摘要目的 探讨人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者及获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者中口腔念珠菌病(oral candidosis,OC)的患病情况及影响因素,以期为防治HIV/AIDS患者口腔真菌感染性疾病提供依据.方法 对2008年3月至2012年9月于昆明市第三人民医院感染一科就诊的1 566例(男性1 062例,女性504例,年龄0.2～ 84.0岁)HIV/AIDS患者进行口腔检查,HIV病毒载量(HIV-RNA)和外周血CD4计数采用流式细胞技术进行分析,高效抗反转录病毒药物(highly active antiretroviral therapy,HAART)使用情况和传播途径等信息通过问卷获得,采用SPSS17.0统计软件建立数据库,分析比较不同HIV-RNA和CD4计数水平及HAART对OC患病率的影响.结果 1 566例HIV/AIDS患者的OC患病率为31.0％(486/1 566),无性别差异,表现为红斑型、假膜型和口角炎型3种形式,患病率分别为13.9％(217/1 566)、17.0％(267/1 566)和4.9％(77/1 566),其中75例患者有两种以上表现形式,3型患者的平均CD4水平[中位数(四分位数间距)]分别为81.0(146.0)、74.0(152.0)和69.0(121.5)个/μl,差异无统计学意义(P＞0.05).未使用和使用HAART患者OC的患病率分别为36.3％(402/1 107)和18.3％(84/459),二者差异有统计学意义(P=0.000).OC与非OC患者CD4计数[分别为81.0(150.0)、179.0(231.3)个/μl]和HIV病毒载量水平差异均有统计学意义(Z=-10.261,P=0.000;Z=-4.762,P=0.000).结论 云南地区HIV/AIDS患者OC患病率很高,包括假膜型、红斑型和口角炎型,未检出增殖型;OC的患病率与患者免疫抑制程度和HIV病毒载量有关.

abstractsObjective To assess the incidence of oral candidiasis and its influencing factors in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS).Methods An oral examination was conducted in the 1 566 HIV/AIDS patients in the Third Hospital of Kunming from March 2008 to September 2012 (M/F:1 062/504,age range:0.2 to 84.0 years old).The HIV viral load(HIV-RNA) and peripheral blood CD4 count were respectively analyzed by Bayer Q340 fluorescence signal surveying instrument(bDNA method) and flow cytometry analysis.The information on usage of highly active anti-retroviral(HAART) drugs and transmission of HIV were obtained through questionnaires.The incidence of oral candidiasis in patients with different HIV-RNA levels and CD4 count and the use of HAART was analyzed and compared.Results The total incidence of oral candidosis was 31.0％(486/1 566) and there was no difference in sex.The oral lesions were presented by three types,psudomembranous candidosis(PC),erythematous candidosis(EC) and angular cheilitis(AC),and the morbidity was 13.9％(217/1 566),17.0％(267/1 566) and 4.9％(77/1 566),respectively.The average level of CD4 count in psudomembranous candidosis,erythematous candidosis and angular cheilitis[81.0 (146.0),74.0 (152.0) and 69.0 (121.5) cell/μl] showed no significant difference(P ＞ 0.05).The incidence of oral candidiasis in non-HAART and HAART subjects were 36.3％(402/1 107) and 18.3％(84/459),respectively(P=0.000).The CD4 count and absolute counts of HIV viral load in oral candidiasis patients and non-oral candidiasis patients had significant difference(Z=-10.261,P=0.000 and Z=-4.762,P=0.000).Conclusions The morbidity of oral candidiasis in HIV/AIDS patients in Yunnan Province was high,including PC,EC and AC and hyperplastic candidosis was not detected.The incidence was related to the degree of immune suppression and HIV viral load.