Bachou Hanifa, Tylleskär Thorkild, Downing Robert, Tumwine James K
Department of Paediatrics and Child Health, Makerere University Medical School, P O Box 7072, Kampala, Uganda.
Nutr J. 2006 Oct 16;5:27. doi: 10.1186/1475-2891-5-27.
The aim of this study was to describe the clinical features, haematological findings and CD4+ and CD8+ cell counts of severely malnourished children in relation to human immunodeficiency virus (HIV) infection.
The study was conducted in the paediatric wards of Mulago hospital, which is Uganda's national referral and teaching hospital. We studied 315 severely malnourished children (presence of oedema and/or weight-for-height: z-score < -3) and have presented our findings. At admission, the CD4+ and CD8+ cells were measured by the flow cytometry and HIV serology was confirmed by Enzyme linked Immunoassay for children >18 months of age, and RNA PCR was performed for those < or =18 months. Complete blood count, including differential counts, was determined using a Beckman Coulter counter.
Among the 315 children, 119 (38%) were female; the median age of these children was 17 months (Interquartile range 12-24 months), and no difference was observed in the HIV status with regard to gender or age. The children showed a high prevalence of infections: pneumonia (68%), diarrhoea (38%), urinary tract infection (26%) and bacteraemia (18%), with no significant difference with regard to the HIV status (HIV-positive versus HIV-negative children). However, the HIV-positive children were more likely to have persistent diarrhoea than the HIV-uninfected severely malnourished children (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2-3.6). When compared with the HIV-negative children, the HIV-positive children showed a significantly lower median white blood cell count (10700 versus 8700) and lymphocyte count (4033 versus 2687). The CD4+ cell percentages were more likely to be lower in children with non-oedematous malnutrition than in those with oedematous malnutrition even after controlling for the HIV infection. The novel observation of this study is that the CD4+ percentages in both HIV-positive and HIV-negative children without oedema were lower that those in children with oedema. These observations appear to imply that the development of oedema requires a certain degree of immunocompetence, which is an interesting clue to the pathophysiology of oedema in severe malnutrition.
本研究旨在描述与人类免疫缺陷病毒（HIV）感染相关的重度营养不良儿童的临床特征、血液学检查结果以及CD4+和CD8+细胞计数。
本研究在乌干达国家转诊和教学医院穆拉戈医院的儿科病房进行。我们研究了315名重度营养不良儿童（存在水肿和/或身高别体重：z评分＜-3）并展示了我们的研究结果。入院时，通过流式细胞术检测CD4+和CD8+细胞，18个月以上儿童通过酶联免疫吸附测定法确认HIV血清学，18个月及以下儿童进行RNA聚合酶链反应。使用贝克曼库尔特血细胞分析仪测定全血细胞计数，包括分类计数。
在315名儿童中，119名（38%）为女性；这些儿童的中位年龄为17个月（四分位间距12 - 24个月），在HIV感染状况方面未观察到性别或年龄差异。儿童感染患病率较高：肺炎（68%）、腹泻（38%）、尿路感染（26%）和菌血症（18%），在HIV感染状况（HIV阳性与HIV阴性儿童）方面无显著差异。然而，与未感染HIV的重度营养不良儿童相比，HIV阳性儿童更易出现持续性腹泻（比值比（OR）2.0，95%置信区间（CI）1.2 - 3.6）。与HIV阴性儿童相比，HIV阳性儿童的中位白细胞计数（10700对8700）和淋巴细胞计数（4033对2687）显著更低。即使在控制HIV感染后，非水肿性营养不良儿童的CD4+细胞百分比仍比水肿性营养不良儿童更易降低。本研究的新发现是，无水肿的HIV阳性和HIV阴性儿童的CD4+百分比均低于有水肿的儿童。这些观察结果似乎意味着水肿的发生需要一定程度的免疫能力，这是重度营养不良中水肿病理生理学的一个有趣线索。
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