【摘要】：目的：動態(tài)監(jiān)測接受HAART治療第一年AIDS患者口腔健康、外周血CD4+T淋巴細胞計數(shù)、Thl/Th2細胞亞群水平等的關系,探討HAART治療對AIDS患者口腔健康、局部與全身免疫的影響。 方法：本研究納入2011年5月至2012年12月期間在廣西壯族自治區(qū)疾病預防控制中心艾滋病門診確診為AIDS并接受HAART治療成人患者30例作為實驗組,詳細病史采集、口腔�？茩z查并記錄,同時收集外周靜脈血采用流式細胞檢測技術檢測CD4+T淋巴細胞計數(shù)及Thl/Th2細胞亞群百分比。分別在AIDS患者HAART治療后3個月、6個月、12個月復診時復查并收集記錄相關數(shù)據(jù)。按照年齡、性別配對原則納入健康者23例作為對照組,比較健康人群與AIDS患者基線時各項數(shù)據(jù)之間的差異。 結果：本研究納入的30例AIDS患者基線調(diào)查時,無任何口腔主訴14例,有主訴癥狀16例,包括口干7例,口腔潰瘍3例、牙齦出血疼痛3例、口苦2例,口腔白膜、舌部辣感各1例,其中1例患者主訴口干和牙齦出血。17例AIDS患者出現(xiàn)口腔表征,包括口腔毛狀白斑9例(男7例,女2例),口腔念珠菌病6例(偽膜型4例、紅斑型2例),口腔潰瘍3例,口腔白斑2例,口干癥、單純皰疹性口炎、灼口綜合征各1例,兩種口腔表征并存者6例。在HAART治療期間,可見新發(fā)口腔念珠菌病、口腔潰瘍、單純皰疹病毒性口角炎,而未見新發(fā)口腔毛狀白斑病損�？谇荒钪榫〈蠖鄶�(shù)能在HAART治療初期(1-3月)消失；口腔毛狀白斑則較緩慢,治療初期均未見消失,主要表現(xiàn)為病損范圍縮小和色澤變淺,到HAART12個月時,5例消失,4例仍存在。 AIDS患者組及健康對照組CD4+T淋巴細胞及CD4/CD8比值結果：AIDS患者組基線調(diào)查時、HAART治療3個月、6個月、12個月CD4+T淋巴細胞計數(shù)分別為210.77±117.13個/mm3,311.30±149.40個／mm3,316.70±144.10個/mm3,373.83±159.21個/mm3,四組數(shù)據(jù)采用重復測量的方差分析,經(jīng)Mauchly法檢驗(W=0.846,P=0.464),滿足sphericity條件,結果不需要校正(F=32.194, P0.001), CD4+T淋巴細胞計數(shù)在基線調(diào)查時、HAART治療3個月、6個月、12個月總體差異具有統(tǒng)計學意義,繼續(xù)經(jīng)LSD-t檢驗,兩兩比較得,基線時CD4+T細胞計數(shù)與HAART治療3個月、6個月、12個月,HAART3個月與12個月,HAART6個月與12個月結果差異均有統(tǒng)計學意義,而HAART治療3個月和6個月CD4+T淋巴細胞計數(shù)水平差異無統(tǒng)計學意義。CD4/CD8比值在基線調(diào)查時、HAART治療3個月、6個月、12個月分別為0.28±0.19、0.38±0.20、0.43±0.22、0.50±0.27,四組數(shù)據(jù)采用重復測量的方差分析,經(jīng)Mauchly法檢驗(W=0.282,P0.001),不滿足sphericity條件,結果經(jīng)Greenhouse-Geisser法校正(F=23.011, P0.001), CD4/CD8比值在基線調(diào)查時、HAART治療3個月、6個月、12個月總體差異具有統(tǒng)計學意義,繼續(xù)經(jīng)LSD-t檢驗,兩兩比較得,CD4/CD8比值結果差異均有統(tǒng)計學意義,AIDS患者組基線時與健康對照組CD4+T淋巴細胞計數(shù)分別為210.77±117.13個/mm3,757.48±232.50個／mm3,采用兩獨立樣本t檢驗方法,兩組差異有統(tǒng)計學意義(t=10.318,P0.001),前者CD4+T淋巴細胞計數(shù)明顯低于后者；而HAART治療12個月時CD4+T淋巴細胞計數(shù)(373.83±159.21個/mm3)與健康對照組(757.48±232.50個／mm3)比較,采用兩獨立樣本t檢驗方法,兩組差異有統(tǒng)計學意義(t=7.126,P0.001),前者CD4+T淋巴細胞計數(shù)亦明顯低于后者。 