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Objective:To investigate the occurrence of carotid artery abnormalities in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients and the related risk factors affecting the occurrence of carotid artery abnormalities.Methods:A total of 169 regular follow-up outpatients with HIV/AIDS from April 2003 to December 2019 in Peking Union Medical College Hospital, whose carotid artery ultrasound examination were performed from July 2015 to December 2019 were included. The patients were divided into young (≤44 years old), middle-aged and elderly (≥45 years old) according to their ages, and the physical examination data of the included patients were collected.The statistical methods were logistic regression analysis and single sample t test. Results:Among the 169 HIV/AIDS patients, 40(23.7%) had abnormal carotid artery and 129(76.3%) had no abnormal carotid artery. Middle-aged and elderly people (odds ratio ( OR)=3.85, 95%confidence interval (95% CI) 1.54-9.65, P<0.01), hypertension ( OR=6.24, 95% CI 1.95-20.00, P<0.01), hyperlipidemia ( OR=2.44, 95% CI 1.00-5.93, P<0.05), and elevated human leucocyte antigen (HLA)-DR + CD8 + /CD8 + ( OR=1.03, 95% CI 1.01-1.06, P<0.05) were the risk factors for carotid artery abnormality. The common carotid artery inner medium film thickness (IMT) of patients in HIV/AIDS group Ⅰ (20 to 30 years old), group Ⅱ (31 to 40 years old), group Ⅲ (41 to 50 years old) were (0.061 0±0.001 2), (0.062 9±0.001 4) and (0.065 6±0.002 6) cm, respectively, which were thicker than the control groups ((0.051±0.003), (0.056±0.004) and (0.063±0.002) cm, respectively). The differences were all statistically significant ( t=5.119, 4.775 and 1.739, respectively, all P<0.05). The common carotid artery IMT of patients in HIV/AIDS group A (30 to 44 years old) and group B (45 to 59 years old) were (0.062 6±0.001 1) and (0.072 3±0.003 4) cm, respectively, which were thicker than the control groups ((0.052±0.011) and (0.064±0.015) cm, respectively), the differences were both statistically significant ( t=9.520 and 3.012, respectively, both P<0.01). Conclusion:Younger HIV-positive people have a higher probability of abnormal carotid arteries and may be at greater risk of cardiovascular disease than HIV-negative people of the same age, suggesting that HIV-positive people, especially young people, should be examined early with ultrasound of the neck arteries to detect abnormalities and intervene as soon as possible.
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Objective:To investigate the characteristics and prognostic value of peripheral blood T lymphocyte subsets in patients with severe influenza.Methods:This was a single-center cross-sectional study in influenza patients admitted to Peking Union Medical College Hospital from August 2017 to April 2018. Peripheral blood lymphocyte subsets were detected by flow cytometry in both patients and 108 healthy controls. Influenza patients were divided into mild group and severe group. Severe patients were further classified into alive and fatal subgroups.Results:A total of 42 influenza patients were recruited in this study, including 24 severe cases (6 deaths). The remaining 18 cases were mild. The peripheral blood lymphocyte counts and lymphocyte subset counts (B, NK, CD4 +T, CD8 +T) in either mild patients[795 (571,1 007), 43 (23,144), 70 (47,135), 330 (256,457), 226 (148,366) cells/μl respectively] or severe patients[661 (474,1 151),92 (52,139), 54 (34,134), 373 (235,555), 180 (105,310) cells/μl respectively] were both significantly lower than those of healthy controls [1 963 (1 603,2 394),179 (119,239), 356 (231,496), 663 (531,824), 481 (341,693) cells/μl respectively]. Meanwhile, the T cells and CD8 +T counts in fatal patients [370 (260,537) cells/μl and 87 (74,105) cells/μl] were significantly lower than those in severe and alive patients [722 (390,990) cells/μl and 222 (154,404) cells/μl]. CD8 +HLA-DR/CD8 +and CD8 +CD38 +/CD8 +T cell activating subgroups in mild cases[(53.7±19.2)% and 74.8% (64.1%,83.7%) respectively] were significantly higher than those in severe cases[(38.5±21.7)% and 53.3% (45.3%,67.2%) respectively].Moreover,CD8 +HLA-DR/CD8 +count in severe and alive group was higher than that in fatal group [(46.1±19.1)% vs. (18.2±14.6)%, P<0.01]. Logistic regression analysis showed that CD8 +T cell count ( OR=0.952, 95 %CI 0.910-0.997, P=0.035) and CD8 +HLA-DR/CD8 +T ( OR=0.916, 95 %CI 0.850-0.987, P=0.022) were both negatively correlated with mortality.Peripheral blood lymphocyte counts in mild cases rapidly decreased within 1 day after diagnosis, and returned to the basic level one week later. Conclusions:All peripheral blood lymphocyte subsets (T,B,NK) in patients with influenza are significantly reduced. These findings are consistent with the immunological characteristics of respiratory viral infections, in which peripheral lymphocytes (especially T cells) migrate to respiratory tract in the early stage and circulate to the peripheral blood after recovery. The activated CD8 +T cell counts in peripheral blood are negatively correlated with the severity of disease, which could be considered as a prognostic indicator of severe influenza.
