| Objective To understand the risk of cardiovascular disease in patients with poor immune reconstitution in AIDS,and to explore the risk factors related to cardiovascular disease,among the traditional risk factors of cardiovascular disease,HIV-related factors,inflammation and other indicators.At the same time,the characteristics of TCM syndrome types in patients with poor immune reconstitution of AIDS were analyzed,which provided the basis for the clinical work of the diagnosis and treatment of this disease with integrated traditional Chinese and Western medicine.Methods 1.In this study,a cross-sectional survey method was used to collect the clinical data of 300 AIDS patients with poor immune reconstitution in outpatients of Hangzhou Xixi Hospital from December 2020 to December 2021,including basic information,HIV-related information data,traditional risk factors for cardiovascular disease,markers of inflammation,and other laboratory items.At the same time,we completed the patient’s carotid artery ultrasound and cardiac ultrasound examination,and performed the cardiovascular disease risk score（D:A:D score）and the judgment of TCM syndrome types.2.Set 300 patients with AIDS immune reconstitution well matched in age and gender as the control group,collect the same clinical data as the research group,and analyze the differences in various indicators between the two groups.Through statistical analysis,the possible risk factors of cardiovascular disease and the characteristics of TCM syndrome types in AIDS patients with poor immune reconstitution were obtained.Results 1.The median of CD4+T lymphocytes in the study group was 287.5（83,349）/ul,which was lower than 581（353,1546）/ul in the control group with good immune reconstitution;50 patients（16.7%）with carotid plaques in the study group higher than that of the control group in 31 cases（10.33%）.The median blood glucose of the study group was 5.47（4.22,18.94）mmol/L higher than that of the control group,5.35（4.33,5.18）mmol/L.The median total cholesterol in the study group was 4.65（2.81,9.84）mmol/L higher than that in the control group,4.32（2.64,9.2）mmol/L.The levels of PCT in both groups（99%）were within the normal range;44 patients（14.7%）with elevated ESR in the study group were higher than 25（8.3%）in the control group;47 people（15.7%）in the study group had higher CRP than 27 people in the control group（9%）.AST/ALT,creatinine and uric acid in the study group were higher than those in the control group.The difference between the two groups was statistically significant（P<0.05）.2.The distribution of TCM syndrome types of AIDS patients with poor immune reconstitution in the study group were 100 cases（33.3%）of spleen deficiency with dampness,83 cases（27.7%）of damp-heat type,60 cases（20%）of spleen and kidney yang deficiency,and 46 cases of qi deficiency（46%）.15.3%),11 cases（3.7%）of phlegm and blood stasis type;in the control group,147 cases（49%）of patients with good immune reconstitution were most distributed.The difference between the two groups was statistically significant（x2=41.254,P<0.01）.3.The median 10-year CVD prevalence rate of patients with poor immune reconstitution in AIDS was 2.8（0.26,93.19）%higher than that of the control group,which was 2.465（0.07,93.19）%.The difference was statistically significant（P=0.038<0.05）.The number of patients with abnormal cardiac color Doppler ultrasound in the study group with poor immune reconstitution was 249（83%）higher than that in the control group,and the difference between the two groups was statistically significant（χ2=12.196,P<0.01）.There were 249 cases（83%）of patients in the study group who showed abnormality by cardiac color Doppler ultrasound,and 213 cases（71%）of the patients in the control group who showed abnormality by color Doppler echocardiography,and the difference between the two groups was statistically significant（χ2=12.196,P<0.01）.4.Multivariate ordinal logistic regression analysis was performed with the 10-year CVD risk rate of AIDS patients with poor immune reconstitution as the dependent variable.The analysis results were:total cholesterol（OR:2.46,95%CI:1.561～3.876,P<0.01）,cervical vascular plaque（OR:0.101,95%CI:0.035～0.286,P<0.01）,smoking（OR:0.04,95%CI:0.002～0.12,P<0.01）,CD4+T lymphocytes（OR:0.99,95%CI:0.970～0.999,P=0.045）,ESR（OR:1.06,95%CI:0.009～0.102,P=0.019）was significantly correlated with the risk factors of CVD within 10 years（D:A:D score）,and was an independent factor for the risk of CVD.Binary Logistic regression analysis was performed using the abnormality of cardiac color Doppler ultrasound as the dependent variable in patients with poor immune reconstitution in AIDS.The results showed that the total number of B cells CD19+（OR:0.995,95%CI:0.99～0.999,P=0.006<0.05）may be associated with cardiac abnormalities.Conclusion 1.The CVD risk of AIDS patients with poor immune reconstitution is higher than the CVD risk of AIDS patients with good immune reconstitution.2.The risk factors of CVD in AIDS patients with poor immune reconstitution include:high cholesterol,smoking,carotid plaque formation,elevated erythrocyte sedimentation rate,low level of CD4+T lymphocytes,and low level of CD19+.To a certain extent,elevated CD4+T lymphocytes and elevated CD19+are protective factors for CVD in patients with poor immune reconstitution in AIDS.3.The TCM syndromes of AIDS patients with poor immune reconstitution are mainly spleen deficiency with dampness,which is closely related to the spleen and stomach,followed by dampness-heat syndrome,spleen and kidney yang deficiency,qi deficiency,syndrome of intermingled phlegm and blood stasis. |