AIDS患者組及健康對照組Thl/Th2細胞亞群：AIDS患者組基線調(diào)查時、HAART治療3個月、6個月、12個月Th1細胞亞群百分比水平分別為0.82±0.45%、1.12±0.41%、1.51±0.48%、2.41±0.40%,四組數(shù)據(jù)采用重復測量的方差分析,結果不需校正(F=79.523,P0.001),基線調(diào)查時、HAART治療3個月、6個月、12個月總體差異具有統(tǒng)計學意義,繼續(xù)經(jīng)LSD-t檢驗,兩兩比較得,各組間Th1細胞亞群百分比水平差異均有統(tǒng)計學意義�；�調(diào)查時、HAART治療3個月、6個月、12個月Th2細胞亞群百分比水平分別為4.29±0.79%、4.06±1.08%、3.08±0.64%、2.67±0.37%,四組數(shù)據(jù)采用重復測量的方差分析(W=0.591,P=0.012),不滿足sphericity條件,結果經(jīng)Greenhouse-Geisser法校正(F=29.065,P0.001),基線調(diào)查時、HAART治療3個月、6個月、12個月Th2細胞亞群百分比水平總體差異具有統(tǒng)計學意義,繼續(xù)經(jīng)LSD-t檢驗,兩兩比較得,各組間Th2細胞亞群百分比水平差異均有統(tǒng)計學意義。AIDS患者組基線時與健康對照組Th1百分比水平分別為0.82±0.45%,4.68±0.54%,采用兩獨立樣本t檢驗方法(t=28.173,P0.001),兩組差異有統(tǒng)計學意義,前者Th1百分比水平明顯低于后者；HAART治療12個月時Th1百分比水平(2.41±0.40%)與健康對照組(4.68±0.54%)比較,采用兩獨立樣本t檢驗方法(t=17.508,P0.001),兩組差異有統(tǒng)計學意義,前者Th1百分比水平也明顯低于后者。AIDS患者組基線時與健康對照組Th2百分比水平分別為4.29±0.79%,1.64±0.23%,采用兩獨立樣本t檢驗方法(t=-17.494,P0.001),兩組差異有統(tǒng)計學意義,前者Th2百分比水平明顯高于后者；HAART治療12個月時Th2百分比水平(2.67±0.37%)與健康對照組(1.64±0.23%)比較,采用兩獨立樣本t檢驗方法(t=-12.427,P0.001),兩組差異有統(tǒng)計學意義,前者Th2百分比水平也明顯高于后者。 體重：AIDS患者基線時、HAART治療3個月、6個月、12個月體重分別為53.93±8.81kg、55.38±8.66kg、55.48±9.25kg、55.85±9.89kg。為消除AIDS患者個體體重差異,計算HAART治療3個月、6個月、12個月體重與基線體重變化率,30例AIDS患者四次隨訪過程中體重變化率分別為0.83(5.93)%,1.89(8.19)%,3.63±8.06%,結果提示AIDS患者HAART治療期間體重有增長趨勢,但三組體重變化率數(shù)據(jù)經(jīng)非參數(shù)檢驗(Friedman Test, χ2=0.178, P=0.673),三組間差異無統(tǒng)計學意義。 經(jīng)雙變量相關性分析Spearman法,CD4+T淋巴細胞計數(shù)與HAART治療時間呈正相關關系(r=0.357,P0.001)；CD4/CD8比值與HAART治療時間呈正相關關系(r=0.337,P0.001)；Thl細胞亞群百分比與HAART治療時間呈正相關關系(r=0.781,P0.001)；Th2細胞亞群百分比與HAART治療時間呈的負相關關系(r=-0.712,,P0.001)；AIDS患者體重與HAART治療時間相關性不明顯(r=0.073,P=0.430)；口腔表征與CD4+T細胞計數(shù)成負相關關系(r=-0.383,P0.05)。 結論：本研究通過為期12個月的臨床與實驗室指標觀察,經(jīng)評價分析,初步得出以下結論： 1. AIDS患者常出現(xiàn)口腔表征,其中以口腔念珠菌病和口腔毛狀白斑較多見�？谇荒钪榫�、口腔潰瘍、單純皰疹病毒性口角炎等在治療過程中可反復出現(xiàn)；大部分口腔念珠菌病在治療初期消失或得到控制,其反應最為迅速,而口腔毛狀白斑的反應則次之。 2. AIDS患者外周血CD4+T淋巴細胞計數(shù),Thl細胞亞群百分比降低,Th2亞群百分比升高,HIV感染破壞了Thl/Th2平衡。AIDS患者在HAART治療期間,CD4+T淋巴細胞計數(shù)上升,CD4/CD8比值升高,Thl/Th2失衡狀態(tài)有一定程度緩解,提示機體達到一定程度的免疫重建。 3.口腔表征與CD4+T淋巴細胞計數(shù)呈負相關關系,有口腔表征AIDS患者CD4/CD8比值較低,提示患者在免疫功能相對高的情況下,罹患口腔表征的機會越低,口腔表征可以考慮作為艾滋病病情進展及HAART治療效果的一個參考指標。
[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
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R512.91;R781

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3 馮磊;饒和平;李丹;Armim Bader;吳南屏;;HIV感染者Th1/Th2細胞因子變化及機會性感染的臨床意義[A];傳染病診治高峰論壇暨2007年浙江省感染病學、肝病學學術年會論文匯編[C];2007年

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