文章摘要
杨涤,赵红心,郜桂菊,魏凯,张俐,韩宁,肖江,李鑫,王芳,梁洪远,张伟,吴亮.HIV/AIDS手术切口愈合与CD4+T淋巴细胞计数的关系[J].中华流行病学杂志,2014,35(12):1333-1336
HIV/AIDS手术切口愈合与CD4+T淋巴细胞计数的关系
Relationship between CD4+ T lymphocyte cell count and the prognosis (including the healing of the incision wound) of HIV/AIDS patients who had undergone surgical operation
投稿时间:2014-06-05  
DOI:10.3760/cma.j.issn.0254-6450.2014.12.005
中文关键词: HIV感染者/AIDS患者;手术
英文关键词: HIV/AIDS;Surgery
基金项目:美国NIH项目(1R01MH092225-01); 北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合防治示范区建设研究(2012ZX10004-904)
作者单位E-mail
杨涤 首都医科大学附属北京地坛医院感染中心, 北京 100015  
赵红心 首都医科大学附属北京地坛医院感染中心, 北京 100015 13911022130@163.com 
郜桂菊 首都医科大学附属北京地坛医院感染中心, 北京 100015 guiju.gao@163.com 
魏凯 首都医科大学附属北京地坛医院感染中心, 北京 100015  
张俐 首都医科大学附属北京地坛医院感染中心, 北京 100015  
韩宁 首都医科大学附属北京地坛医院感染中心, 北京 100015  
肖江 首都医科大学附属北京地坛医院感染中心, 北京 100015  
李鑫 首都医科大学附属北京地坛医院感染中心, 北京 100015  
王芳 首都医科大学附属北京地坛医院感染中心, 北京 100015  
梁洪远 首都医科大学附属北京地坛医院感染中心, 北京 100015  
张伟 首都医科大学附属北京地坛医院感染中心, 北京 100015  
吴亮 首都医科大学附属北京地坛医院感染中心, 北京 100015  
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中文摘要:
      目的 探讨HIV/AIDS手术预后及切口愈合与CD4+T淋巴细胞计数的关系.方法 以北京地坛医院2008年1月至2012年12月手术治疗的234例HIV/AIDS住院患者为研究对象,采用回顾性分析的方法,对患者的年龄、性别、发现抗HIV(+)时间、手术时CD4+T淋巴细胞计数、是否为急诊手术、手术部位、切口分类、术后切口愈合级别、切口感染情况、术后并发症及预后进行分析.统计学采用Wilcoxon 秩和检验、χ2检验、Kruskal-Wallis H检验和Spearman相关分析,比较不同的切口愈合级别的患者CD4+T淋巴细胞计数水平的差异、不同CD4+T淋巴细胞计数水平的甲级愈合率和HIV/AIDS相关因素与手术切口愈合率的关系.结果 (1)共有234例患者,男性125例,女性109例,性别比为1.15:1,平均年龄(36.17±11.56)岁.发现抗HIV(+)时间为0~204个月.CD4+T淋巴细胞计数M为388.5 cell/μl.其中23.93%患者CD4+T 淋巴细胞计数<200 cell/μl.(2)急诊手术占7.26%.发病部位涉及23个器官,48种疾病.Ⅰ类切口占21.37%,Ⅱ类切口49.57%,Ⅲ类切口29.06%.86.32%切口为甲级愈合,11.97%为乙级愈合,1.71%为丙级愈合.4.27%患者出现术后并发症.术后出现并发症与未出现并发症患者的CD4+T淋巴细胞计数差异统计学意义(P>0.05),两组患者感染HIV的时间差异统计学意义(P>0.05).甲级愈合与乙、丙级愈合的CD4+T淋巴细胞计数水平差异统计学意义(P>0.05).不同CD4+T淋巴细胞计数水平的甲级愈合率差异统计学意义(P>0.05).手术切口愈合情况与CD4+T淋巴细胞计数水平、抗病毒治疗时间长短、HIV感染时间明显相关性(P>0.05).结论 严格把握手术适应症和禁忌症,对需要手术的HIV/AIDS进行手术治疗,总体预后良好.低CD4+T淋巴细胞计数并不是手术的绝对禁忌.切口愈合情况与CD4+T淋巴细胞计数、抗病毒治疗时间长短及HIV感染时间明显相关性.
英文摘要:
      Objective To explore the relationship between CD4+T lymphocyte cell count and prognosis as well as healing of the surgical incision in HIV/AIDS patients who had received operation. Methods Data were collected and analysed retrospectively from 234 HIV/AIDS patients hospitalized at the Beijing Ditan hospital who underwent operation between January 2008 and December 2012. Following factors were taken into consideration that including:age,gender,time and where that anti-HIV(+) was diagnosed,CD4+T lymphocyte cell count at the time of operation,part of the body that being operated,typology of incision,different levels of healing on the surgical incision,infection at the incision site,post-operative complications and the prognosis,etc. Wilcoxon rank sum test,χ2 test,Kruskal-Wallis H test and Spearman rank correlation were used for statistical analysis to compare the different levels on healing of the incision in relation to the different CD4+T lymphocyte cell counts. Rates of level A healing under different CD4+T cell counts were also compared. Results 1)Among the 234 patients including 125 males and 109 females,the average age was 36.17±11.56 years old. Time after discovery of anti-HIV(+) was between 0 and 204 months. The medium CD4+T cell count was 388.5 cell/μl; 23.93% of the patients having CD4+T lymphocyte cell counts as <200 cell/μl. 2)7.26% of the operations were emergent. There were 23 different organs affected at the time of operation,due to 48 different kinds of illness. 21.37% of the operations belonged to class Ⅰ incision,49.57% was class Ⅱ incision and 29.06% was class Ⅲ incision. 86.32% of the incisions resulted in level A healing,12.51% resulted in level B and 1.71% in level C. 4.27% of the patients developed post-operative complications. Differences between level A healing and level B or C healing in terms of CD4+T lymphocyte cell count were not significant (P>0.05). There was no statistically significant difference on the CD4+T lymphocyte count in patients with or without postoperative complications. Difference of the HIV infection time was also not statistically significant between the two groups of patients. Rate of level A healing for the different CD4+T lymphocyte cell count was not significant (P>0.05). Healing of the incision did not show significant correlation with CD4+T lymphocyte cell count,duration of antiretroviral therapy or the time that HIV infection was discovered (P>0.05). Conclusion As long as both the in/exclusion criteria were strictly followed,prognosis for operation on HIV/AIDS seemed to be generally good. Low CD4+T lymphocyte cell count should not be taken as a exclusion criteria for operation on HIV/AIDS patients.
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