目的:分析艾滋病患者抗病毒治疗后的临床疗效,比较不同基线CD4+T淋巴细胞计数增长情况。方法:纳入51例符合治疗标准的初治患者,采用国家标准抗病毒治疗一线方案和卫生部统一提供的免费药物,通过对服药后半月、1月、3月、6月、12月的时段进行临床评估和实验室检查,并比较不同基线CD4+T淋巴细胞计数水平治疗后的增长情况。结果:治疗12月后,各方案组疗效无差异,不同基线CD4+T淋巴细胞计数的增长有显著差异。毒副反应为肝损伤、过敏性皮疹,消化道反应为主。结论:HAART可显著的抑制体内HIV病毒的复制,重建机体的免疫功能,缓解患者病情,有利于存活期的延长。严重的毒副作用发生较少。
Objective To evaluate the effect of a health education for preventing HIV/AIDS in floating population. Methods A computerized literature search was carried out in PubMed, CBM (Chinese Biomedical Database), CNKI (Chinese National Knowledge Infrastructure), Wanfang (Chinese) and VIP (Chinese) databases to collect articles published between 1996 and 2006 concerning the effect of a HIV/AIDS education intervention in floating population. We also checked the reference lists of relevant articles. The study type was self-control intervention study. Meta-analyses were performed to assess 3 outcomes of the intervention, i.e. knowledge about HIV transmission, means of prevention and attitudes towards HIV/AIDS patients. Fixed and random effect models were employed to combine results after a heterogeneity test, with rate difference (RD) used as the indicator of intervention effect. Results The analysis showed that the RD for knowing the sexual transmission route of HIV, the RD for knowing the effect of condoms for HIV prevention, and the RD for changing attitudes towards HIV/AIDS patients, i.e. treating them as ordinary people, were increased by 16% (0.10, 0.22), 22% (0.17, 0.28) and 19% (0.13, 0.25), respectively. Conclusion Health education for preventing HIV/AIDS is effective in changing knowledge and attitudes in floating population.
【摘要】 目的 探讨艾滋病患者合并机会性感染的临床特征并评价其治疗效果。 方法 回顾分析2003年-2009年53例确诊为艾滋病患者的临床资料，对患者合并机会性感染的临床特征，包括发生机会性感染的时间、发生机会性感染时CD4+T细胞计数、起病急缓、严重程度等，进行观察和分析，并给予国家推荐的标准治疗方案进行治疗，通过临床症状、病毒载量、CD4+T细胞计数、影像学监测进行疗效分析，随访时间为初治至出院后6年。 结果 53例艾滋病患者均为重症感染，41例为混合感染，其中2个以上部位感染者为36例（67.9%），2种以上病原体感染者为28例（52.8%），3种以上病原体感染者13例（24.5%）。最常见的机会性感染为结核35.8%（19/53）；其次为卡氏肺孢子菌肺炎30.2%（16/53）；败血症20.8%（11/53），此外，尚有隐球菌感染15.1%（8/53）、弓形虫感染3.8%（2/53）、带状疱疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨细胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。机会性感染治疗有效率为77.4%（41/53），病死率为22.6%（12/53），其中隐球菌脑膜炎或混合感染者病死率最高。 结论 艾滋病患者在CD4+T细胞计数lt;350/mm3时各种机会感染明显升高，且随着CD4+T细胞计数的下降呈增高趋势，艾滋病合并机会性感染最常见的是结核，其次卡氏肺孢子菌肺炎；合并结核的治疗效果较好，合并隐球菌脑病的病死率最高。早期启动高效抗逆转录病毒治疗效果好。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) combined with opportunistic infections and its treatment. Methods We retrospectively analyzed the clinical data of 53 patients diagnosed to have AIDS in our hospital between 2003 and 2009. The clinical features (such as time of the onset of opportunistic infections, CD4+ T cells value at the onset, severity of the infection, etc.) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67.9%) had infections in two or more parts of the body, 28 (52.8%) were infected by two or more pathogens, and 13 (24.5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35.8%,19/53) followed by pneumocystis carinii pneumonia (30.2%,16/53) and septicemia (20.8%,11/53). Other infections included cryptococcal infection (15.1%, 8/53), toxoplasma gondii infection (3.8%, 2/53), herpes zoster virus infection (7.5%, 4/53), candidiasis (17.0%, 9/53), cytomegalovirus infection (7.5%, 4/53), combined hepatitis B (11.3%, 6/53), and hepatitis C (3.8%, 2/53). Effective treatment rate for opportunistic infections was 77.4% (41/53) with a mortality of 22.6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.
