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北京协和医院感染内科李太生教授等经过4年研究，在国际上率先报道了中国艾滋病病毒(human immunodeficiency virus，HIV)感染者14. 6%合并乙型肝炎病毒(hepatitis B virus，HBV)感染，但高共感率并未影响到目前国产一线抗艾药物的疗效和肝毒性。相关论文5月17日在线发表于全球艾滋病研究领域最著名的杂志《艾滋病》上，与5月10日出版的《新英格兰医学杂志》呼吁全球警惕艾滋病合并乙肝病毒感染带来的肝损伤严重后果形成呼应。
经过长期规范的“鸡尾酒”治疗后，艾滋病患者体内病毒得到有效控制，由机会性感染引发的艾滋病患者死亡率逐年下降。与此同时，合并肝脏、肾脏、心血管及神经系统的疾病以及糖尿病等代谢性疾病，正成为影响艾滋病患者健康状况的主因。2008年，李太生教授意识到，摸清HIV感染人群中究竟有多少人合并HBV感染，合并感染对艾滋病的起病、发展及治疗会带来哪些影响，对乙肝高发的中国乃至东南亚国家和地区的艾滋病防控工作具有重要的现实意义。
自2008年起，李太生带领课题组从全国12个医疗中心募集了550例HIV感染者纳入该项研究，对这些从未接受过“鸡尾酒”疗法和其他抗艾治疗的初治患者免费发放国产一线抗艾药物，并依乙肝“两对半”的情况将患者分为从未感染组、既往感染组、慢性乙肝组以及单纯乙肝核心抗体阳性组4大组别，进行长达48周的随访观察。结果发现，HIV感染人群中14. 6%合并感染慢性乙肝，合并感染者CD4水平相对较低。分析原因，可能是二者感染途径相同、HIV感染后免疫力的下降使乙肝感染率提高所致。值得欣慰的是，研究同时发现，目前国产一线抗艾药物对HIV感染者的治疗效果并不受是否感染HBV的影响，产生肝毒性的几率也较小。
(北京协和医院党委综合办 段文利)
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[1] Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee [J]. JAMA, 1995, 274: 639-644. DOI: 10.1001/jama.1995.03530080055041
[2] Heyland DK, Cook DJ, Crifth L, et al. The atributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group [J]. Am J Respir Crit Care Med, 1999, 159:1249-1256. DOI: 10.1164/ajrccm.159.4.9807050
[3] Girou E, Stephan F, Novara A, et al. Risk factors and outcome of nosocomial infections: results of a matched casecontrol study of ICU patients [J]. Am J Respir Crit Care Med, 1998, 157:1151-1158. DOI: 10.1164/ajrccm.157.4.9701129
[4] Fabregas N, Ewig S, Torres A, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate postmortem lung biopsies[J]. Thorax, 1999, 54: 867-873. DOI: 10.1136/thx.54.10.867
[5] Heyland D, Ewig S, Torres A. Pro/con clinical debate: the use of a protected specimen brush in the diagnosis of ventilator associated pneumonia[J]. Crit Care, 2002, 6:117120.
[6] Canadian Critical Care Trials Group. Arandomizedrial of diagnostic techniques for ventilator-associated pneumonia[J]. N Engl J Med, 2006, 355: 2619-2630. DOI: 10.1056/NEJMoa052904
[7] Jackson SR, Emnst NE, Mueller EW, et al. Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients[J]. Am J Surg, 2008, 195: 159-163. DOI: 10.1016/j.amjsurg.2007.09.030
[8] Mentec H, May-Michelangeli L, Rabbat A, et al. Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia. A multicentre prospective study[J]. Intensive Care Med, 2004, 30:1319-1326. DOI: 10.1007/s00134-004-2284-7
[9] Leo A, Galindo-Galindo J, Folch E, et al. Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventilator-associated pneumonia[J]. Med Intensiva, 2008, 32: 115-120. DOI: 10.1016/S0210-5691(08)70921-5
[10] Flanagan PG, Findlay GP, Magee JT, et al. The diagnosis of ventilator-associated pneumonia using nonbronchoscopic, nondirected lung lavages[J]. Intensive Care Med, 2000, 26: 20-30. DOI: 10.1007/s001340050007
[11] Lorente L, Lecuona M, Jimeńez A, et al. Ventilator associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial[J]. Crit Care, 2006, 10:R116. DOI: 10.1186/cc5009
[12] Siempos Ⅱ, Vardakas KZ, Kopterides P, et al. Impact of passive humidification on clinical outcomes of mechanically ventilated patients: a metaanalysis of randomized controlled trials[J]. Crit Care Med, 2007, 35: 2843-2851.
