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目的观察艾滋病患者高效抗逆转录病毒治疗(HAART)启动后发生免疫重建炎性综合(IRIS)的临床特征,并探讨IRIS发生影响因素。方法以2003年6月—2013年6月接受HAART治疗的艾滋病患者102例为研究对象,设立6个月随访期。分别与HAART启动时,启动后90 d和180 d检测患者HIV RNA病毒载量和CD4+细胞计数,根据观察期内是否出现IRIS将患者分为IRIS组(19例)和非IRIS组(83例)。收集2组一般资料,实验室和影像检查资料。结果 IRIS发病率18.6%(19/102),HAART启动后IRIS发生平均为33 d,感染类型以结核分枝杆菌感染为主(57.9%,11/19)。IRIS组和非IRIS组CD4+细胞计数基线比较差异有统计学意义(P<0.01);HAART启动后2组HIV RNA病毒载量呈下降趋势,CD4+细胞计数呈上升趋势。经分析,HAART启动时CD4+细胞计数(OR=6.45,95%CI∶4.59~15.6)和HAART启动后HIV RNA病毒载量变化(>2 log10拷贝/m L)(OR=3.12,95%CI∶1.45~6.24)与IRIS发生相关。结论 IRIS多发生于HAART启动后3个月内,HAART启动前基线CD4+细胞水平越低,HAART启动后HIV RNA病毒载量变化越大,则患者IRIS发生风险越大,应积极开展对症抗感染治疗。
Objective To observe the clinical features of immunosuppressive inflammatory syndrome (IRIS) after initiation of active antiretroviral therapy (HAART) in AIDS patients and to explore the influencing factors of IRIS. Methods A total of 102 HIV-infected patients who underwent HAART treatment from June 2003 to June 2013 were selected as the study subjects and established a 6-month follow-up period. Patients were divided into IRIS group (n = 19) and non-IRIS group (n = 83) according to whether IRIS was observed or not at the start of HAART and HIV-RNA viral load and CD4 + . Collect 2 sets of general information, laboratory and imaging information. Results The incidence of IRIS was 18.6% (19/102). The average IRIS incidence was 33 days after HAART was started, and the infection type was mainly Mycobacterium tuberculosis (57.9%, 11/19). There was significant difference in baseline CD4 + cell counts between IRIS group and non-IRIS group (P <0.01). After HAART started, the HIV RNA viral load in 2 groups decreased and CD4 + cell count increased. After analysis, the CD4 + cell count (OR = 6.45, 95% CI: 4.59 ~ 15.6) and HA RNA viral load change (> 2 log10 copies / m L) after HAART initiation (OR = 3.12, 95% CI: 1.45 ~ 6.24) and IRIS related. Conclusions IRIS mostly occurs within 3 months after the initiation of HAART. The lower the baseline CD4 + cell level before HAART is started, the greater the change of HIV RNA viral load after HAART is started, the greater the risk of IRIS in patients and should be actively treated with symptomatic and anti-infective therapy .