AIDS患者接受HAART治疗第一年期间口腔健康及全身免疫状况动态监测
发布时间：2019-06-28 18:16
【摘要】：目的：动态监测接受HAART治疗第一年AIDS患者口腔健康、外周血CD4+T淋巴细胞计数、Thl/Th2细胞亚群水平等的关系,探讨HAART治疗对AIDS患者口腔健康、局部与全身免疫的影响。 方法：本研究纳入2011年5月至2012年12月期间在广西壮族自治区疾病预防控制中心艾滋病门诊确诊为AIDS并接受HAART治疗成人患者30例作为实验组,详细病史采集、口腔专科检查并记录,同时收集外周静脉血采用流式细胞检测技术检测CD4+T淋巴细胞计数及Thl/Th2细胞亚群百分比。分别在AIDS患者HAART治疗后3个月、6个月、12个月复诊时复查并收集记录相关数据。按照年龄、性别配对原则纳入健康者23例作为对照组,比较健康人群与AIDS患者基线时各项数据之间的差异。 结果：本研究纳入的30例AIDS患者基线调查时,无任何口腔主诉14例,有主诉症状16例,包括口干7例,口腔溃疡3例、牙龈出血疼痛3例、口苦2例,口腔白膜、舌部辣感各1例,其中1例患者主诉口干和牙龈出血。17例AIDS患者出现口腔表征,包括口腔毛状白斑9例(男7例,女2例),口腔念珠菌病6例(伪膜型4例、红斑型2例),口腔溃疡3例,口腔白斑2例,口干症、单纯疱疹性口炎、灼口综合征各1例,两种口腔表征并存者6例。在HAART治疗期间,可见新发口腔念珠菌病、口腔溃疡、单纯疱疹病毒性口角炎,而未见新发口腔毛状白斑病损。口腔念珠菌病大多数能在HAART治疗初期(1-3月)消失；口腔毛状白斑则较缓慢,治疗初期均未见消失,主要表现为病损范围缩小和色泽变浅,到HAART12个月时,5例消失,4例仍存在。 AIDS患者组及健康对照组CD4+T淋巴细胞及CD4/CD8比值结果：AIDS患者组基线调查时、HAART治疗3个月、6个月、12个月CD4+T淋巴细胞计数分别为210.77±117.13个/mm3,311.30±149.40个／mm3,316.70±144.10个/mm3,373.83±159.21个/mm3,四组数据采用重复测量的方差分析,经Mauchly法检验(W=0.846,P=0.464),满足sphericity条件,结果不需要校正(F=32.194, P0.001), CD4+T淋巴细胞计数在基线调查时、HAART治疗3个月、6个月、12个月总体差异具有统计学意义,继续经LSD-t检验,两两比较得,基线时CD4+T细胞计数与HAART治疗3个月、6个月、12个月,HAART3个月与12个月,HAART6个月与12个月结果差异均有统计学意义,而HAART治疗3个月和6个月CD4+T淋巴细胞计数水平差异无统计学意义。CD4/CD8比值在基线调查时、HAART治疗3个月、6个月、12个月分别为0.28±0.19、0.38±0.20、0.43±0.22、0.50±0.27,四组数据采用重复测量的方差分析,经Mauchly法检验(W=0.282,P0.001),不满足sphericity条件,结果经Greenhouse-Geisser法校正(F=23.011, P0.001), CD4/CD8比值在基线调查时、HAART治疗3个月、6个月、12个月总体差异具有统计学意义,继续经LSD-t检验,两两比较得,CD4/CD8比值结果差异均有统计学意义,AIDS患者组基线时与健康对照组CD4+T淋巴细胞计数分别为210.77±117.13个/mm3,757.48±232.50个／mm3,采用两独立样本t检验方法,两组差异有统计学意义(t=10.318,P0.001),前者CD4+T淋巴细胞计数明显低于后者；而HAART治疗12个月时CD4+T淋巴细胞计数(373.83±159.21个/mm3)与健康对照组(757.48±232.50个／mm3)比较,采用两独立样本t检验方法,两组差异有统计学意义(t=7.126,P0.001),前者CD4+T淋巴细胞计数亦明显低于后者。 AIDS患者组及健康对照组Thl/Th2细胞亚群：AIDS患者组基线调查时、HAART治疗3个月、6个月、12个月Th1细胞亚群百分比水平分别为0.82±0.45%、1.12±0.41%、1.51±0.48%、2.41±0.40%,四组数据采用重复测量的方差分析,结果不需校正(F=79.523,P0.001),基线调查时、HAART治疗3个月、6个月、12个月总体差异具有统计学意义,继续经LSD-t检验,两两比较得,各组间Th1细胞亚群百分比水平差异均有统计学意义。基线调查时、HAART治疗3个月、6个月、12个月Th2细胞亚群百分比水平分别为4.29±0.79%、4.06±1.08%、3.08±0.64%、2.67±0.37%,四组数据采用重复测量的方差分析(W=0.591,P=0.012),不满足sphericity条件,结果经Greenhouse-Geisser法校正(F=29.065,P0.001),基线调查时、HAART治疗3个月、6个月、12个月Th2细胞亚群百分比水平总体差异具有统计学意义,继续经LSD-t检验,两两比较得,各组间Th2细胞亚群百分比水平差异均有统计学意义。AIDS患者组基线时与健康对照组Th1百分比水平分别为0.82±0.45%,4.68±0.54%,采用两独立样本t检验方法(t=28.173,P0.001),两组差异有统计学意义,前者Th1百分比水平明显低于后者；HAART治疗12个月时Th1百分比水平(2.41±0.40%)与健康对照组(4.68±0.54%)比较,采用两独立样本t检验方法(t=17.508,P0.001),两组差异有统计学意义,前者Th1百分比水平也明显低于后者。AIDS患者组基线时与健康对照组Th2百分比水平分别为4.29±0.79%,1.64±0.23%,采用两独立样本t检验方法(t=-17.494,P0.001),两组差异有统计学意义,前者Th2百分比水平明显高于后者；HAART治疗12个月时Th2百分比水平(2.67±0.37%)与健康对照组(1.64±0.23%)比较,采用两独立样本t检验方法(t=-12.427,P0.001),两组差异有统计学意义,前者Th2百分比水平也明显高于后者。 体重：AIDS患者基线时、HAART治疗3个月、6个月、12个月体重分别为53.93±8.81kg、55.38±8.66kg、55.48±9.25kg、55.85±9.89kg。为消除AIDS患者个体体重差异,计算HAART治疗3个月、6个月、12个月体重与基线体重变化率,30例AIDS患者四次随访过程中体重变化率分别为0.83(5.93)%,1.89(8.19)%,3.63±8.06%,结果提示AIDS患者HAART治疗期间体重有增长趋势,但三组体重变化率数据经非参数检验(Friedman Test, χ2=0.178, P=0.673),三组间差异无统计学意义。 经双变量相关性分析Spearman法,CD4+T淋巴细胞计数与HAART治疗时间呈正相关关系(r=0.357,P0.001)；CD4/CD8比值与HAART治疗时间呈正相关关系(r=0.337,P0.001)；Thl细胞亚群百分比与HAART治疗时间呈正相关关系(r=0.781,P0.001)；Th2细胞亚群百分比与HAART治疗时间呈的负相关关系(r=-0.712,,P0.001)；AIDS患者体重与HAART治疗时间相关性不明显(r=0.073,P=0.430)；口腔表征与CD4+T细胞计数成负相关关系(r=-0.383,P0.05)。 结论：本研究通过为期12个月的临床与实验室指标观察,经评价分析,初步得出以下结论： 1. AIDS患者常出现口腔表征,其中以口腔念珠菌病和口腔毛状白斑较多见。口腔念珠菌病、口腔溃疡、单纯疱疹病毒性口角炎等在治疗过程中可反复出现；大部分口腔念珠菌病在治疗初期消失或得到控制,其反应最为迅速,而口腔毛状白斑的反应则次之。 2. AIDS患者外周血CD4+T淋巴细胞计数,Thl细胞亚群百分比降低,Th2亚群百分比升高,HIV感染破坏了Thl/Th2平衡。AIDS患者在HAART治疗期间,CD4+T淋巴细胞计数上升,CD4/CD8比值升高,Thl/Th2失衡状态有一定程度缓解,提示机体达到一定程度的免疫重建。 3.口腔表征与CD4+T淋巴细胞计数呈负相关关系,有口腔表征AIDS患者CD4/CD8比值较低,提示患者在免疫功能相对高的情况下,罹患口腔表征的机会越低,口腔表征可以考虑作为艾滋病病情进展及HAART治疗效果的一个参考指标。
