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目的分析不同体成分及其他因素与中国男性人类免疫缺陷病毒(HIV)或获得性免疫缺陷综合征(AIDS)患者接受高效抗逆转录病毒治疗(HAART)后免疫重建不全的相关性。方法回顾性分析2007年至2015年接受HAART1年以上并获得病毒抑制(HIV-1 RNA<400拷贝/ml)的男性HIV/AIDS患者资料,包括患者临床、免疫学及病毒学资料,其中包括HAART开始前1个月内测量的患者体质量、身高、全身体成分。经身高校正后得到体质量指数(BMI)、肌肉指数(LMI)、脂肪指数(FMI)、骨矿含量/身高。根据患者接受HAART 1年后是否出现免疫重建不全(CD4细胞计数<350细胞/μl),将患者分为免疫学未完全应答组(CD4细胞计数<350细胞/μl)、免疫学完全应答组(CD4细胞计数≥350细胞/μl)。应用t检验、卡方检验及Wilcoxon秩和检验比较两组患者的差异,应用多因素Logistics回归分析接受HAART 1年后免疫重建不全的影响因素。结果共纳入84例男性HIV/AIDS患者。两组患者的年龄(Z=-2.479,P=0.013)、基线BMI(t=2.030,P=0.045)、LMI(t=2.200,P=0.029)、CD4细胞计数(Z=6.416,P=0.000)差异有统计学意义。两组患者的基线病毒载量、FMI、骨矿含量/身高、HAART时间、HAART方案差异无统计学意义(P>0.05)。BMI(OR=0.742,95%CI=0.554-0.993,P=0.044)、LMI(OR=0.459,95%CI=0.249-0.844,P=0.012)、HAART时间(OR=10.161,95%CI=1.110-93.052,P=0.040)、基线CD4细胞计数(OR=80.051,95%CI=8.396-762.563,P=0.000)与免疫重建不全具有相关性。年龄(OR=1.497,95%CI=0.213-10.505,P=0.685)、病毒载量(OR=0.333,95%CI=0.071-1.572,P=0.164)、FMI(OR=0.797,95%CI=0.546-1.164,P=0.240)、全身骨矿含量/身高(OR=1.145,95%CI=0.037-35.676,P=0.938)及HAART方案(OR=0.430,95%CI=0.159-1.159,P=0.095)与免疫重建不全无相关性。结论基线CD4细胞计数及治疗时间可影响免疫重建,基线BMI或基线LMI较高是免疫重建不全的保护因素,基线FMI和全身骨矿物质含量/身高与免疫重建不全无关。
Objective To analyze the association of different body composition and other factors with immune reconstitution in Chinese men with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) after receiving effective antiretroviral therapy (HAART). METHODS: Retrospective analysis of data on male HIV / AIDS patients who had been harvested from HIVART for 1 year (HIV-1 RNA <400 copies / ml) from 2007 to 2015, including clinical, immunological and virological data of patients, including HAART Body mass, height, and body composition of the patient measured within 1 month before starting. The body mass index (BMI), muscle index (LMI), fat index (FMI), bone mineral content / height were corrected after height correction. Patients were divided into immunocompromised group (CD4 cell count <350 cells / μl), immunocomplementary group (immunocomplexed group) according to whether immunocompletion occurred 1 year after receiving HAART (CD4 count <350 cells / μl) CD4 cell count> 350 cells / [mu] l). The t-test, chi-square test and Wilcoxon rank-sum test were used to compare the differences between the two groups of patients. The influencing factors of immune reconstitution after one year of HAART were analyzed by multi-factor Logistic regression. Results A total of 84 male HIV / AIDS patients were enrolled. The patients in the two groups had significant differences in age (Z = -2.479, P = 0.013), baseline BMI (t = 2.030, P = 0.045), LMI )The difference was statistically significant. There was no significant difference in baseline viral load, FMI, bone mineral content / height, HAART time and HAART regimen between the two groups (P> 0.05). (OR = 0.742, 95% CI = 0.554-0.993, P = 0.044), LMI (OR = 0.459,95% CI = 0.249-0.844, P = 0.012) -93.052, P = 0.040). Baseline CD4 cell count (OR = 80.051, 95% CI = 8.396-762.563, P = 0.000) was associated with incomplete immune reconstitution. (OR = 0.49, 95% CI = 0.213-10.505, P = 0.685), viral load (OR = 0.333, 95% CI = 0.071-1.572, P = 0.164) (OR = 0.145, 95% CI = 0.037-35.676, P = 0.938) and HAART regimen (OR = 0.430, 95% CI = 0.159-1.159, P = 0.095) had no correlation with immune reconstitution. Conclusions Baseline CD4 cell count and duration of treatment may affect immune reconstitution. Baseline BMI or baseline LMI are protective factors of immune reconstitution. Baseline FMI and systemic bone mineral content / height are not associated with immune reconstitution.