HIV/AIDS-TB患者抗结核药物治疗强化期红细胞系的变化

Changes in erythrocyte lineage in patients with HIV/AIDS-TB during intensive period of therapy with antituberculosis drugs

摘要:

目的 分析接受抗逆转录病毒治疗（ART）及不同ART方案联合抗结核药物治疗的人类免疫缺陷病毒/艾滋病合并结核分枝杆菌感染（HIV/AIDS-TB）患者在强化期内血液学红细胞系的变化情况。方法 选取2014-2017年某传染病专科医院确诊为HIV/AIDS-TB的患者，分为在ART基础上接受抗结核药物联合治疗组（A组），抗结核药物治疗8周内开始ART联合治疗组（B组），抗结核药物治疗8周后开始ART治疗组（C组）；检测并比较治疗前基线（0周）和治疗后1、2、4、8周等红细胞系参数红细胞（RBC）、血红蛋白（HGB）、红细胞平均体积（MCV）和红细胞分布宽度（RDW-CV）变化的差异。结果 共选取180例HIV/AIDS-TB患者，其中A组71例、B组75例、C组34例；共85.00%（153例）的患者发生轻度贫血，其中A、B、C组分别为84.51%（60/71）、85.33%（64/75）和85.29%（29/34）。抗结核药物治疗后，A、B和C组患者RBC绝对值增减差异均无统计学意义（均P>0.05）；治疗4周后，B组患者HGB增加均高于基线（均P<0.05）；A、B和C组患者MCV和RDW-CV在治疗后均较基线上升（均P<0.05），但C组治疗8周时RDW-CV恢复至基线水平。A、B两组患者中TDF/3TC/EFV方案在联合抗结核药物治疗4周时，HGB均较基线增高（均P<0.05），其他方案均无统计学意义（均P>0.05）。结论 HIV/AIDS-TB患者在抗结核药物治疗后应尽快启动ART治疗，最好8周内开始ART治疗，不同ART方案联合抗结核治疗患者的红细胞系参数变化有差异，TDF治疗方案效果较为理想。

Abstract:

Objective To analyze changes in hematological erythrocyte lineage in patients with HIV/AIDS and Mycobacterium tuberculosis infection (HIV/AIDS-TB) during intensive period of antiretroviral therapy (ART) and different ART regimens combined with anti-tuberculosis drugs. Methods Patients who were confirmed with HIV/AIDS-TB in an infectious disease hospital from 2014 to 2017 were selected and divided into three groups:group A received combination therapy of anti-tuberculosis drugs on the basis of ART, group B started ART within 8 weeks of anti-tuberculosis drug therapy, group C started ART after 8 weeks of anti-tuberculosis drug therapy; changes in parameters of erythrocyte lineage, such as red blood cell(RBC), hemoglobin(HGB), mean corpuscular volume(MCV), and RBC distribution width (RDW-CV) before therapy(baseline, at 0 week) and 1, 2, 4, and 8 weeks after therapy were detected and compared. Results A total of 180 patients with HIV/AIDS-TB were enrolled, group A, B, and C were 71, 75, and 34 cases respectively; 85.00% (n=153) of patients developed mild anemia, 84.51% (60/71), 85.33% (64/75), and 85.29% (29/34) were in group A, B, and C respectively. After anti-tuberculosis drug therapy, changes in absolute value of RBC in group A, B, and C had no significant difference (all P>0.05); after 4 weeks of therapy, increase of HGB in patients in group B was higher than baseline (P<0.05); MCV and RDW-CV in group A, B, and C after therapy were all higher than baseline (all P<0.05), but RDW-CV in group C recovered to baseline level at 8 weeks of therapy. HGB of group A and B at 4 weeks of TDF/3TC/EFV regimen combined anti-tuberculosis drug therapy were both higher than that of baseline (both P<0.05), but there was no significant difference in other regimens (all P>0.05). Conclusion Patients with HIV/AIDS-TB should start ART as soon as possible after anti-tuberculosis drug therapy, preferably within 8 weeks, changes in erythrocyte parameters in patients treated with different ART regimens combined with anti-tuberculosis therapy are different, effect of TDF therapy is ideal.