[Abstract]:Objective: To study the relationship of HAART to the oral health, peripheral blood CD4 + T lymphocyte count, Thl/ Th2 cell subpopulation level in AIDS patients during the first year of HAART treatment, and to explore the effect of HAART on the oral health, local and systemic immunity in AIDS patients. Methods: The study included 30 cases of AIDS in the AIDS clinic of Guangxi Zhuang Autonomous Region during the period from May 2011 to December 2012 and treated with HAART as experimental group. The CD4 + T lymphocyte count and the Thl/ Th2 cell subpopulation were detected by flow cytometry at the same time. Reexamination and collection of records in 3 months,6 months and 12 months after HAART treatment in AIDS patients, respectively Data.23 cases of healthy persons were included in the control group according to the age and gender matching principle, and the data between the healthy population and the data at baseline of the AIDS patient were compared Results: In 30 cases of AIDS patient's baseline survey included in this study, there were no oral complaints in 14 cases, and there were 16 cases of complaints, including 7 cases of dry mouth,3 cases of oral ulcer,3 cases of gingival bleeding pain,2 cases of oral pain, white membrane of oral cavity, and tongue. Of the 17 patients with AIDS, there were 9 cases (7 males and 2 females),6 cases of oral candidiasis (4 cases of pseudomembranous type,2 cases of erythema type),3 cases of oral ulcer and 2 oral leukoplakia. 1 case of xerostomia, herpetic stomatitis, and burning-mouth syndrome. Six patients co-exist. During the HAART treatment, new oral candidiasis, stomatitis, herpes simplex keratitis, and no new oral hair were seen. The majority of oral candidiasis can disappear in the early stage of HAART treatment (1-3 months); the leukoplakia in the oral cavity is slow, and the initial stage of the treatment is not seen, and the main performance is that the disease-loss range is reduced and the color is light, and at the end of the HAART 12 months,5 cases are disappeared. 4. The results of the ratio of CD4 + T lymphocytes and CD4/ CD8 in the AIDS patient group and the healthy control group were 210.77 and 117.13/ mm3, 311.30, 149.40/ mm3, 316.70, 144.10 pieces/ mm3, 373.83-159, respectively, when the baseline of the AIDS patient group and the healthy control group were measured. .21/ mm3, four groups of data were subjected to a repeated measurement of analysis of variance, tested by the Mauchly method (W = 0.846, P = 0.464), and the results did not require correction (F = 32.194, P0.001), while the CD4 + T lymphocyte count was 3 months,6 months,12 months overall, The difference of CD4 + T cell count and HAART in 3-month,6-month,12-month, HAART3-month and 12-month, HAART 6-month and 12-month results was statistically significant. Heterogeneity was statistically significant while HAART was treated for 3 months and 6 months of CD4 + T lymphocyte count levels The difference was not significant. In the baseline study, the ratio of CD4/ CD8 was 0.28, 0.19, 0.38, 0.20, 0.43, 0.22, 0.50 and 0.27, respectively. The four groups of data were tested with repeated measurements (W = 0.282, P.001), and the results were corrected by the Greenhouse-Geisser method (F = 23.011). (P 0.001), the