Moore R D, Keruly J C, Chaisson R E
Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Arch Intern Med. 1995 Oct 9;155(18):1965-70.
In human immunodeficiency virus (HIV) disease, neutropenia occurs most commonly in patients who are also severely immunosuppressed. It is not currently known whether neutropenia is an independent risk factor for the development of bacterial infection, which is a potentially serious complication of advanced HIV disease.
We compared the incidence of bacterial infection between 118 neutropenic patients (absolute neutrophil count [ANC], < 1 x 10(9)/L) and 118 nonneutropenic patients matched for CD4+ lymphocyte count, use of injecting drugs, and follow-up time from a demographically heterogeneous urban cohort of HIV-infected patients followed up longitudinally at the Johns Hopkins Hospital. The incidence of serious infection was analyzed separately for patients with an ANC of less than 1, less than 0.75, or less than 0.5 x 10(9)/L.
There were no statistically significant associations found between neutropenia and several individual bacterial infections, including bacteremia, pneumonia, endocarditis, bacterial enterocolitis, and infection of normally sterile sites for any level of neutropenia. However, for all these infections combined, the adjusted relative risk for the occurrence of bacterial infection was 2.33 (95% confidence interval, 1.00 to 5.40; P = .05) for patients with an ANC of less than 1 x 10(9)/L and 7.92 (95% confidence interval, 1.18 to 53.2; P = .03) for those with an ANC of less than 0.5 x 10(9)/L. The incidence of serious bacterial infection ranged from two to three infections per 100 person-months of neutropenia for patients with an ANC of less than 1 x 10(9)/L and three to five infections per 100 person-months of neutropenia for patients with an ANC of less than 0.5 x 10(9)/L for all bacterial infections combined.
Our matched cohort analysis indicates that neutropenia is an independent risk factor for bacterial infection in patients with advanced HIV disease. Given the incidence of infection, the cost-effectiveness of interventions to prevent neutropenia in advanced HIV disease should be assessed.
在人类免疫缺陷病毒（HIV）疾病中，中性粒细胞减少最常见于严重免疫抑制的患者。目前尚不清楚中性粒细胞减少是否是细菌感染发生的独立危险因素，而细菌感染是晚期HIV疾病的一种潜在严重并发症。
我们比较了118例中性粒细胞减少患者（绝对中性粒细胞计数[ANC]＜1×10⁹/L）与118例非中性粒细胞减少患者的细菌感染发生率，这些非中性粒细胞减少患者在CD4⁺淋巴细胞计数、注射吸毒情况及随访时间方面与之匹配，来自约翰霍普金斯医院纵向随访的一个人口统计学特征各异的城市HIV感染患者队列。对ANC分别低于1、低于0.75或低于0.5×10⁹/L的患者的严重感染发生率进行了单独分析。
对于任何程度的中性粒细胞减少，中性粒细胞减少与几种个别细菌感染（包括菌血症、肺炎、心内膜炎、细菌性小肠结肠炎以及正常无菌部位的感染）之间均未发现具有统计学意义的关联。然而，对于所有这些感染合并情况，ANC低于1×10⁹/L的患者发生细菌感染的调整后相对风险为2.33（95%置信区间，1.00至5.40；P = 0.05），ANC低于0.5×10⁹/L的患者为7.92（95%置信区间，1.18至53.2；P = 0.03）。对于所有合并的细菌感染，ANC低于1×10⁹/L的患者每100人月中性粒细胞减少的严重细菌感染发生率为2至3次感染，ANC低于0.5×10⁹/L的患者为每100人月中性粒细胞减少3至5次感染。
我们的匹配队列分析表明，中性粒细胞减少是晚期HIV疾病患者细菌感染的独立危险因素。鉴于感染发生率，应评估预防晚期HIV疾病中性粒细胞减少的干预措施的成本效益。
