MedNexus
2020年 · 第133卷第23期
出版日期 2020-12-05电子版 ￥0.00元
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Editorial
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人类免疫缺陷病毒暴露前和暴露后预防的公共卫生意义Xu Jun-Jie, Shang Hong
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001150
摘要
为到2030年消除全球人类免疫缺陷病毒感染和获得性免疫缺陷综合征（HIV/AIDS）流行病对公共卫生的威胁，联合国艾滋病毒/艾滋病联合规划署于2014年启动了90-90-90控制目标，以帮助结束艾滋病毒的传播。中国积极应对，扩大和扩大艾滋病毒检测，实施早期抗逆转录病毒治疗。在实现90-90-90目标方面，中国在2018年实现了更高的百分比（83.4%vs79.5%）和第三（94.2%vs79.9%）高于全球平均水平，但低于第一个“90”目标的百分比（69.3%）vs79.9%），其目标是让90%的艾滋病毒感染者（PLWHIV）了解他们的艾滋病毒状况。同时，中国PLWHIV的估计数量由2013年的81万例增加至2018年的125万例。此外，虽然艾滋病在2019年全国法定法定传染病病例数中排名第三，但在此类疾病导致的死亡人数中排名第一。上述证据表明，过度依赖HIV检测和早期ART远远不足以完全控制HIV。有必要推进直接预防和控制战略，降低关键人群感染艾滋病毒的风险。艾滋病毒接触前预防（PrEP）和非职业接触后预防（nPEP）只是这项工作中需要充分利用的两项措施。
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获得性免疫缺陷综合征抗逆转录病毒治疗的进展与挑战Bai Ruo-Jing, Dai Li-Li, Wu Hao
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001226
摘要
自1983年首次被隔离以来，人类免疫缺陷病毒（HIV）已导致近5000万人死亡，影响全球数百万人。联合抗逆转录病毒疗法（ART）因其对HIV复制和传播控制的有益作用而被普遍推荐用于HIV感染。[
Original Article
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大学生、非学生青年和老年男男性行为者中人类免疫缺陷病毒发病率和耐药性的差异：来自中国七个主要城市的横断面研究Zhang Jing, Xu Jun-Jie, Chu Zhen-Xing, Hu Qing-Hai, Han Xiao-Xu, Zhao Bin, Jiang Yong-Jun, Geng Wen-Qing, Shang Hong
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001161
摘要
Background:
Human immunodeficiency virus (HIV) prevalence among student men who have sex with men (MSM) in college is more than 5.0% and keeps on increasing in China. This study aims to clarify the proportion of HIV recent infection, its propeller and the source among college student MSM.
Methods:
We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013. HIV recent infections (≤168 days) and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay (BED-CEIA) testing strategy. HIV-related behaviors and transmitted drug resistance (TDR) were investigated and compared between the college student MSM, < 25-year-old non-student youth MSM (NSYM), and ≥25-year-old non-student non-youth MSM (NSNYM), using structured survey, and analyses of drug resistance.
Results:
Overall, 4496 (4496/4526, 99.3%) were eligible for enrollment, comprising 565 college student MSM, 1094 NSYM, and 2837 NSNYM. The proportion of HIV recent infection were 70.3% (26/37), 50.8% (65/128) and 35.1% (95/271), the HIV incidence rate were 10.0 (95% CI: 6.2-13.9)/100 person-year (PY), 12.9 (95% CI: 9.8-16.1 )/100PY, 6.8 (95% CI: 5.4-8.2)/100 PY, and TDR prevalences were 7.4% (2/27), 2.0%, (2/98) and 4.9% (11/226), among student MSM, NSYM, and NSNYM, respectively. Among HIV positive student MSM with age <21 years, the proportion of HIV recent infection is 90.9% (10/11). Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.0-5.8).
Conclusions:
College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013. The HIV infections were more likely to happen during the early year of college life among student MSM.
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人类免疫缺陷病毒相关性隐球菌性脑膜炎的临床特征和治疗结果：2年回顾性分析Song Wei, Shen Yin-Zhong, Wang Zhen-Yan, Qi Tang-Kai, Liu Li, Zhang Ren-Fang, Wang Jiang-Rong, Tang Yang, Chen Jun, Sun Jian-Jun 等
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001191
摘要
Background:
Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.
Methods:
Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.
Results:
Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm3, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25-12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ2 = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166-13.269, P= 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548-35.974, P = 0.001) were associated with higher mortality at 8 weeks.
Conclusion:
This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.
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中国上海人类免疫缺陷病毒(HIV)伴弥漫性大B细胞淋巴瘤(DLBCL)患者的临床结局Sun Jian-Jun, Liu Li, Wang Jiang-Rong, Shen Yin-Zhong, Qi Tang-Kai, Wang Zhen-Yan, Tang Yang, Song Wei, Chen Jun, Zhang Ren-Fang
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001180
摘要
Background:
Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus (HIV). However, little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV (PLHIV). Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab(R-CHOP) as front line therapy for PLHIV with diffuse large B-cell lymphoma (DLBCL) receiving modern combined antiretroviral therapy (cART).