ratio of CD4/ CD8 in the baseline study was statistically significant for the 3-month,6-month, and 12-month overall differences in HAART treatment, and the ratio of CD4/ CD8 was poor after two-step comparison with LSD-t test. The number of CD4 + T lymphocytes in the healthy control group was 210.77, 117.13/ mm3, 757.48 and 232.50/ mm3, respectively, and the difference between the two groups was statistically significant (t = 10.318, P0.001), the former was CD4 + T lymphocytes. The counts of CD4 + T lymphocytes (373.83-159.21/ mm3) and healthy control group (757.48-232.50/ mm3) were compared with healthy control group (757.48-232.50/ mm3). The number of Th1/ Th2 cell subsets in AIDS patients and healthy control group was 0.82%, 0.45%, 1.12% 0.41%, 1.51% 0.48%, 2.41% and 0.40%, respectively. The results of the analysis of variance of repeated measurements did not need to be corrected (F = 79.523, P.001). When the baseline was investigated, HAART was treated for 3 months,6 months and 12 months. The overall difference in the 12-month period was of statistical significance and continued to be tested by LSD-t. The percentage of Th1 cell subpopulations in each group was compared. The levels of Th2 cell subpopulations were 4.29%, 0.79%, 4.06%, 1.08%, 3.08%, 0.64%, 2.67% and 0.37%, respectively. Correction (F = 29.065, P0.001), when baseline survey, HAART treatment for 3 months,6 months,12-month Th2 cell subpopulation percentage level overall difference has statistical significance, continue to be tested by LSD-t, two comparisons, the percentage of Th2 cell subpopulations in each group The level difference was statistically significant. The percentage of Th1 in the healthy control group was 0.82%, 0.45%, 4.68% and 0.54%, respectively, and the difference between the two groups was statistically significant (t = 28.173, P 0.001). The percentage of the two groups was significantly lower than that of the latter; the level of Th1 (2.41% 0.40%) and the healthy control group (4.68% 0.54%) were compared with the healthy control group (4.68% 0.54%), and the difference of the two groups was statistically significant (t = 17.508, P0.001). The percentage of Th2 in the patients with AIDS was 4.29%, 0.79%, 1.64 and 0.23%, respectively. The two independent samples t were used to test (t =-17.494, P 0.001). The percentage of the two groups was significantly higher than that of the latter; the level of Th2 (2.67% 0.37%) and the healthy control group (1.64-0.23%) were compared with the healthy control group (1.64-0.23%). The subspecific level was also significantly higher than that of the latter. Body weight: HAART was treated for 3 months,6 months,12 months at a baseline of 53.93, 8.81 kg, 55.38 to 8.66 kg, 55.48 to 9.25 k, respectively, at the baseline of the AIDS patient. (g) 55.85-9.89 kg. In order to eliminate the individual body weight difference in AIDS patients, the body weight and the change rate of the baseline body weight were calculated for the 3-month,6-month,12-month body weight and the baseline body weight. The change of body weight was 0.83 (5.93)%, 1.89 (8.19)% and 3.63-8.06% in the follow-up of 30 patients with AIDS. There was an increase in body weight during ART treatment, but the three groups of body weight change rate data were not tested (Friedman Test, Sup2 = 0.178, P = 0.67). 