| In recent years, with the increasing number of HIV-infected persons, AIDS has become a global problem. The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization reported that 33.3 million people have infected HIV in the world by the end of 2009. With the wide use of Highly Active Anti-Retroviral Therapy (HAART), the survival time of AIDS-infected people has got extended and their life quality has improved accordingly. More and more HIV-infected patients with the concurrent infection of surgical diseases are in the need of operation therapy.Sepsis is a common complication following severe trauma, burn, infection and major surgery. It is a systemic inflammatory response syndrome accompanied by infection factors. This process causes the imbalance between proinflammatory and antiinflammatory mediators, which in turn resulted in the dysfunction of immune function and aggravation of the infection. Sepsis can further develope into septic shock and multiple organ dysfunction syndrome (MODS), bringing higher mortality rate. At present, the diagnosis and prevention of sepsis has made more and more progress, but its incidence and mortality still remain high. The infection of HIV lowers people's immunity and reduces the number of T lymphocytes. If HIV-infected patients are concurrently infected with sepsis in perioperative period, the changes of their immunity could be more complex and the number of T lymphocytes would change accordingly. ObjectiveThis research is to study the relationship of perioperative sepsis and T lymphocytes subgroup, and explor the changes of T lymphocytes subgroup after perioperative sepsis in different AIDS patients; so that it can provide targeted treatments and preventions and reduce the incidence and mortality of these patients.Materials and MethodsThe subjects of this study are the HIV-infected patients who were admitted to the General Surgery of Shanghai Public Health Clinical Center between July 2008 to July 2010 and they have undergone the operations. All of these patients were diagnosed by the detection of CDC. According to the sepsis diagnostic criteria of American Association of Critical Care in 2001, European Critical Care Association, American College of Chest Physicians (ACCP), American Thoracic Society (ATS) and American Association of Surgical Infection, the patients are divided into sepsis group and non-sepsis group on the basis of whether they had perioperative sepsis. 5ml of peripheral blood are collected into EDTA tube and T achroacyte subgroups are detected. These HIV-infected patients are grouped according to whether they had perioperative sepsis and were concurrently infected with other bacteria or virus, as well as their age, HIV infection time and APACHⅡscore. Then their T achroacyte subgroups in perioperative period are analysed. The results of this study are analyzed with the help of SPSS12.0 statistical software.Results1. There are 116 HIV-affected patients in this study, with 64 concurrently infected with sepsis and 52 having no sepsis. We counted the number of T achroacyte subgroups and found that there were no significant differences in the countings of CD3 and CD8 T lymphocyte between sepsis group and non-sepsis group (P= 0.218, P=0.696), while there were significant differences in CD4 T lymphocyte counting and the ratio of CD4 to CD8 between the two groups. (P=0.002, P= 0.039).2. There were no age differences in CD3 and CD8 T lymphocyte counting in AIDS concurrently infected septic patients among all the age groups (P>0.05), while the differences of CD4 T lymphocyte counting and the ratio of CD4 to CD8 between 30-39 age group and 40-49 age group were significant, with 30-39 age group higher than 40-49 age group (P=0.005, P=0.012).3. There is no operation type difference in CD3 and CD8 T lymphocyte counting between sepsis group and non-sepsis group (P> 0.05). But the number of CD4 T lymphocyte in sepsis group is lower than that of the non-sepsis group, while the ratio of CD4 to CD8 in sepsis group is higher than that of the non-sepsis group in abdominal operation. However, in anus genital operation, the number of CD4 T lymphocyte in sepsis group is higher than that of the non-sepsis group. All these differences are significant (P=0.002, P=0.030, P=0.021). In the other operation types, there is no significant difference in the number of CD4 T lymphocyte.4. Grouping the patients on the basis of the diagnosis time of AIDS, the results showed that the number of CD3 T lymphocyte in 0-months group and 37-months group were significantly higher than that of the 49-months group(P=0.018, P=0.036); while the number of CD4 T lymphocyte in 0-months group and 13-months group were significantly higher than that of the 25-months group,37-months group,49-months group and≥60 months group respectively(P=0.000,0.001,0.000,0.000), (P=0.001,0.010,0.000,0.000). The ratio of CD4 to CD8 in 0- months group and 13- months group are higher than that of the 49- months group and≥60 months group respectively. The differences were significant (P= 0.005,0.008), (P=0.010,0.013). However, there were no statistical differences in the number of CD8 T lymphocyte among these time groups.5. According to APACHⅡscore, the sepsis patients are devided into three groups, the patients with a score between 1-10 in group A, the patients with a score between 10-20 in group B, the patients with a score more than 20 in group C. There were 34,20,10 patients in group A, group B and group C respectively. The results showed that there were no significant differences in the number of CD3, CD4, CD8 T lymphcell and the ratio of CD4 to CD8 between group A and group B; but when compared with group C, the number of CD4 T lymphocyte and the ratio of CD4 to CD8 in group A and group B were both higher, while neither group A nor group B is significantly different from group C in the number of CD3 and CD8 T lymphcell.6. Grouping the patients according to whether they had sepsis or not, we found that there are no significant differences in the number of CD3, CD4, CD8 T lymphcell and the ratio of CD4 to CD8 between sepsis patients who coinfected hepatitis virus, tubercle bacillus or papillomavirus and non-sepsis patients (P> 0.05).7. There are no significant differences in the number of recovered patients who has undergone operations between sepsis patients and non-sepsis patients (x2=0.175, p=0.813).Conclusions1. CD4 lymphocytes, CD4/CD8 decrease is HIV/AIDS patients who underwent surgical happen sepsis reference index the main risk.2. Abdominal surgery and anus genital surgery is high risk occurred sepsis. May abdominal surgery is larger, the anus genital trauma surgery patients with low CD4 lymphocytes concerned.3. Age for HIV/AIDS patients who underwent surgical happen sepsis effect is not apparent, HIV diagnose time surgical patients with HIV/AIDS in perioperative happen sepsis relevant, diagnose time long more vulnerable to sepsis.4. APACHⅡscore and CD4 T achroacyte subgroup, namely negative correlation between the lower CD4 lymphocytes, produced sepsis the more serious.5. Completes the perioperative treatment, happen septic patients surgery could still get satisfactory effect. |
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