CAJ | 학술논문

目的：探讨 HIV／HBV 合并感染的流行病学及临床特征。方法选择广州市第八人民医院2009年9月至2011年8月确诊为 HIV 感染并接受 HAART 的患者为研究对象，筛出 HIV／HBV合并感染者和 HIV 单纯感染者，收集两组患者抗病毒治疗前的资料，比较两组患者 ALT、AST、CD4＋ T淋巴细胞计数和 HIV RNA 水平。HIV／HBV 合并感染患者根据 HBeAg 状态、HBV DNA 水平和CD4＋ T 淋巴细胞分组，比较组间差异。统计学分析采用卡方检验和秩和检验。结果1218例患者中HBsAg 阳性165例（13．5％），筛选出 HIV／HBV 合并感染者121例，HIV 单纯感染者510例。HIV 单纯感染者 ALT 和 AST 水平分别为29和34 U／L，均较 HIV／HBV 合并感染者高（22和25 U／L，Z 值分别为－4．270和－5．780，均 P ＝0．000）。HIV／HBV 合并感染者的 CD4＋ T 淋巴细胞计数较 HIV 单纯感染者明显减少，差异有统计学意义（Z ＝－2．980，P ＝0．003）。HBeAg 阳性的 HIV／HBV 合并感染者CD4＋ T 淋巴细胞计数较 HBeAg 阴性者低（Z ＝－2．660，P ＝0．008）。HBV DNA≥5 lg 拷贝／mL 患者的 CD4＋ T 淋巴细胞计数明显低于 HBV DNA＜5 lg 拷贝／mL 患者（Z ＝－2．311，P ＝0．021）。54例CD4＋ T 淋巴细胞＜50／μL 的患者，HBV DNA 阳性比例为81．5％、HBV DNA≥5 lg 拷贝／mL 的比例为66．7％、ALT、AST 异常比例为44．4％和53．7％，均高于 CD4＋ T 淋巴细胞≥50／μL 的患者，差异均有统计学意义（χ2值分别为6．159、6．618、7．144和9．586，均 P ＜0．05）。结论本研究中 HIV／HBV合并感染率较高，合并感染者 CD4＋ T 淋巴细胞计数较低，尤其 HBeAg 阳性和高 HBV DNA 的患者。CD4＋ T 淋巴细胞与 HBV DNA 复制水平有关。
목적：탐토 HIV／HBV 합병감염적류행병학급림상특정。방법선택엄주시제팔인민의원2009년9월지2011년8월학진위 HIV 감염병접수 HAART 적환자위연구대상，사출 HIV／HBV합병감염자화 HIV 단순감염자，수집량조환자항병독치료전적자료，비교량조환자 ALT、AST、CD4＋ T림파세포계수화 HIV RNA 수평。HIV／HBV 합병감염환자근거 HBeAg 상태、HBV DNA 수평화CD4＋ T 림파세포분조，비교조간차이。통계학분석채용잡방검험화질화검험。결과1218례환자중HBsAg 양성165례（13．5％），사선출 HIV／HBV 합병감염자121례，HIV 단순감염자510례。HIV 단순감염자 ALT 화 AST 수평분별위29화34 U／L，균교 HIV／HBV 합병감염자고（22화25 U／L，Z 치분별위－4．270화－5．780，균 P ＝0．000）。HIV／HBV 합병감염자적 CD4＋ T 림파세포계수교 HIV 단순감염자명현감소，차이유통계학의의（Z ＝－2．980，P ＝0．003）。HBeAg 양성적 HIV／HBV 합병감염자CD4＋ T 림파세포계수교 HBeAg 음성자저（Z ＝－2．660，P ＝0．008）。HBV DNA≥5 lg 고패／mL 환자적 CD4＋ T 림파세포계수명현저우 HBV DNA＜5 lg 고패／mL 환자（Z ＝－2．311，P ＝0．021）。54례CD4＋ T 림파세포＜50／μL 적환자，HBV DNA 양성비례위81．5％、HBV DNA≥5 lg 고패／mL 적비례위66．7％、ALT、AST 이상비례위44．4％화53．7％，균고우 CD4＋ T 림파세포≥50／μL 적환자，차이균유통계학의의（χ2치분별위6．159、6．618、7．144화9．586，균 P ＜0．05）。결론본연구중 HIV／HBV합병감염솔교고，합병감염자 CD4＋ T 림파세포계수교저，우기 HBeAg 양성화고 HBV DNA 적환자。CD4＋ T 림파세포여 HBV DNA 복제수평유관。
Objective To investigate the epidemiologic and clinical features of human immunodeficiency virus (HIV)/hepatitis B virus (HBV)co-infected patients.Methods Patients who confirmed with HIV infection and received highly active anti-retroviral therapy (HAART)at Guangzhou Eighth People′s Hospital were enrolled.HIV/HBV co-infected patients and HIV mono-infected patients were screened and their epidemiological and clinical features were analyzed before HAART.Comparison of the levels of alanine transaminase (ALT),aspartate transaminase (AST),CD4 + T lymphocyte and HIV RNA between the two groups were conducted.The data were statistically analyzed by chi-square test and nonparametric test.Results One hundred and sixty-five out of 1 218 (13.5 %)patients were hepatitis B surface antigen positive.The median ALT and AST levels of HIV mono-infected patients were 29 U/L and 34 U/L respectively,which were both higher than HIV/HBV co-infected patients (22 U/L and 25 U/L, respectively)(Z = - 4.270 and Z = - 5 .780,respectively,both P = 0.000 ).The median CD4 + T lymphocyte count of HIV/HBV co-infected patients was significantly lower than that of HIV mono-infected patients (Z = -2.980,P =0.003 ).The CD4 + T lymphocyte count was lower in hepatitis B e antigen (HBeAg)positive patients than HBeAg negative patients (Z =-2.660,P =0.008).The median CD4 + T lymphocyte count in patients with HBV DNA≥5 lg copy/mL was significantly lower than those with HBV DNA<5 lg copy/mL (Z = -2.311 ,P =0.021 ).The proportions of positive HBV DNA, HBV DNA≥5 lg copy/mL,abnormal ALT and AST in 54 patiens with CD4 + T lymphocyte counts <50/μL were 81 .5 %,66.7%,44.4% and 53.7%,respectively.All were significantly higher than patients with CD4 + T lymphocyte count≥50/μL(χ2 =6.159,P =0.046 ;χ2 =6.618,P =0.037 ;χ2 =7.144,P =0.028 andχ2 =9.586,P =0.008,respectively).Conclusions The prevalence of HBV/HIV co-infection is high in this study.The CD4 + T lymphocyte counts in HIV/HBV co-infected patients are lower,especially in patients with HBeAg positive and high HBV DNA level.The CD4 + T lymphocyte counts are associated with HBV DNA replication levels.