目的 了解艾滋病高发区医务人员血源防护情况以及培训所取得的效果。 方法 采用自行设计的问卷，对凉山州某医院参加培训的职工进行培训前后调查。 结果 培训前89人参加调查，培训后93人参加调查；女性、护士和初级职称者占绝大多数；培训前调查参加者中84.3%接受过预防锐器伤培训，79.8%工作中被锐器刺伤，38.2%报告过职业暴露，95.5%接种过乙肝疫苗；6道知识考核题培训后答对率比培训前均有不同程度的提高，其中4道比较具有统计学上的意义（P＜0.05）。 结论 该院医务人员已具备一定职业防护意识，对一些知识点掌握较好，但培训强化可提高职业暴露报告依从性和预防治疗及时性，更好维护艾滋病高发区医务人员的职业健康。
目的 系统评价单独应用齐多夫定（zidovudine，ZDV）阻断HIV母婴传播的有效性和安全性。方法 采用Cochrane系统评价方法，计算机检索Cochrane图书馆（2007第1期）、PubMed、EMbase、CINAHL、AIDSearch、AIDSLINE、AIDSTRIALS、AIDSDRUGS、AIDSinfo、CRD（center of review and dissemination）、CBMdisc，VIP和CNKI等数据库，以及全球或地区性AIDS相关的会议论文集、政府或非政府组织的相关文件等，检索日期截至2007年4月30日，全面收集全球抗艾滋病病毒药物预防HIV母婴传播的随机对照试验。由两名评价员独立筛查文献、评价质量和提取资料，然后交叉核对，若遇分歧则征求第三方意见讨论解决。使用RevMan软件进行Meta分析。结果 共纳入8个RCT，包括24篇全文和13篇摘要，其方法学质量的Jadad评分≥3分。Meta分析显示：① ZDV与安慰剂比较共纳入4个RCTs（2385例），无论长短疗程、母乳或非母乳喂养人群，ZDV预防HIV母婴传播的效果均优于安慰剂组，降低HIV母婴传播风险43%～50%，且两组死产率、婴儿死亡率、母亲死亡率、早产、低体重儿、出生缺陷、母婴不良反应发生率和母亲产前、产时和产后并发症发生率差异均无统计学意义（Pgt;0.05）。② 1个大样本RCT（1437例）比较了ZDV不同疗程的效果，结果显示ZDV“长–长疗程”（从孕28周开始到产后6周）比“短–短疗程”（从孕35周开始到分娩后3天）降低HIV母婴传播风险61%［RR=0.39，95%CI（0.19，0.82）］。长–长疗程与长–短疗程（从孕28周开始到产后3天）及短-长疗程（从孕35周开始到产后6周）比较，其预防HIV母婴传播的效果差异均无统计学意义（P gt;0.05）。各组死产、新生儿死亡、1年内婴儿死亡、母亲死亡、早产、低体重儿、出生缺陷、母婴不良反应发生率相似（Pgt;0.05）。③ 1个大样本RCT（1 200例）显示：人工喂养+短程ZDV预防HIV母婴传播的效果优于母乳喂养+长程ZDV，可降低婴儿HIV感染风险的35%～39%，但提高了婴儿7个月时的死亡率（9.3% vs 4.9%；P=0.003）；两组婴儿早产率、低体重儿出生率、出生缺陷率、不良反应发生率相似（Pgt;0.05）。④ 2个直接比较短程或超短程ZDV与单剂量奈韦拉平（Nevirapine，NVP）预防HIV母婴传播效果的RCT（702例）显示，NVP可降低HIV母婴传播风险的44%～48%，两组死产、6月内婴儿死亡、母亲死亡、低体重儿、母婴不良反应发生率相似（Pgt;0.05）。结论 无论长短疗程、母乳或非母乳喂养人群，ZDV预防HIV母婴传播的效果均优于安慰剂，且其妊娠结局和不良反应发生情况相似。ZDV“长–长疗程”比“短–短疗程”预防HIV母婴传播效果更好，但长–长疗程与长–短疗程、短–长疗程预防HIV母婴传播的效果相似；各组安全性相似。人工喂养+短程ZDV预防HIV母婴传播的效果优于母乳喂养+长程ZDV，但提高了婴儿7个月时的死亡率。单剂量NVP预防HIV母婴传播效果优于短程和超短程ZDV，且安全性相似。