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目的探讨艾滋病病毒(HIV)感染者围手术期并发脓毒症的危险因素。方法回顾分析2011年2月至2014年9月,在广州市第八人民医院80例HIV感染者,根据术后是否发生脓毒症分为脓毒症组(24例)和非脓毒症组(56例),分别比较两组术前CD+4T淋巴细胞(简称CD4细胞)、CD+8T淋巴细胞(简称CD8细胞)、白细胞、淋巴细胞、HIV核糖核酸(RNA)、降钙素、C反应蛋白等指标的差异。结果术后发生脓毒症24例。在脓毒症组与非脓毒症组之间CD4细胞、CD8细胞、CD4/CD8、HIV RNA、降钙素、总淋巴细胞等影响因素的差异有统计学意义(χ2依次为8.30、6.55、7.29、50.49、15.40、6.01,P均<0.05)。非条件Logistic回归分析结果显示,CD4细胞降低[比值比(OR)=0.41,95%可信区间(CI):0.08~0.75],HIV RNA载量升高(OR=11.30,95%CI:3.69~38.67),降钙素升高(OR=3.75,95%CI:1.52~9.17),与HIV感染者围手术期脓毒症发生的关系有统计学意义。结论 CD4细胞值降低、HIV RNA载量升高、降钙素升高,HIV感染者围手术期发生脓毒症的风险明显增高。有效控制HIV复制,恢复免疫功能,控制术前感染,能减低HIV感染者围手术期发生脓毒症的风险。
Objective To investigate the risk factors of perioperative sepsis among people living with HIV. Methods From February 2011 to September 2014, 80 HIV-infected patients in Guangzhou Eighth People’s Hospital were divided into sepsis group (24 cases) and non-sepsis group according to whether postoperative sepsis occurred (56 cases). Preoperative CD + 4T lymphocytes (CD4 cells for short), CD 8 T lymphocytes (CD8 cells for short), leukocytes, lymphocytes, HIV RNA, calcitonin, Reactive protein and other indicators of the difference. Results Postoperative sepsis in 24 cases. There were significant differences in the influencing factors of CD4, CD8, CD4 / CD8, HIV RNA, calcitonin and total lymphocytes between sepsis group and non-sepsis group (χ2 = 8.30,6.55, P <0.05). Non-conditional logistic regression analysis showed that the CD4 cell level decreased (OR = 0.41, 95% CI: 0.08-0.75) and increased HIV RNA load (OR = 11.30, 95% CI: 3.69 ~ 38.67). Elevated calcitonin (OR = 3.75, 95% CI: 1.52-9.17) correlated with the incidence of perioperative sepsis in HIV-infected patients. CONCLUSIONS: The CD4 cell level is decreased, the HIV RNA load is increased, and calcitonin is elevated. The risk of perinatal sepsis in HIV-infected patients is significantly increased. Effective control of HIV replication, immune function recovery, preoperative infection control can reduce the risk of perioperative sepsis in HIV-infected persons.