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Objective@#To investigate the characteristics and prognostic value of peripheral blood T lymphocyte subsets in patients with severe influenza.@*Methods@#This was a single-center cross-sectional study in influenza patients admitted to Peking Union Medical College Hospital from August 2017 to April 2018. Peripheral blood lymphocyte subsets were detected by flow cytometry in both patients and 108 healthy controls. Influenza patients were divided into mild group and severe group. Severe patients were further classified into alive and fatal subgroups.@*Results@#A total of 42 influenza patients were recruited in this study, including 24 severe cases (6 deaths). The remaining 18 cases were mild. The peripheral blood lymphocyte counts and lymphocyte subset counts (B, NK, CD4+T, CD8+T) in either mild patients[795 (571,1 007), 43 (23,144), 70 (47,135), 330 (256,457), 226 (148,366) cells/μl respectively] or severe patients[661 (474,1 151),92 (52,139), 54 (34,134), 373 (235,555), 180 (105,310) cells/μl respectively] were both significantly lower than those of healthy controls [1 963 (1 603,2 394),179 (119,239), 356 (231,496), 663 (531,824), 481 (341,693) cells/μl respectively]. Meanwhile, the T cells and CD8+T counts in fatal patients [370 (260,537) cells/μl and 87 (74,105) cells/μl] were significantly lower than those in severe and alive patients [722 (390,990) cells/μl and 222 (154,404) cells/μl]. CD8+HLA-DR/CD8+and CD8+CD38+/CD8+T cell activating subgroups in mild cases[(53.7±19.2)% and 74.8% (64.1%,83.7%) respectively] were significantly higher than those in severe cases[(38.5±21.7)% and 53.3% (45.3%,67.2%) respectively].Moreover,CD8+HLA-DR/CD8+count in severe and alive group was higher than that in fatal group [(46.1±19.1)% vs. (18.2±14.6)%, P<0.01]. Logistic regression analysis showed that CD8+T cell count (OR=0.952, 95%CI 0.910-0.997, P=0.035) and CD8+HLA-DR/CD8+T (OR=0.916, 95%CI 0.850-0.987, P=0.022) were both negatively correlated with mortality.Peripheral blood lymphocyte counts in mild cases rapidly decreased within 1 day after diagnosis, and returned to the basic level one week later.@*Conclusions@#All peripheral blood lymphocyte subsets (T,B,NK) in patients with influenza are significantly reduced. These findings are consistent with the immunological characteristics of respiratory viral infections, in which peripheral lymphocytes (especially T cells) migrate to respiratory tract in the early stage and circulate to the peripheral blood after recovery. The activated CD8+T cell counts in peripheral blood are negatively correlated with the severity of disease, which could be considered as a prognostic indicator of severe influenza.
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The distribution of peripheral blood lymphocyte subsets were compared between patients with colorectal cancer and healthy controls.The number of natural killer(NK) cells and CD8+T cells and the percentage of naive CD4+T cells were all decreased significantly in patients.On the contrary,the percentages of memory CD4+T cells,HLA-DR+ CD8+ T cells and CD38+ CD8+ T cells were significantly increased.It suggests that the tumor killing effect of cytotoxic lymphocytes in peripheral blood is impaired in patients with colorectal cancer,whereas the immune response is over stimulated.
