Keiser P, Rademacher S, Smith J W, Skiest D, Vadde V
University of Texas Southwestern Medical Center, The Department of Veterans Affairs Medical Center, Dallas 75216, USA.
Am J Med. 1998 Jan;104(1):48-55. doi: 10.1016/s0002-9343(97)00269-6.
Neutropenia occurs in up to 17% of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival.
A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI).
The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm3 versus 40 cells/ mm3, P=0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P=0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P=0.002). In a multivariate analysis, significant decreased risk for bacteremia was found with G-CSF use (odds ratio [OR]=0.15, P=0.02). Survival was longer in patients treated with G-CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP.
We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients.
在高达17%的人类免疫缺陷病毒（HIV）感染个体中会出现中性粒细胞减少症。虽然粒细胞集落刺激因子（G-CSF）可逆转HIV相关的中性粒细胞减少症，但尚未证实这种治疗方法能减少细菌感染并影响生存率。
对152例中性粒细胞减少的HIV感染患者进行回顾性队列研究，以确定G-CSF的治疗效用。回顾了1991年至1994年期间在帕克兰纪念医院接受G-CSF治疗的71例患者和从未接受G-CSF治疗的81例患者的病历，以了解菌血症发生率、G-CSF使用情况、抗逆转录病毒疗法（AR）、卡氏肺孢子虫肺炎预防（PCPP）和机会性感染（OI）情况。
两组患者具有相似的基线特征，包括CD4细胞计数（37个细胞/mm³对40个细胞/mm³，P = 0.7）。单因素分析显示，与对照组相比，G-CSF治疗组的所有菌血症发生率有下降趋势（0.54次菌血症/100患者月对2.2次菌血症/100患者月，P = 0.064），且与未治疗组相比，G-CSF治疗组的革兰氏阴性杆菌菌血症发生率显著下降（0.09次革兰氏阴性杆菌菌血症/100患者月对1.7次革兰氏阴性杆菌菌血症/100患者月，P = 0.002）。在多因素分析中，使用G-CSF可显著降低菌血症风险（比值比[OR]=0.15，P = 0.02）。接受G-CSF治疗的患者生存期比未治疗组更长（中位数：397天对165天）。使用Cox比例风险模型进行的多因素分析显示，接受G-CSF、ARs、PCPP治疗的患者死亡风险降低。
我们得出结论，在中性粒细胞减少的HIV感染患者中，使用G-CSF与菌血症减少相关，且与生存期延长相关。