3) There was no statistical significance between the three groups. The positive correlation between CD4 + T lymphocyte count and HAART treatment time (r = 0.357, P 0.001) and the positive correlation between CD4/ CD8 ratio and HAART treatment time (r = 0.337, P0.001) and the positive correlation between the percentage of CD4/ CD8 and HAART (r = 0.337, P0.001). The relationship between the percentage of Th2 cells and the time of HAART treatment (r =-0.712, P 0.001), the correlation between the weight of the patients with AIDS and the time of HAART treatment (r = 0.073, P = 0.430), and the negative correlation between the oral characterization and CD4 + T cell counts. Department (r =-0.383, P0.05). Conclusion: This study is based on a 12-month clinical and experimental study. The results are as follows:1. The patients with AIDS often appear in the mouth. The cavity is characterized by more common oral candidiasis and oral hair leukoplakia, and the oral candidiasis, oral ulcer, herpes simplex virus stomatitis and the like can be repeated repeatedly in the treatment process, most of the oral candidiasis disappears or is controlled in the early stage of treatment, 2. The CD4 + T lymphocyte counts in peripheral blood of AIDS patients and the percentage of Thl cell subsets decreased, Th The percentage of subpopulations increased and the HIV infection destroyed the Thl/ Th2 balance. The CD4 + T lymphocyte count increased, the CD4/ CD8 ratio increased, and the Thl/ Th2 loss during the HAART treatment. 3. There was a negative correlation between the oral characterization and the CD4 + T lymphocyte count, and the ratio of CD4/ CD8 in the patients with AIDS was lower. It is suggested that the lower the chance of oral characterization in the case of relatively high immune function, the oral characterization may
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91;R781
本文编号：2507508
[Abstract]:Objective: To study the relationship of HAART to the oral health, peripheral blood CD4 + T lymphocyte count, Thl/ Th2 cell subpopulation level in AIDS patients during the first year of HAART treatment, and to explore the effect of HAART on the oral health, local and systemic immunity in AIDS patients. Methods: The study included 30 cases of AIDS in the AIDS clinic of Guangxi Zhuang Autonomous Region during the period from May 2011 to December 2012 and treated with HAART as experimental group. The CD4 + T lymphocyte count and the Thl/ Th2 cell subpopulation were detected by flow cytometry at the same time. Reexamination and collection of records in 3 months,6 months and 12 months after HAART treatment in AIDS patients, respectively Data.23 cases of healthy persons were included in the control group according to the age and gender matching principle, and the data between the healthy population and the data at baseline of the AIDS patient were compared Results: In 30 cases of AIDS patient's baseline survey included in this study, there were no oral complaints in 14 cases, and there were 16 cases of complaints, including 7 cases of dry mouth,3 cases of oral ulcer,3 cases of gingival bleeding pain,2 cases of oral pain, white membrane of oral cavity, and tongue. Of the 17 patients with AIDS, there were 9 cases (7 males and 2 females),6 cases of oral candidiasis (4 cases of pseudomembranous type,2 cases of erythema type),3 cases of oral ulcer and 2 oral leukoplakia. 