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Objective To investigate the clinical features and T lymphocytes subsets in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) infection.Methods A total of 48 hospitalized patients with human immunodeficiency virus (HIV)-1/AIDS and CMV infections were recruited at Peking Union Medical College Hospital from Jan 2010 to Aug 2017.Their clinical features and immune function were retrospectively analyzed.Patients with only HIV/AIDS in previous study were recruited as controls,Results All 48 patients were at C3 stage,including 36 men and 12 women.Five of them were younger than 30 years old,33 cases within 31-50 years old,and 10 cases older than 50 years old.Thirty-five patients had CD4+T lymphocytes ≤ 50 cells/μl,7 cases with CD4+T cells 51-100/μl,3 cases with 101-200 cells/μl,and 3 cases over 200 cells/μl.As to CMV infections,there were 31 cases of CMV viremia,1 case of CMV encephalitis,1 case of CMV enteritis,5 cases of CMV pneumonia,and 9 cases of CMV retinitis.Other opportunistic infections were also common including 16 cases of pneumocystis pneumonia,9 cases of tuberculosis,5 cases of syphilis,18 cases of digestive tract fungal infections,8 cases of pulmonary fungal infections,2 cases of EB virus infections,2 cases of HIV encephalopathy/progressive multifocal leukoencephalopathy (PML),3 cases of cryptococcal meningitis,1 case of toxoplasma infection.In group of both CMV and HIV/AIDS infections,100％ patients had inverted CD4+/CD8+ ratio.The immune activation marker CD8+CD38+/CD8+ was higher (61.6％-98.8％) with a median value of 91.2％ in 40 patients.HLA-DR+ CD8+/CD8+,another marker for T cell activation,was 25.5％-98.0％ in 44 patients with a median value of 60.3％.Thirty-six patients had both immune activation markers positive.There was no significant difference in counts of B cells,natural killer cells,CD4+ T cells,CD8+ T cells and immune activation subsets stratified by gender and age (P＞0.05).Meanwhile,neither serum HIV viral load nor serum CMV viral load was correlated with HLA-DR+CD8+/CD8+,CD8+CD38+/CD8+,CD4+T cell counts,and CD4+/CD8+ ratio in the CMV and HIV/AIDS co-infection group(all P＞0.05),while HIV viral load in HIV/AIDS only group was significantly correlated with HLA-DR+CD8+T/CD8+,CD38+CD8+/CD8+,CD4+ T cell counts,CD4+/CD8+ ratio (r=0.473,0.575,-0.767 and-0.678,respectively,all P＜0.05).Conclusions CMV infections develop in HIV patients with advanced stage.CMV infection can cause life-threatening multiple organ lesions,especially in those with CD4+ T cells less than 100 cells/μl.It is of great importance to screen CMV-IgM,pp65 antigen,CMV DNA to make early diagnosis and treatment.
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Objective The effect of different doses of ethylnitrosourea(ENU)and cyclophosphamide(CP)on the loss rate of CD59 on peripheral blood erythrocytes was explored to optimize the detection method of Pig-a gene mutation. Methods According to the weight and loss rate of CD59 on peripheral blood erythrocytes,rats were divided into 4 groups:the control group,CP 40 mg/kg group,ENU 10 mg/kg group and ENU 40 mg/kg group(n=6). The control group was injected i.p. with PBS,other groups were injected i.p. with corresponding solutions. The body weight of rats on days 0,7,14,21, 28, 42 and 56 were recorded. At the same time, blood samples were collected and incubated with antibodies,and the loss rate of RBCCD59-was detected by flow cytometry. Results Compared with the control group, at different time points, the body weight and weight gain of ENU 10 mg/kg group and ENU 40 mg/kg group had no statistically significant difference(P > 0.05),while those in the CP 40 mg/kg group were significantly decreased(P <0.05). The loss rate of RBCCD59-was significantly increased in the CP 40 mg/kg group at 28,42 and 56 days, ENU 10 mg/kg group at 42 and 56 days,and ENU 40 mg/kg group at 7,14,21,28,42 and 56 days,(P < 0.05). The results showed a dose-response relationship. Conclusions Under the conditions of this Pig-a mutation detection method,ENU is superior to CP on raising loss rate of RBCCD59-,ENU 40 mg/kg is better than 10 mg/kg,and 28 days is suitable as the test period.
