AIDS合并结核感染患者抗逆转录病毒治疗后发生免疫重建炎性综合征高危因素分析

摘要

Objective To investigate the risk factors of immune reconstitution inflammation syndrome (IRIS) in acquired immune deficiency syndrome patients with tuberculosis infection after highly active anti-retroviral therapy(HAART). Methods Eighty patients with both AIDS and tuberculosis were assigned to two different therapy groups, two weeks group and 8 weeks group. The two weeks group was composed of 38 patients who simultaneously accepted HAART after two weeks of tuberculosis therapy. The eight weeks group was composed of 42 patients who simultaneously accepted HAART after eight weeks of tuberculosis therapy. The clinical symptoms and CD4" T cell count of all the patients during first three months of HAART were described. And the risk factors of IRIS were analyzed. Results The CD4+ T cell count of most of patients was increased after three months of HAART ( P < 0.01 ). The rates of IRIS in patients with CD4+ T cell count <50/μL was significantly higher than that in patients with CD4+ T cell count ≥50/μL(X2 = 5. 107, P = 0. 024). The rates of IRIS in the two weeks group was higher than that in the eight weeks group, but not significantly different(X2 = 0. 436, P = 0. 509). Low baseline CD4+ T cell count was a risk factor of IRIS( OR =3.348,95% CI : 1. 276 - 8. 784, P = 0.014). Conclusions HAART can reconstruct patients'immunization. The time of tuberculosis therapy before initiation of HAART might not correlate to the development of IRIS, but control of tuberculosis might be the risk of development of IRIS during treatment in AIDS patients with tuberculosis. And low baseline CD4" T cell count might increase the risk of development of IRIS. So in order to detect IRIS earlier,attention should be paid to patients with low baseline CD4+ T cell count.%目的 探讨艾滋病合并结核感染患者(acquired immune deficiency syndrome patients with tuberculosis infection,AIDS/TB)在高效抗逆转录病毒治疗(highly active anti-retroviral therapy,HAART)中出现免疫重建炎性综合征(immune reconstitution inflammation syndrome,IRIS)的可能影响因素.方法 将80例AIDS/TB患者分成两个治疗组(一组38例为2周组即在抗结核治疗2周后同时HAART,另一组42例为8周组即在抗结核治疗8周后同时HAART),对其在抗病毒治疗的前3个月内的临床症状及CD4+T细胞计数进行描述,分析其发生IRIS的危险因素.结果 绝大多数患者在接受HAART后3个月CD4+T细胞计数显著上升(P＜0.01).基线CD4+T细胞计数＜50/μL的病例发生IRIS的几率较基线CD4+T细胞计数≥50/μL的病例明显增高(x2=5.107,P=0.024).IRIS在2周组中的发病率较8周组高,但差异无统计学意义(x2=0.436,P=0.509).低基线CD4+T细胞计数是HAART后发生IRIS的危险因素(OR= 3.348,95%CI为1.276～8.784,P=0.014).结论 HAART可使患者的免疫重建,AIDS/TB患者在治疗过程中发生IRIS可能与开始HAART之前的抗结核治疗时间无关,而与HAART前结核病的控制程度有关.低基线CD4+T细胞计数可能使IRIS的危险性增加,因此对于CD4+T细胞计数低下的患者,应加强观察,以期及早发现IRIS.