Liu Aimei, Liu Cunxu, Deng Xiaojun, Huang Yongbao, Liao Linchu, Meng Zhihao, He Minfu, Huang Junli
Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China.
Infectious Disease Medical Quality Control Center, Liuzhou, Guangxi, China.
PeerJ. 2021 Sep 20;9:e12023. doi: 10.7717/peerj.12023. eCollection 2021.
HIV/AIDS is a chronic disease leading to complications in infected individuals that often require surgical intervention. These patients' serum CD4 T lymphocyte (CD4) counts represent one of the most important indicators of their ability to tolerate surgical treatment. Previous studies have demonstrated that CD4 cell count (CD4-CC) < 200 cells/μl may increase the risk of surgical complications in these patients, limiting their ability to undergo surgery, which may negatively affect their quality of life. Further investigation into the surgical outcomes of patients with CD4-CC < 200 cells/μl should provide guidance in making appropriate clinical decisions for the optimal healthcare of this patient demographic.
All enrolled patients were selected from 14 prefecture-level general hospitals in Guangxi, China, and were referred to AIDS outpost hospitals for inpatient surgical therapy. A total cohort of 168 adult patients was retrospectively analyzed. Multifactorial and stratified analyses were performed to evaluate the in surgical outcome differences for patients with CD4-CC < 200 cells/μl ( = 43), using those with CD4-CC ≥ 200 cells/μl ( = 125) as controls.
Poor incisional healing was used as the primary outcome indicator, and postoperative complications were used as the secondary outcome indicator. In the patient group with CD4-CC < 200 cells/μl, the risk of surgical complications was significantly increased (OR 2.379; 95% CI [1.049-5.394]) after adjustment. Adjusted stratified analysis of the CD4-CC < 200 cells/μl group revealed that individuals over 60 years (OR 27.504; 95% CI [2.297-329.317]) with erythrocyte counts below 4.00/ml for males or 3.50/ml for females (OR 3.353; 95% CI [1.079-10.419]) had a significantly higher risk of postoperative complications; this finding was statistically different from the control (CD4 ≥ 200 cells/μl) group. However, there was no significant difference between the two groups regarding the risk of poorly healed incision outcomes.
Preliminary findings suggest that a serum CD4-CC < 200 cells/μl is not a definitive contraindication for surgical therapy and that baseline and surgical characteristics may help predict surgical outcomes in these patients. Further studies are needed to confirm these findings.
艾滋病毒/艾滋病是一种慢性疾病，会导致感染个体出现并发症，常常需要进行手术干预。这些患者的血清CD4 T淋巴细胞（CD4）计数是其耐受手术治疗能力的最重要指标之一。既往研究表明，CD4细胞计数（CD4-CC）<200个/μl可能会增加这些患者手术并发症的风险，限制其接受手术的能力，这可能会对他们的生活质量产生负面影响。对CD4-CC<200个/μl患者的手术结局进行进一步研究，应为该患者群体的最佳医疗保健做出适当临床决策提供指导。
所有纳入研究的患者均选自中国广西的14家地级市综合医院，并被转诊至艾滋病前哨医院接受住院手术治疗。对总共168例成年患者进行回顾性分析。以CD4-CC≥200个/μl的患者（n = 125）作为对照，进行多因素和分层分析，以评估CD4-CC<200个/μl的患者（n = 43）的手术结局差异。
将切口愈合不良用作主要结局指标，术后并发症用作次要结局指标。在CD4-CC<200个/μl的患者组中，调整后手术并发症的风险显著增加（OR 2.379；95%CI[1.049 - 5.394]）。对CD4-CC<200个/μl组进行调整后的分层分析显示，60岁以上的个体（OR 27.504；95%CI[2.297 - 329.317]），男性红细胞计数低于4.00/ml或女性低于3.50/ml（OR 3.353；95%CI[1.079 - 10.419]）术后并发症的风险显著更高；这一发现与对照组（CD4≥200个/μl）在统计学上存在差异。然而，两组在切口愈合不良结局的风险方面没有显著差异。
初步研究结果表明，血清CD4-CC<200个/μl并非手术治疗的绝对禁忌证，基线和手术特征可能有助于预测这些患者的手术结局。需要进一步研究来证实这些发现。