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Objective To investigate the common opportunistic infections and the characteristics of peripheral lymphocyte subsets in patients with systemic lupus erythematosus (SLE). Methods From December 2013 to December 2016, peripheral lymphocyte subsets were consecutively detected by flow cytometry in treated SLE patients with or without opportunistic infections(OIs).The lymphocyte subsets in healthy donors were used as normal control group. Results A total of 145 treated SLE patients were enrolled including 108 with OIs and 37 without OIs.The common OIs were cytomegalovirus(CMV)diseases (66/108), Pneumocystis jirovecii pneumonia (PJP, 16/108), other fungal infections (16/108), Epstein-Barr virus (EBV, 15/108) and tuberculosis (14/108). Compared with treated SLE without OIs, total lymphocyte, CD4+T,and CD8+T lymphocyte counts were significantly reduced in SLE with OIs[1 260(780,1 810)cells/μl vs. 565(399,1 043)cells/μl,P<0.001; 485(280,811)cells/μl vs. 173(95,327)cells/μl,P<0.001; 464 (339,764)cells/μl vs.265(158,424)cells/μl,P=0.003,respectively].Conclusions The common OIs in treated SLE patients were CMV diseases,PJP,other fungi,EBV and tuberculosis.OIs are prone to develop in SLE patients with severe lymphocytopenia,especially CD4+T cell depletion.
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Objective To understand the changes of cardiac systolic and diastolic function in human immunodeficiency virus (HIV)-infected patients without evidence of cardiac disease in China.Methods Forty-two HIV-infected patients who were followed up in the Department of Infectious Diseases at Peking Union Medical College Hospital without cardiac involvement were recruited.All the HIV-infected patients had received highly active antiroviral therapy (HAART) for more than 12 months with viral suppression.And 30 age and sex matched healthy subjects without cardiac disease manifestations were enrolled as controls.Every group members underwent transthoracic echocardiography evaluation.The indexes of cardiac systolic and diastolic function between HIV-infected patients and healthy controls were compared.Results Diastolic abnormality occurred in 20 cases in HIV-infected group and 6 cases in control group, with statistically significant difference (χ2=5.79, P=0.007).The E wave deceleration time (EDT) in HIV-infected patients were significantly decreased than healthy controls ([161.87±21.64] ms vs.[190.34±37.22], t=-3.20, P=0.002).There were no significant differences of E/A ratio ([1.16±0.35] vs.[1.19±0.26]), E/Ea ratio ([5.43±1.99] vs.[5.78±0.91]), isovolumic relaxation time (IVRT), ([93.18±20.34] ms vs.[93.57±18.55]ms), Ea ([10.18±2.80] cm/s vs.[11.45±2.75] cm/s) between HIV-infected patients and controls (t=1.13,1.53,0.67 and 0.29, respectively, all P>0.05).Among cardiac systolic function markers, left ventricular ejection fractions in HIV-infected patients and control group were (66.7±6.4)% and (68.7±4.2)%, respectively.And left ventricular shortening rates were (37.08±4.79)% and (38.17±3.96)%, respectively.Both showed no significant difference between the two groups (t=-1.51 and-1.00, respectively, both P>0.05).Conclusions Compared with control group, subclinical cardiac diastolic dysfunction is more frequently observed in HIV-infected patients.However, there are no significant differences of cardiac systolic function markers between HIV-infected patients and controls.
