35.3 pg、336.1 g/L、395.4/μl、795.4/μl)显著高于对照组的(12.7 g/dl、87.5 fl、28.4 pg、322.6 g/L、300.7/μl、679.7/μl)(P＜0.05)， WBC和RBC水平(4.9×103/μl和4.0×106/μl)显著低于对照组(5.8×103/μl和4.7×106/μl)(P＜0.05)。结论高效抗病毒治疗可降低HIV患者贫血和血小板降低发生率，但易发生白细胞、粒细胞和淋巴细胞减少症。临床医生应根据患者血液学指标变化考虑药物组合、疗程和禁忌。目的：探討人類免疫缺陷病毒(human immunodeficiency virus，HIV)暘性患者高效抗逆轉錄病毒治療血液學指標變化，與臨床疾病的關繫。方法我院2013年11月-2014年12月收治的100例HIV暘性患者，隨機分為兩組，55例高效抗逆轉錄病毒(highly active antiretroviral therapy，HAART)治療組(On HAART)和45例未進行該治療的HIV患者為對照組(HAART na?ve)，分彆採用流式細胞術(flow cytometry，FCM)檢測外週血T淋巴細胞亞群百分比、細胞計數，採用覈痠熒光染料和FCM檢測白細胞計數(white blood cell，WBC)、紅細胞計數(red blood cell，RBC)、血色素(hemoglobin，Hgb)、紅細胞壓積(hematocrit，HCT)、平均RBC體積(mean corpuscular volume，MCV)、平均RBC血紅蛋白(mean corpuscular hemoglobin，MCH)、平均血紅蛋白濃度(mean corpuscular hemoglobin concentration，MCHC)、RBC分佈寬度(red blood cell volume distribution width，RDW)、血小闆計數(platelets，PLT)、血小闆容積(plateletcrit，PCT)、血小闆分佈寬度(platelet distribution width，PDW)和血小闆平均體積(mean platelet volume，MPV)等，採用免疫比濁法檢測凝血酶原時間(prothrombin time，PT)、凝血酶原活動度(prothrombin activity，PTA)水平，併採用熒光定量PCR法檢測患者HIV病毒載量(HIVRNA)。觀察HIV暘性患者經高效抗逆轉錄病毒治療血液學指標變化特點。結果治療組與對照組在治療前血液學指標差異無統計學意義(P＞0.05)。治療後治療組Hgb、MCV、MCH、MCHC、CD4和CD8+ T淋巴細胞數(14.2 g/dl、90.5 fl、35.3 pg、336.1 g/L、395.4/μl、795.4/μl)顯著高于對照組的(12.7 g/dl、87.5 fl、28.4 pg、322.6 g/L、300.7/μl、679.7/μl)(P＜0.05)， WBC和RBC水平(4.9×103/μl和4.0×106/μl)顯著低于對照組(5.8×103/μl和4.7×106/μl)(P＜0.05)。結論高效抗病毒治療可降低HIV患者貧血和血小闆降低髮生率，但易髮生白細胞、粒細胞和淋巴細胞減少癥。臨床醫生應根據患者血液學指標變化攷慮藥物組閤、療程和禁忌。
목적：탐토인류면역결함병독(human immunodeficiency virus，HIV)양성환자고효항역전록병독치료혈액학지표변화，여림상질병적관계。방법아원2013년11월-2014년12월수치적100례HIV양성환자，수궤분위량조，55례고효항역전록병독(highly active antiretroviral therapy，HAART)치료조(On HAART)화45례미진행해치료적HIV환자위대조조(HAART na?ve)，분별채용류식세포술(flow cytometry，FCM)검측외주혈T림파세포아군백분비、세포계수，채용핵산형광염료화FCM검측백세포계수(white blood cell，WBC)、홍세포계수(red blood cell，RBC)、혈색소(hemoglobin，Hgb)、홍세포압적(hematocrit，HCT)、평균RBC체적(mean corpuscular volume，MCV)、평균RBC혈홍단백(mean corpuscular hemoglobin，MCH)、평균혈홍단백농도(mean corpuscular hemoglobin concentration，MCHC)、RBC분포관도(red blood cell volume distribution width，RDW)、혈소판계수(platelets，PLT)、혈소판용적(plateletcrit，PCT)、혈소판분포관도(platelet distribution width，PDW)화혈소판평균체적(mean platelet volume，MPV)등，채용면역비탁법검측응혈매원시간(prothrombin time，PT)、응혈매원활동도(prothrombin activity，PTA)수평，병채용형광정량PCR법검측환자HIV병독재량(HIVRNA)。관찰HIV양성환자경고효항역전록병독치료혈액학지표변화특점。결과치료조여대조조재치료전혈액학지표차이무통계학의의(P＞0.05)。치료후치료조Hgb、MCV、MCH、MCHC、CD4화CD8+ T림파세포수(14.2 g/dl、90.5 fl、35.3 pg、336.1 g/L、395.4/μl、795.4/μl)현저고우대조조적(12.7 g/dl、87.5 fl、28.4 pg、322.6 g/L、300.7/μl、679.7/μl)(P＜0.05)， WBC화RBC수평(4.9×103/μl화4.0×106/μl)현저저우대조조(5.8×103/μl화4.7×106/μl)(P＜0.05)。결론고효항병독치료가강저HIV환자빈혈화혈소판강저발생솔，단역발생백세포、립세포화림파세포감소증。림상의생응근거환자혈액학지표변화고필약물조합、료정화금기。
Objective To investigate hematological parameters changes in human immunodeficiency virus (HIV) positive patients taking active antiretroviral treatment and explore its clinical significance.Methods One hundred HIV positive patients admitted to our hospital from November 2013 to December 2014 were enrolled in this study, and they were divided into two groups: highly active antiretroviral therapy (HAART) group (n=55) and HARRT na?ve group (n=45). The levels of peripheral blood CD3+, CD3+ CD4+ and CD3+CD8+ T-lymphocytes were detected by flow cytometry. WBC, RBC, Hgb, HCT, MCV, MCH, MCHC, RDW, PLT, and MPV were determinedby nucleic acid fluorescent dye method and flow cytometry. PT and PTA levels were detected by immunoturbidimetry. HIVRNA were determined by fluorescent quantitation PCR methods, and the characteristics of hematological parameters in HIV positive patients taking active antiretroviral treatment were observed.Results There was no statistically significant difference between observation group and control group in hematology indexes (P>0.05). Prevalence of anemia, leucopenia, thrombocytopenia, neutropenia and lymphopenia were 12.0%, 36.0%, 4.0%, 28.0% and 5.3% in patients taking HAART and 30.7%, 16.9%, 9.2%, 13.8% and 4.6% in HAART na?ve patients respectively. There were significant differences in total WBC, RBC, Hgb, MCV, MCH, MCHC, MPV and CD4 counts between patients taking HAART and HAART na?ve patients (P<0.05).ConclusionHAART can reduce the incidence of anemia and thrombocytopenia in patients with HIV, but it is prone to have leucopenia, neutropenia and lymphopenia. Clinicians need to take consideration about drug combination, course of treatment and treatment taboo in HIV positive patients according to changes of hematological indexes.