Methods:
A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019. The demographic and clinical data were collected, and overall survival (OS) and progression-free survival (PFS) analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis. Additionally, a Cox multiple regression model was constructed to identify related factors for OS.
Results:
A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months (interquartile range [IQR]: 8-29 months). The proportion of high international prognostic index (IPI) patients was much larger in the DA-EPOCH-R group (n = 29) than that in the R-CHOP group (n = 25). The CD4 cell counts and HIV RNA levels were not significantly different between the two groups. The 2-year OS for all patients was 73%. However, OS was not significantly different between the two groups, with a 2-year OS rate of 78% for the DA-EPOCH-R group and 66% for the R-CHOP group. Only an IPI greater than 3 was associated with a decrease in OS, with a hazard ratio of 5.0. The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups.
Conclusions:
Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy. No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.
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同种异体自然杀伤细胞免疫治疗对人类免疫缺陷病毒1型免疫无应答者的安全性和有效性：简要报告Xia Huan, Wang Yin, Sun Hua-Li, Gao Li-Ying, Cao Yu, Zaongo Silvere D., Zeng Rong-Nan, Wu Hao, Zhang Ming-Jie, Ma Ping
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001189
摘要
Background:
Allogeneic natural killer (NK) cell immunotherapy is recognized as a promising anti-tumor strategy, but whether it plays a role in poor CD4 recovery among human immunodeficiency virus type 1 (HIV-1) infected patients is unknown. This study aimed to investigate the safety and effectiveness of allogeneic NK cells immunotherapy on HIV-1 immunological non-responders (INRs) receiving antiretroviral therapy (ART).
Methods:
From February to April 2018, a prospective, randomized, controlled, open-label clinical trial, which enrolled 20 HIV-1 INRs following specific inclusion criteria, was conducted at Nankai University Second People’s Hospital. Participants were randomly allocated (simple randomization 1:1) to either the combined treatment (NK + ART) group (n = 10) or the control (ART) group (n = 10). The allogenic highly activated NK cells from killer cell immunoglobulin-like receptor (KIR)/human leukocyte antigen (HLA)-Cw mismatched healthy donor were prepared (108 cells in each injection) and intravenously infused to each recruited patient of NK+ART group in three courses. Key immune parameters (CD4 count, CD8 count, CD4/CD8 ratio), laboratory tests (count of blood cells, biochemistry panel) and symptoms at baseline and at month 1, 3, 6, 9, 12, and 24 were measured/collected to analyze the safety and efficacy of the therapy. Comparisons were between the seven time-points of both groups using repeated measurement analysis of variance (ANOVA) test. Generalized estimating equations (GEE) model was performed to evaluate the overall effect of the NK+ART group vs. the ART group.
Results:
From baseline to 24 months, we noted a mean CD4 count augmentation (139 to 243 cells/μL) in the NK + ART group and (144 to 176 cells/μL) in the ART group (difference, 67; 95% CI, 10 to 124; P = 0.024). Our estimations revealed that NK+ART group could improve CD4 level (β = 54.59, P= 0.006) and CD8 level (β = 322.47, P= 0.010) on average among the six measurements compared with the ART group. Only two (2/10, 20%) participants in the NK+ART group developed a transient mild fever after the first course.
Conclusions:
This preliminary study informs that HIV-1 INRs, allogenic NK cells immunotherapy is safe and could significantly improve CD4 recovery but not CD4/CD8 ratio. The practical effects, however, need long-term follow-up observations. Further study on the potential underlying mechanism is warranted.
Registration info:
www.chictr.org.cn/showproj.aspx?proj=34912 (No. ChiCTR1900020634).
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深圳市接受一线抗逆转录病毒治疗3年的人类免疫缺陷病毒感染者血脂变化及血脂异常危险因素分析Sun Li-Qin, Liu Jia-Ye, He Yun, Zhou Yang, Xu Liu-Mei, Zhang Lu-Kun, Zhao Fang, Liu Xiao-Ning, Song Ying, Cao Ting-Zhi 等
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001245
摘要
Background:
Lipid abnormalities are prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and contribute to increasing risk of cardiovascular events. This study aims to investigate the incidence of dyslipidemia and its risk factors in PLWH after receiving different first-line free antiretroviral regimens.
Methods:
PLWH who sought care at the Third People’s Hospital of Shenzhen from January 2014 to December 2018 were included, and the baseline characteristics and clinical data during the follow-up were collected, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The risk factors of dyslipidemia after antiretroviral therapy were analyzed with the generalized estimating equation model.
