中华临床医师杂志(电子版) 2017年2月,11卷3期

临床论著

艾滋病免费抗病毒治疗长期疗效和血常规变化

张美1 张红2 李旺泉2 李群辉1 吴昊1 张宏伟1

100069 首都医科大学附属北京佑安医院感染中心1;342100 江西省,赣州市安远人民医院重症监护室2
张宏伟,Email: Hongwei9988@msn.com

摘要:  [1] Corbacho B, Duarte A, Keding A, et al. Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus: economic evaluation alongside the PROFHER trial[J]. Bone Joint J, 2016, 98-B(2): 152-159.   [2] 曾洁明, 张文佳, 黄住, 等. 老年患者肱骨近端骨折保守治疗与手术治疗的生存质量分析[J]. 国际医药卫生导报, 2012, 18(19): 2818-2821.   [3] 方礼明, 张亚军, 王博, 等. 手术与非手术治疗老年肱骨近端骨折的疗效分析[J]. 中华创伤骨科杂志, 2012, 14(1): 80-82.   [4] Hanson B, Neidenbach P, de Boer P, et al. Functional outcomes after nonoperative management of fractures of the proximal humerus[J]. J Shoulder Elbow Surg, 2009, 18(4): 612-621.   [5] McLaurin TM. Proximal humerus fractures in the elderly are we operating on too many?[J]. Bull Hosp Jt Dis, 2004, 62(1/2): 24-32.   [6] Sun Y, Li L, Dai J, et al. Treatment of complex proximal humeral fracture: plate and tension band fixation versus conservative therapy[J]. Int J Clin Exp Med, 2015, 8(5): 7143-7151.   [7] Oostenbrink JB, Koopmanschap MA, Rutten FF. Standardisation of costs: the Dutch Manual for Costing in economic evaluations[J]. Pharmacoeconomics, 2002, 20(7): 443-454.   [8] Lotters FJ, van den Bergh JP, de Vries F, et al. Current and future incidence and costs of osteoporosis-related fractures in the netherlands: combining claims data with bmd measurements[J]. Calcif Tissue Int, 2016, 98(3): 235-243.   [9] 张楠, 石学峰, 吴晶. 增量成本效果比在卫生技术评估中的应用[J]. 中国卫生政策研究, 2012, 5(2): 64-68.   [10] 刘昊楠, 贺良, 张贵林, 等. 老年股骨颈骨折患者总体费用和生活质量的关系[J]. 中华医学杂志, 2015, 95(33): 2686-2689.   [11] 刘昊楠, 贺良, 张贵林, 等. 空心钉内固定和人工股骨头置换术治疗股骨颈骨折的成本效果分析[J]. 中国矫形外科杂志, 2015, 23(14): 1268-1271.   [12] Fjalestad T, Hole MO, Jorgensen JJ, et al. Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients[J]. Injury, 2010, 41(6): 599-605.   [13] Polinder S, Iordens GI, Panneman MJ, et al. Trends in incidence and costs of injuries to the shoulder, arm and wrist in The Netherlands between 1986 and 2008[J]. BMC Public Health, 2013, 13: 531.   [14] Sanders RJ, Thissen LG, Teepen JC, et al. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment[J]. J Shoulder Elbow Surg, 2011, 20(7): 1118-1124.   [15] Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial[J]. J Shoulder Elbow Surg, 2011, 20(5): 747-755.   [16] Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient[J]. J Bone Joint Surg Br, 2001, 83(6): 799-804.

关键词:获得性免疫缺陷综合征; 血红蛋白类; 淋巴细胞计数; 抗病毒治疗

北京地区艾滋病扩大治疗策略的评价研究(D161100000416003)

Efficacy and blood profile changes of long-term antiretroviral treatment in HIV/AIDS patients

Zhang Mei1, Zhang Hong2, Li Wangquan2, Li Qunhui1, Wu Hao1, Zhang Hongwei1.

Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China; 2Intensive Care Unit, Anyuan People's Hospital, Ganzhou 342100, China
Zhang Hongwei, Email: hongwei9988@msn.com

Abstract:  Objective To investigate the efficacy and blood profile changes of long-term antiretroviral treatment (ART) in HIV/AIDS patients. Methods The study enrolled all HIV/AIDS patients taken ART in Beijing You'an Hospital from January 1, 2005 to December 31, 2010. Clinical and laboratory data were collected at baseline and every six months after treatment and were analyzed. These mainly included WHO staging, antiretroviral regimens, CD4 T lymphocytes, viral loads, blood routine test and liver function. The Wilcoxon signed-rank test was used to compare the differences between baseline and different treatment times. Spearman rank correlation analysis was used to analyze the correlation between the variables. Results The median follow-up time of the 543 patients was 36.0 months (quartile range: 25.0 to 50.0 months). Before antiretroviral therapy, the median of CD4 counts, leukocyte counts, total lymphocyte counts and hemoglobin were 161 cells/μl, 4.20×109/L, 1.33×109/L and 132 g/L, respectively. After 90 months of treatment, they were increased to 437 cells/μl, 5.75×109/L, 2.10×109/L and 147 g/L, respectively (all P<0.05). Total lymphocyte count and hemoglobin were positively correlated to CD4 T cells count. Conclusions Long-term antiretroviral therapy for HIV/AIDS has a good effect. Total lymphocyte count and hemoglobin can be used as monitoring indicators of efficacy of long-term ART in resource-poor areas.

Keywords:Acquired immunodeficiency syndrome; Hemoglobin; Lymphocyte count; Antiretroviral therapy

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参考文献

  目的 了解HIV/AIDS患者长期免费抗病毒治疗的效果和血常规变化。方法 选择北京佑安医院2005年1月1日至2010年12月31日所有纳入免费抗病毒治疗的患者,采集治疗前和治疗后每隔6个月的临床和实验室检查数据,其中主要包括WHO分期、抗病毒治疗方案,CD4 T淋巴细胞(CD4)检测、病毒载量检测、血常规和肝功能。以Wilcoxon符号秩检验比较研究对象治疗前和不同治疗时间的差异,以Spearman等级相关检验分析研究变量之间的相关性。结果 543例患者随访时间中位数为36.0个月(四分位距25.0~50.0个月)。接受抗病毒治疗前,患者的CD4 T细胞计数、白细胞计数、总淋巴细胞计数和血红蛋白中位数分别为161个/μl、4.20×109/L、1.33×109/L、132 g/L,治疗90个月后,分别增长到437个/μl、5.75×109/L、2.10×109/L和147 g/L(P均<0.05),且总淋巴细胞计数和血红蛋白与CD4 T细胞计数呈正相关。结论 长期抗病毒治疗对HIV/AIDS具有良好效果;总淋巴细胞计数和血红蛋白可以作为资源匮乏地区高效联合抗反转录病毒治疗长期治疗疗效的监测指标。
(编辑:马超 收稿日期:2016-10-31)