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Objective To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital.Methods The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0.Results A total of 715 421 patients were screened,and 1 012 (0.14％) patients were HIV positive,and HIV infection were confirmed in 776 (0.11％) patients by Western Blot testing.The detection rate of HIV infection increased from 0.05％ in 2003 to 0.17％ in 2014 (trend x2=66.83,P=0.000),and the increase during 2012-2014 was obvious.Of the 776 newly diagnosed HIV-infected individuals,631 (81.31％) were men and 145 (18.69％) were women.The percentage of the males infected with HIV increased from 50.00％ to 90.26％ (trend x2=58.41,P=0.000).The median age was 36 years (interquartile range:27-43),and the age group 18-50 years were mostly affected.In the 776 patients infected with HIV,634 (81.70％) were infected through sexual contacts,and the proportion of sexual transmissions increased with year (trend x2=126.38,P=0.000).The proportion of infected men who have sex with men (MSM) increased from 0％ in 2003 to 53.90％ in 2014 (trend X2=11.96,P=0.001),similar to the trend in western countries.The proportion of infected patients who were not married increased from 18.75％ to 42.21％ (trend x2=43.74,P=0.000).The top three source departments of HIV/AIDS cases were internal medicine (51.03％),emergency room (18.30％) and dermatology (13.53％).The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75％ in 2003 to 2.60％ in 2014.No HIV/AIDS patients were detected in department of surgery,department of otorhinolaryngology,department of ophthalmology,department of stomatology and health examination center in 2003,but 14 cases (9.10％),11 cases (7.14％) and 4 cases (2.60％) were detected in these departments respectively in 2014.Conclusion The HIV detection rate increased with year in Peking Union Medical College Hospital,suggesting the necessity of strengthened HIV test in general hospitals.MSM are the population at high risk,to whom more attention should be paid.
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Objective To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital.Methods The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0.Results A total of 715 421 patients were screened,and 1 012 (0.14％) patients were HIV positive,and HIV infection were confirmed in 776 (0.11％) patients by Western Blot testing.The detection rate of HIV infection increased from 0.05％ in 2003 to 0.17％ in 2014 (trend x2=66.83,P=0.000),and the increase during 2012-2014 was obvious.Of the 776 newly diagnosed HIV-infected individuals,631 (81.31％) were men and 145 (18.69％) were women.The percentage of the males infected with HIV increased from 50.00％ to 90.26％ (trend x2=58.41,P=0.000).The median age was 36 years (interquartile range:27-43),and the age group 18-50 years were mostly affected.In the 776 patients infected with HIV,634 (81.70％) were infected through sexual contacts,and the proportion of sexual transmissions increased with year (trend x2=126.38,P=0.000).The proportion of infected men who have sex with men (MSM) increased from 0％ in 2003 to 53.90％ in 2014 (trend X2=11.96,P=0.001),similar to the trend in western countries.The proportion of infected patients who were not married increased from 18.75％ to 42.21％ (trend x2=43.74,P=0.000).The top three source departments of HIV/AIDS cases were internal medicine (51.03％),emergency room (18.30％) and dermatology (13.53％).The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75％ in 2003 to 2.60％ in 2014.No HIV/AIDS patients were detected in department of surgery,department of otorhinolaryngology,department of ophthalmology,department of stomatology and health examination center in 2003,but 14 cases (9.10％),11 cases (7.14％) and 4 cases (2.60％) were detected in these departments respectively in 2014.Conclusion The HIV detection rate increased with year in Peking Union Medical College Hospital,suggesting the necessity of strengthened HIV test in general hospitals.MSM are the population at high risk,to whom more attention should be paid.
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Objective To determine the immunophenotypic features of peripheral lymphocytes in adult patients with Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) and chronic active EBV infection (CAEBV).Methods Eighteen IM patients,12 CAEBV patients and 18 healthy donors were included.Lymphocyte subsets including CD3-CD+19 B cells,CD3-CD+16/56 NK cells,CD4+ and CD8+T cells in peripheral blood were measured by flow cytometry.The expression of activation markers (HLA-DR and CD38) on CD8+T cells and CD28 expression on T cells were also determined.Kruskal-Wallis H and MannWhitney U tests were used to compare variables among groups.Results IM patients had dramatically increased CD8+T cell counts than healthy donors (5.22 × 109/L vs 0.54 × 109/L,P ＜ 0.001).B cell counts moderately reduced in patients with IM than in healthy donors.No difference was found in absolute CD4+T cell and NK cell counts between IM and healthy donors.The levels of HLA-DR and CD38 on CD8+T cells significantly increased in IM patients compared with those in healthy controls.The intensity of CD28 on CD8+T cells significantly decreased,which was not seen on CD4+T cells.The median cell counts of B,NK,CD4+T and CD8+T subsets in CAEBV patients were 0.02 × 109/L,0.06 × 109/L,0.26 × 109/L and 0.21 ×109/L respectively,which were significantly lower than those in healthy donors (0.22 × 109/L,0.38 ×109/L,0.78 × 109/L,0.54 × 109/L) and IM patients (0.12 × 109/L,0.40 × 109/L,0.91 × 109/L,5.22 ×109/L).The positive rates of HLA-DR and CD38 on CD8+T cells in CAEBV patients were higher than those in healthy controls,but lower than those in IM patients.Conclusions The immunophenotypic pattern in adult patients with IM is characterized by a dramatic increase of extensively activated CD8+ T cells,a moderate reduction of CD+19B cells and no significant change of CD4+T cells and CD+16/56NK cells.CAEBV is featured by an immunosuppression status as demonstrated by significantly decreased B,NK,CD4+T and CD8+T subsets.