Results:
Among the 7623 PLWH included, the mean levels of TC, HDL-C and LDL-C were 4.23 ± 0.85 mmol/L, 1.27 ± 0.29 mmol/L and 2.54 ± 0.65 mmol/L, respectively, and the median TG was 1.17 (IQR: 0.85-1.68) mmol/L. Compared with that in PLWH receiving tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + ritonavir-boosted lopinavir (LPV/r), zidovudine (AZT) + 3TC + efavirenz (EFV), and AZT + 3TC + LPV/r, the incidence of dyslipidemia was lower in PLWH receiving TDF + 3TC + EFV. In multivariate analysis, we found that the risks of elevations of TG, TC, and LDL-C were higher with TDF + 3TC + LPV/r (TG: odds ratio [OR] = 2.82, 95% confidence interval [CI]: 2.55-3.11, P < 0.001; TC: OR = 1.24, 95% CI: 1.14-1.35, P < 0.001; LDL: OR = 1.06, 95% CI: 1.00-1.12, P = 0.041), AZT + 3TC + EFV (TG: OR = 1.41, 95% CI: 1.28-1.55, P < 0.001; TC: OR = 1.43, 95% CI: 1.31-1.56, P < 0.001; LDL: OR = 1.18, 95% CI: 1.12-1.25, P < 0.001), and AZT + 3TC + LPV/r (TG: OR = 3.08, 95% CI: 2.65-3.59, P < 0.001; TC: OR = 2.40, 95% CI: 1.96-2.94, P < 0.001; LDL: OR = 1.52, 95% CI: 1.37-1.69, P < 0.001) than with TDF + 3TC + EFV, while treatment with TDF + 3TC + LPV/r was less likely to restore HDL-C levels compared with TDF + 3TC + EFV (OR = 0.95, 95% CI: 0.92-0.97, P < 0.001). In addition to antiretroviral regimens, antiretroviral therapy duration, older age, overweight, obesity and other traditional factors were also important risk factors for dyslipidemia.
Conclusion:
The incidence of dyslipidemia varies with different antiretroviral regimens, with TDF + 3TC + EFV having lower risk for dyslipidemia than the other first-line free antiretroviral regimens in China.
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前后路治疗四节段脊髓型颈椎病的比较Zhai Ji-Liang, Guo Shi-Gong, Nie Li, Hu Jian-Hua
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001146
摘要
Background:
The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.
Methods:
A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.
Results:
There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.
Conclusions:
Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
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口腔感觉主诉患者病例对照研究的多因素分析Jin Jian-Qiu, Cui Hong-Mei, Han Ying, Su Sha, Liu Hong-Wei
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001190
摘要
Background:
There are an increasing number of patients with oral sensory complaints (OSCs) presenting to our dental clinic. For most dentists, it is difficult to distinguish burning mouth syndrome (BMS) from other oral mucosal diseases that may cause symptoms such as burning mouth. It is beneficial to effectively distinguish OSC patients to reduce misdiagnosis and eliminate burning symptoms as much as possible.
Methods:
Patients with oral burning sensations in the oral mucosal disease clinic were collected from the Peking University Hospital of Stomatology between September 1, 2014 and December 31, 2018. After excluding oral candidiasis, anemic stomatitis, dental material allergy, and other diseases from patients with oral sensory complaints, basic conditions such as gender, age, education level, job status, hyperglycemia, hypertension, hyperlipidemia, history of brain abnormalities, history of cervical spondylitis, history of thyroid disease, history of thyroid disease and insomnia were obtained. The BMS patients were compared with the control group. The t test and Chi-square test were used for statistical analysis to compare the clinical symptoms of these diseases and explore the risk factors for BMS.
Results:
In this case-control study, 395 patients (321 females and 74 males, mean age 55.26 ± 10.51 years) with oral sensory complaints and 391 healthy controls (281 females and 110 males, mean age 47.11 ± 13.10 years) were enrolled, among which, 8.4% (33/395) had oral candidiasis, 1.3% (5/395) had dental material allergy, 0.8% (3/395) had anemic stomatitis and 0.5% (2/395) had lichen planus. A total of 352 patients were eventually diagnosed with BMS. Anxiety and depression were more severe in BMS patients, as were the incidences of sleep disorders and brain abnormalities. Logistic regression analysis showed that age (odds ratio [OR]= 2.79, 95% confidence interval [CI]: 1.61-4.83, P < 0.001), total cholesterol level (OR= 2.92, 95% CI: 1.32-6.50, P = 0.009) and anxiety score (OR = 1.75, 95% CI: 1.01-2.77, P = 0.017) significantly increased the incidence of BMS. Patients with hyperglycemia (OR = 0.46, 95% CI: 0.23-0.89, P = 0.022), low body mass index (BMI: OR = 0.57, 95% CI: 0.34-0.93, P = 0.026) and low education level (OR = 3.43, 95% CI: 1.91-6.15, P < 0.001) were more likely to suffer from BMS.
Conclusions:
Oral candidiasis, anemic stomatitis, and dental material allergy with burning symptoms should be excluded from patients with BMS. It is recommended to conduct a questionnaire survey (including anxiety and depression), blood cell analysis, and salivary fungus culture for all patients with an oral burning sensation. It is necessary to conduct a patch test on patients with oral burning sensations and metal restorations.
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骨髓间充质干细胞来源的外来体微小RNA调节急性髓系白血病细胞增殖和凋亡Xu Yi-Chuan, Lin Yan-Si, Zhang Ling, Lu Ying, Sun Yan-Ling, Fang Zhi-Gang, