Tran H S, Moncure M, Tarnoff M, Goodman M, Puc M M, Kroon D, Eydelman J, Ross S E
Department of Surgery, University of Medicine and Dentistry-Robert Wood Johnson Medical School, and Cooper Hospital/University Medical Center, Camden, New Jersey, USA.
Am J Surg. 2000 Sep;180(3):228-33. doi: 10.1016/s0002-9610(00)00450-5.
Plasma viral load has recently been associated with clinical outcome in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). We hypothetized that, in addition to CD4 lymphocytes, plasma HIV-1 RNA counts are predictive of postoperative outcome.
HIV-infected and AIDS patients admitted to a major teaching hospital requiring invasive or surgical procedures were retrospectively analyzed for postoperative outcome. Preoperative and postoperative immune cell counts including plasma HIV-1 RNA counts were recorded. Chi-square analysis, Fisher's exact test, and multivariate regression were performed with statistical significance P </=0.05.
Fifty-five consecutive patients between 14 and 62 years of age were admitted in a 1-year period and underwent 64 diagnostic and therapeutic procedures. Fourteen (22%) postoperative infections and 18 (28%) complications other than infection, with an overall mortality of 11%, were documented. Total preoperative white blood cell count ([WBC] P <0.01), preoperative percent lymphocyte count (P <0.01), absolute postoperative CD4 lymphocyte count (P <0.01), and postoperative plasma viral load (P <0.0001) are associated with mortality. Multivariate regression indicated that postoperative percent CD4 lymphocyte count is an independent predictor of both postoperative infection and other complications (P <0.05, R = 0.848, power = 0.9911), while the decrement in percent CD4 lymphocyte count is an independent predictor of postoperative complications other than infection (P <0.05, R = 0.596, power = 0.7838).
In accordance with the medical literature for clinical outcome in HIV-infected and AIDS patients, both immune cell counts and HIV-1 RNA counts were found to associate with postoperative mortality. However, the postoperative and decrement in percent CD4 lymphocyte proved to be the independent predictors of postoperative complications.
血浆病毒载量最近已与人免疫缺陷病毒（HIV）感染和获得性免疫缺陷综合征（AIDS）患者的临床结局相关。我们推测，除了CD4淋巴细胞外，血浆HIV-1 RNA计数可预测术后结局。
对一家大型教学医院收治的需要进行侵入性或外科手术的HIV感染和AIDS患者的术后结局进行回顾性分析。记录术前和术后的免疫细胞计数，包括血浆HIV-1 RNA计数。进行卡方分析、Fisher精确检验和多因素回归分析，统计学显著性P≤0.05。
在1年期间收治了55例年龄在14至62岁之间的连续患者，他们接受了64项诊断和治疗程序。记录到14例（22%）术后感染和18例（28%）非感染性并发症，总死亡率为11%。术前白细胞总数（[WBC] P<0.01）、术前淋巴细胞百分比计数（P<0.01）、术后CD4淋巴细胞绝对计数（P<0.01）和术后血浆病毒载量（P<0.0001）与死亡率相关。多因素回归分析表明，术后CD4淋巴细胞百分比是术后感染和其他并发症的独立预测因素（P<0.05，R=0.848，效能=0.9911），而CD4淋巴细胞百分比的下降是术后非感染性并发症的独立预测因素（P<0.05，R=0.596，效能=0.7838）。
根据关于HIV感染和AIDS患者临床结局的医学文献，发现免疫细胞计数和HIV-1 RNA计数均与术后死亡率相关。然而，术后CD4淋巴细胞百分比及其下降被证明是术后并发症的独立预测因素。