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Objective To analyze the correlation between CD4+ T cell count and HLA-DR or CD38 expression on peripheral CD8+ T cells in treatment-naive Chinese HIV/AIDS patients.Methods A total of 471 treatment-naive HIV-infected patients and 53 healthy volunteers were enrolled.HLA-DR or CD38 expression on peripheral CD8+ T cells, CD4+ T cell count, naive CD4+ T cell subsets and CD28 expression on T cells were measured by flow cytometry.Plasma HIV RNA load was quantified by real-time PCR (COBAS TaqMan RT-PCR).Mann-Whitney U test and Spearman's rank correlation test were used for statistical analysis.Results CD38 expression intensity on CD8+ T cells was negatively correlated with CD4+ T cell count (r =-0.53, P ＜ 0.001) and naive CD4+ T cell count (r =-0.48, P ＜ 0.001).CD38 expression on CD8+ T cells also displayed significantly negative correlation with CD28 expression on CD8+ T cells (r =-0.46, P ＜ 0.001).HLA-DR expression on CD8+ T cells did not show significant correlation with CD4+ T cell count.Only weak positive correlation was found between CD38 intensity on CD8+ T cells and plasma HIV RNA load.Conclusions Compared with HLA-DR, CD38 expression on CD8+ T cells shows more significant negative correlation with CD4+ T cell count in treatment-naive patients.CD38 and HLA-DR may play different roles on the persistent immune activation in HIV infection.
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Objective To evaluate the accuracy of lymphocyte count as a surrogate for CD4+T cell count in treatment-na(i)ve HIV-infected adults.Methods A total of 2 013 HIV-infected patients were screened at 23 sites in China.CD4+ T cell counts were measured by flow cytometry.Correlation between CD4+ T cell count and peripheral lymphocyte count were analyzed by spearman coefficient.AUCRoc were used to evaluate the performance of lymphocyte count as a surrogate for CD4+ T cell count.Results The lymphocyte count and CD4+T cell count of these 2 013 patients were (1 600±670) × 106/L and (244 ± 148) × 106/L respectively.CDa+ T cell count were positively correlated with lymphocyte count(r =0.482,P ＜0.000 1).AUCROC of lymphocyte count as a surrogate for CD4+ T cell counts of ＜ 100 × 106/L,＜200 × 106/L and ＜ 350 × 106/L were 0.790 (95％ CI 0.761-0.818,P ＜ 0.000 1),0.733 (95％ CI 0.710-0.755,P ＜ 0.000 1) and 0.732 (95％ CI 0.706-0.758,P ＜ 0.000 1) respectively.Conclusion Lymphocyte count could be considerad as a potential surrogate marker for CD4+ T cell count in HIV/AIDS patients not having access to T cell subset test by flowcytometry.
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Objective To evaluate the influence of long-term nucleotide reverse transcriptase inhibitors (NRTIs) on lipids metabolism in HIV/AIDS patients and correlating clinical factors.Methods A total of 118 HIV/AIDS patients were divided into 3 groups:untreated group (40 patients),highly active antiretroviral therapy(HAART) for 1-2 years group (37 patients) and HAART over 5 years group (41 patients),with 20 healthy individuals as the control group.Clinical lipodystrophy (LD) was defined as concordance between patient's report of change and physical examination.Fat mass (FM) was measured by dual-energy X-ray absorptiometry (DXA).Results There was no significant difference in the incidence of LD between HAART for 1-2 years group and HAART over 5 years group (51.2％ vs 40.5％,P =0.345).The prevalence of LD was 2.4 folds with strvudine (d4T) treatment compared with zidovudine (AZT)-containing regimens (61.6％ vs 23.5％,P =0.001).Based on DXA measurements,FM of total body and limbs were significantly lower in the HAART over 5 years group than that in the control group,the untreated group and the HAART for 1-2 years group (P ＜ 0.05).Trunk FM was significantly lower in the HAART over 5 years group than the untreated group and the HAART for 1-2 years group (P ＜ 0.05).FM of total body and trunk were significantly lower in patients without LD in the HAART over 5 years group than patients without LD in the HAART for 1-2 years group (P ＜ 0.05).FM was correlated positively with body weight and BMI.Limbs FM was correlated negatively with peripheral blood triglyceride concentration.Conclusions HIV/AIDS patients with NRTIs therapy have high prevalence of LD,which mainly occurs 1-2 years after therapy,and increases with d4T treatment compared with AZT-containing regimens.There was no significant difference in the incidence of LD between the HAART for 1-2 years group and the HAART over 5 years group.FM was significantly decreased after long-term HAART in the patients with or without LD.DXA can evaluate LD objectively and guide further clinical treatment.
