微量营养素与T细胞亚群：卢旺达感染与未感染HIV的重度营养不良儿童的比较

Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children.

作者信息

Ndagije F, Baribwira C, Coulter J B S

机构信息

Liverpool School of Tropical Medicine, Liverpool, UK.

出版信息

Ann Trop Paediatr. 2007 Dec;27(4):269-75. doi: 10.1179/146532807X245652.

DOI:10.1179/146532807X245652

PMID:18053343

Abstract

OBJECTIVE

To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children.

DESIGN

Cross-sectional study in two centres.

SETTING

Children admitted to the malnutrition units in Kigali and Butare, Rwanda.

PATIENTS

A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z- score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected.

METHODS

CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count.

RESULTS

The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+ %. In HIV uninfected children, CD4+ % was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper.

CONCLUSIONS

In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.

摘要

目的

测定感染和未感染艾滋病毒的严重营养不良儿童的CD4+细胞水平和微量营养素水平。

设计

在两个中心进行的横断面研究。

地点

卢旺达基加利和布塔雷营养不良治疗科室收治的儿童。

患者

共112名年龄在2个月至5岁之间的严重营养不良儿童（身高别体重Z评分＜-3标准差±水肿）。其中52名（46.4%）感染了艾滋病毒。

方法

检测CD4+细胞计数、硒、锌和铜水平。计算CD4细胞百分比占总淋巴细胞计数的比例。

结果

52名感染艾滋病毒儿童的平均年龄（18个月）低于60名未感染儿童（26个月）（p=0.01）。感染艾滋病毒的儿童中有6名（11.5%）患有水肿型营养不良，而未感染组这一比例为50%。感染艾滋病毒组的平均（标准差）CD4+细胞计数为1054（780），未感染组为1579（721）（p=0.001）。在年龄＜12个月（p=0.09）、12 - 24个月（p=0.045）和＞36个月（p=0.001）的儿童中，感染艾滋病毒组的CD4+细胞计数也显著低于未感染组。在感染艾滋病毒的儿童中，17%有严重免疫抑制（CD4+细胞＜15%），33%有中度免疫抑制（15% - 24%），50%无免疫抑制（＞25%），而未感染艾滋病毒组相应比例分别为9%、12%和80%（p＜0.001）。两组中约三分之一的儿童硒和锌水平较低，77%的儿童铜水平升高。多变量分析显示，感染艾滋病毒儿童中硒与CD4+细胞计数之间存在显著相关性（r=0.36，p＜0.001），而锌和铜与CD4+细胞百分比无相关性。在未感染艾滋病毒的儿童中，CD4+细胞百分比与硒（r=0.282，p=0.03）和锌（r=0.264，p=0.047）相关，但与铜无关。