1 case of xerostomia, herpetic stomatitis, and burning-mouth syndrome. Six patients co-exist. During the HAART treatment, new oral candidiasis, stomatitis, herpes simplex keratitis, and no new oral hair were seen. The majority of oral candidiasis can disappear in the early stage of HAART treatment (1-3 months); the leukoplakia in the oral cavity is slow, and the initial stage of the treatment is not seen, and the main performance is that the disease-loss range is reduced and the color is light, and at the end of the HAART 12 months,5 cases are disappeared. 4. The results of the ratio of CD4 + T lymphocytes and CD4/ CD8 in the AIDS patient group and the healthy control group were 210.77 and 117.13/ mm3, 311.30, 149.40/ mm3, 316.70, 144.10 pieces/ mm3, 373.83-159, respectively, when the baseline of the AIDS patient group and the healthy control group were measured. .21/ mm3, four groups of data were subjected to a repeated measurement of analysis of variance, tested by the Mauchly method (W = 0.846, P = 0.464), and the results did not require correction (F = 32.194, P0.001), while the CD4 + T lymphocyte count was 3 months,6 months,12 months overall, The difference of CD4 + T cell count and HAART in 3-month,6-month,12-month, HAART3-month and 12-month, HAART 6-month and 12-month results was statistically significant. Heterogeneity was statistically significant while HAART was treated for 3 months and 6 months of CD4 + T lymphocyte count levels The difference was not significant. In the baseline study, the ratio of CD4/ CD8 was 0.28, 0.19, 0.38, 0.20, 0.43, 0.22, 0.50 and 0.27, respectively. The four groups of data were tested with repeated measurements (W = 0.282, P.001), and the results were corrected by the Greenhouse-Geisser method (F = 23.011). (P 0.001), the ratio of CD4/ CD8 in the baseline study was statistically significant for the 3-month,6-month, and 12-month overall differences in HAART treatment, and the ratio of CD4/ CD8 was poor after two-step comparison with LSD-t test. The number of CD4 + T lymphocytes in the healthy control group was 210.77, 117.13/ mm3, 757.48 and 232.50/ mm3, respectively, and the difference between the two groups was statistically significant (t = 10.318, P0.001), the former was CD4 + T lymphocytes. The counts of CD4 + T lymphocytes (373.83-159.21/ mm3) and healthy control group (757.48-232.50/ mm3) were compared with healthy control group (757.48-232.50/ mm3). The number of Th1/ Th2 cell subsets in AIDS patients and healthy control group was 0.82%, 0.45%, 1.12% 0.41%, 1.51% 0.48%, 2.41% and 0.40%, respectively. The results of the analysis of variance of repeated measurements did not need to be corrected (F = 79.523, P.001). When the baseline was investigated, HAART was treated for 3 months,6 months and 12 months. The overall difference in the 12-month period was of statistical significance and continued to be tested by LSD-t. The percentage of Th1 cell subpopulations in each group was compared. The levels of Th2 cell subpopulations were 4.29%, 0.79%, 4.06%, 1.08%, 3.08%, 0.64%, 2.67% and 0.37%, respectively. Correction (F = 29.065, P0.001), when baseline survey, HAART treatment for 3 months,6 months,12-month Th2 cell subpopulation percentage level overall difference has statistical significance, continue to be tested by LSD-t, two comparisons, the percentage of Th2 cell subpopulations in each group The level difference was statistically significant. The percentage of Th1 in the healthy control group was 0.82%, 0.45%, 4.68% and 0.54%, respectively, and the difference between the two groups was statistically significant (t = 28.173, P 0.001). The percentage of the two groups was significantly lower than that of the latter; the level of Th1 (2.41% 0.40%) and the healthy control group (4.68% 0.54%) were compared with the healthy control group (4.68% 0.54%), and the difference of the two groups was statistically significant (t = 17.508, P0.001). The percentage of Th2 in the patients with AIDS was 4.29%, 0.79%, 1.64 and 0.23%, respectively. The two independent samples t were used to test (t =-17.494, P 0.001). The percentage of the two groups was significantly higher than that of the latter; the level of Th2 (2.67% 0.37%) and the healthy control group (1.64-0.23%) were compared with the healthy control group (1.64-0.23%). The subspecific level was also significantly higher than that of the latter. Body weight: HAART was treated for 3 months,6 months,12 months at a baseline of 53.93, 8.81 kg, 55.38 to 8.66 kg, 55.48 to 9.25 k, respectively, at the baseline of the AIDS patient. (g) 55.85-9.89 kg. In order to eliminate the individual body weight difference in AIDS patients, the body weight and the change rate of the baseline body weight were calculated for the 3-month,6-month,12-month body weight and the baseline body weight. The change of body weight was 0.83 (5.93)%, 1.89 (8.19)% and 3.63-8.06% in the follow-up of 30 patients with AIDS. There was an increase in body weight during ART treatment, but the three groups of body weight change rate data were not tested (Friedman Test, Sup2 = 0.178, P = 0.67). 3) There was no statistical significance between the three groups. The positive correlation between CD4 + T lymphocyte count and HAART treatment time (r = 0.357, P 0.001) and the positive correlation between CD4/ CD8 ratio and HAART treatment time (r = 0.337, P0.001) and the positive correlation between the percentage of CD4/ CD8 and HAART (r = 0.337, P0.001). The relationship between the percentage of Th2 cells and the time of HAART treatment (r =-0.712, P 0.001), the correlation between the weight of the patients with AIDS and the time of HAART treatment (r = 0.073, P = 0.430), and the negative correlation between the oral characterization and CD4 + T cell counts. Department (r =-0.383, P0.05). Conclusion: This study is based on a 12-month clinical and experimental study. The results are as follows:1. The patients with AIDS often appear in the mouth. The cavity is characterized by more common oral candidiasis and oral hair leukoplakia, and the oral candidiasis, oral ulcer, herpes simplex virus stomatitis and the like can be repeated repeatedly in the treatment process, most of the oral candidiasis disappears or is controlled in the early stage of treatment, 2. The CD4 + T lymphocyte counts in peripheral blood of AIDS patients and the percentage of Thl cell subsets decreased, Th The percentage of subpopulations increased and the HIV infection destroyed the Thl/ Th2 balance. The CD4 + T lymphocyte count increased, the CD4/ CD8 ratio increased, and the Thl/ Th2 loss during the HAART treatment. 3. There was a negative correlation between the oral characterization and the CD4 + T lymphocyte count, and the ratio of CD4/ CD8 in the patients with AIDS was lower. It is suggested that the lower the chance of oral characterization in the case of relatively high immune function, the oral characterization may
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91;R781
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