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objective To summarize the clinical characteristics of AIDS phobia patients and establish the preliminary clinical diagnostic criteria.Methods The clinical information of 46 AIDS phobia patients was collected and summarized.General demographic data,clinical manifestations and laboratory results were analyzed.Results The clinical characteristics of AIDS phobia patients include:(1)With or without high-risk behavior of HIV-1 infection;(2)Patients repeatedly demanded HIV/AIDS related laboratory tests,suspected or believed in HIV-1 infection with daily life affected;(3)The main complaints were non-specific including influenza-like symptoms(headache,sore throat and so on),fasciculation,formication,arthrodynia,fatigue and complaint of fever with normal body temperature;physical examination did not reveal any positive physical sign except white coated tongue;(4)Symptoms mainly appeared 0-3 months after the high-risk behavior while HIV-1 antibody kept negative;(5)T lymphocyte subsets test was carried out in 23 patients and showed 19(82.6%)with CD4+ T lymphocyte count>500/μl,the remaining 4 were 300-500/μl,with the lowest count of 307/μl.Few patients had inversed CD4+/CD8+ ratio but without excessive CD8+T lymphocyte activation.Conclusion AIDS phobia is a complicated physical and mental disease,whose diagnosis and treatment still need further investigation.
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Objective To evaluate the influence of highly active antiretroviral therapy ( HAART) on bone mineral density ( BMD ) of human immunodeficiency virus ( HIV) infected patients and correlating clinical factors. Methods The clinical data from 2007 to 2008 were analyzed, including 50 patients treated with HAART (named treated group) ,12 HIV-infected antiretroviral-naive patients (named untreated group) and 20 healthy people (named control group).Lumbar, femoral neck, femur, femoral greater trochanter and whole body BMD were measured by dual energy X-ray absorptiometry.The data were respectively analyzed.Results There were 19 (38.0% ) patients with osteopenia and 1(2.0% ) patient with osteoporosis in the treated group.There were 6(50.0% ) patients with osteopenia and 2 (16.7% ) patient with osteoporosis in the untreated group.There were 5(25.0% ) patients with osteopenia, no one with osteoporosis in the control group.The prevalence of osteopenia/osteoporosis was statistically higher in the untreated group than that in the control group (P = 0.02).The BMD of femur, femoral neck and greater trochanter [(0.97±0.14) , (0.91 ±0.13 ) , (0.76 ±0.12) g/cm2] in the HIV-infected group (including the treated and untreated group) were significantly lower than that in the control group [(1.04±.12) , (0.98±.14) , (0.84±0.11) g/cm2 ,P <0.05].There were no significantly differences in the BMD between the untreated group and the treated group.In the treated group, osteopenia/osteoporosis correlated with body weight less than 60 kg (r=0.074,P =0.004) and the viral load before HAART(r=5.103,P =0.021).Conclusions The prevalence of osteopenia and osteoporosis in antiretroviral-naive HIV-infected patients is higher.The BMD of HIV-infected patients are reduced compared with the healthy people.The BMD is similar among HIVinfected patients irrespective of antiretroviral treatment Body weight less than 60 kg and the viral load before HAART are the risk factors of osteopenia/osteoporosis for the HIV-infected antiretroviral patients.