[13] Siempos Ⅱ, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia [J]. Br J Anaesth, 2008, 100: 299306.
[14] Subirana M, Sola I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients[J]. Cochrane Database Syst Rev, 2007: CD004581.
[15] Lindgren S. Regional lung derecruitment after endotracheal suction during volumeor pressure-controlled ventilation: a study using electric impedance tomography[J]. Intensive Care Med, 2007, 33:172-180. DOI: 10.1007/s00134-006-0425-x
[16] Valle's J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia [J]. Ann Intern Med, 1995, 122:179-186. DOI: 10.7326/0003-4819-122-3-199502010-00004
[17] Dezfulian C, Shojania K, Collard HR, et al. Sublottie secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis[J]. AmJ Med, 2005, 118:11-18. DOI: 10.1016/j.amjmed.2004.07.051
[18] Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffis: evaluation of the new Microcuff endotracheal tube[J]. Intens Care Med, 2003, 29: 1849-1853. DOI: 10.1007/s00134-003-1933-6
[19] Poelaert J, Depuydt P, De Wolf A, et al. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study[J]. J Thorac Cardiovasc Surg, 2008, 135: 771-776. DOI: 10.1016/j.jtcvs.2007.08.052
[20] Lorente L, Lecuona M, Jime'nez A, et al. Influence of an endotracheal tube with polyurethane cuff and sublottic secretion drainage on pneumonia[J]. Am J Respir Crit Care Med, 2007, 176:1079-1083. DOI: 10.1164/rccm.200705-761OC
[21] Smulders K, van der Hoeven H, Weers-PothoffI, et al. A randomized clinical trial of intermittent sublottic secretion drainage in patients receiving mechanical ventilation[J]. Chest, 2002, 121: 858-862. DOI: 10.1378/chest.121.3.858
[22] Dragoumanis CK, Vretzakis GI, Papaioannou VE, et al. Investigating the failure to aspirate sublottic secretions with the Evac endotracheal tube[J]. Anesth Analg, 2007, 105: 1083-1085. DOI: 10.1213/01.ane.0000278155.19911.67
[23] Inglis TJ, Lim TM, Ng ML, et al. Structural features of tracheal tube biofilm formed during prolonged mechanical ventilation[J]. Chest, 1995, 108: 1049-1052. DOI: 10.1378/chest.108.4.1049
[24] Kollef MH, Afessa B, Anzueto A, NASCENT Investigation Group. Silvercoated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial[J]. JAMA, 2008, 300: 805-813.
[25] Raad I, Darouiche R, Hachem R, et al. The broad-spectrum activity and efficacy of catheters coated with minocycline and rifampin[J]. J Infect Dis, 1996, 173: 418-424. DOI: 10.1093/infdis/173.2.418
[26] Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilatorassociated pneumonia[J]. Chest, 2002, 122: 262-268. DOI: 10.1378/chest.122.1.262
[27] Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit ICU-Acquired Pneumonia Study Group[J]. Intens Care Med, 1996, 22: 387-394. DOI: 10.1007/BF01712153
[28] Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis[J]. Crit Care, 2008, 23: 91-100. DOI: 10.1016/j.jcrc.2007.08.007
[29] Parker CM, Kutsogiannis J, Muscedere J, et al. Ventilatorassociated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes[J]. J Crit Care, 2008, 23:1826.
[30] Sanders KM, Adhikari NK, Friedrich JO, et al. Previous. cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: secondary analysis from a randomized trial[J]. J Crit Care, 2008, 23: 58-63. DOI: 10.1016/j.jcrc.2008.01.009
[31] Depuydt P, Benoit D, Vogelaers D, et al. Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia[J]. Intens Care Med, 2008, 34: 675-682. DOI: 10.1007/s00134-007-0953-z
[32] Joffe AR, Muscedere J, Marshall JC, et al. The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study[J]. J Crit Care, 2008, 23: 82-90. DOI: 10.1016/j.jcrc.2007.12.006
[33] Chastre J, Wolf M, Fagon JY, et al. Comparison of8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial[J]. JAMA, 2003, 290: 2588-2598. DOI: 10.1001/jama.290.19.2588
[34] Giantsou E, Liratzopoulos N, Efraimidou E, et al. De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate[J]. Intens Care Med, 2007, 33: 1533-1540. DOI: 10.1007/s00134-007-0619-x
[35] Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy[J]. Crit Care Med, 2007, 35: 1888-1895. DOI: 10.1097/01.CCM.0000275389.31974.22
[36] Heyland DK, Dodek P, Muscedere J, et al Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia[J]. Crit Care Med, 2008, 36: 737-744. DOI: 10.1097/01.CCM.0B013E31816203D6
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