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Objective To study the prevalence, clinical characteristics and risk factors of HIV-related lipodystrophy syndrome (HIV-LD) in our cohort of HIV-1 infected Chinese adults. Methods In a cross-sectional study, 55 HIV-infected patients were recruited from the HIV clinic of Peking Union Medical College Hospital; most of them were undergoing the first-class highly active antiretroviral therapy (HAART) of today in China. Lipoatrophy or lipohypertrophy was defined if there was concordance between the report of fat change and clinical examination of the participants. Whole body dual-energy X-ray absorptiometry (DEXA) scanning was performed. Results Prevalence of clinical body fat redistribution in the present study was 47.3%. Comparing with non-LD patients, HIV-LD patients had elder age and longer exposure to HAART(P<0.05). HAART exposure and stavudine(d4T) usage were two independent risk factors for HIV-LD. Conclusions HIV-related fat redistribution does exist in Chinese HIV population. Peripheral lipoatrophy occurs commonly in HIV-infected adults but is not associated with increased trunk fat. HAART exposure and especially d4T usage are independent risk factors for HIV-LD.
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We collected the clinical information of 21 in-patients diagnosed as Lyme disease in Peking Union College Univemity Hospital from Apr. 1994 to Jan. 2008. The clinical manifestations, laboratory tests, therapy and prognosis were analyzed retrospectively. 16 of 21 (76%) patients had fever, 14 of 21 (67%) eases had skin lesion, 17 patients had nervous symptoms, 10 cases showed arthrosis and only 2 of 21 eases involved in heart. The antibiotics of penieilin,ceftriaxone and doxyeycline were used for therapy. All of the 21 patients improved clinically and discharged. 12 cases were followed up for 1 month to 12 years and 2 of them relapsed, both of whom were in Stage Ⅲ. 8 cases remained persistent symptoms. As the manifestations of Lyme disease are complicated, for clinical borderline cases the prompt detection of etiological agent may be useful for early diagnosis. The antibiotic therapy should begin as early as possible to avoid developing chronic Lyme disease.
ABSTRACT
Objective To compare the simple cases of hand-foot-mouth disease(HFMD) with HFMD patients complicated with encephalitis and HFMD cases complicated with pulmonary edema (PE). To explore predictor factors of disease progression and unfavorable prognosis. Methods Forty-one EV71-infected children admitted to the Fuyang First People's Hospital in Anhui Province from March to May in 2008 were investigated in the research, who were classified as encephalitis-complicated cases ( encephalitis group, n = 15 ), PE-complicated cases ( PE group, n = 15 ) and simple cases (simple group, n= 11 ). Their clinical manifestation, laboratory findings, and immunophenotypes of peripheral blood lymphocyte were analyzed to find predictors associated with disease progression and unfavorable outcomes. Results The mortality rate in PE group was 66.7%, which was significantly higher than that in encephalitis group. Ninty-three point three percent cases in PE group and encephalitis group were younger than 3 years old, with statistic difference compared to simple group. Patients in PE group had higher total blood white cell (WBC) counts and higher absolute neutrophil counts and tended to have higher breathing rate, heart i'ate and glucose level than encephalitis group. The percentages of T cells and natural killer (NK) cells were significantly lower among patients complicated with encephalitis than simple HFMD patients.Conclusions PE is one predictor for poor prognosis. Factors correlated with unfavorable outcome include high WBC, high absolute neutrophil counts; elevated breathing rate, heart rate and glucose level. The immunophenotypes of peripheral blood lymphocytes can also predict the disease progression.
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Objective To investigate the significance and characteristics of T lymphocyte subsets and co-stimulatory CD28 in peripheral blood of patients with primary biliary cirrhosis. Methods Tri-colour flow-cytometry was used to detect the levels of T lymphocyte subsets in peripheral blood in 98 patients with primary biliary cirrhosis and 30 age and gender matched healthy controls. Results Compared to control group the percentage of CD4+ T increased and CD8+ T lymphocyte decreased in the PBC group. The CD4+/CD8+ ratio in the PBC group was higher than that in the control group (P<0.05). And the percentage of CD4+CD28- T cells and CD8+CD28- T cells increased, too (P<0.05). Conclusion There are immunological abnormalities in PBC and the expression of co-stimulator CD28 is significantly decreased. CD8+CD28-T lymphocytes may have immune regulatory effect in PBC.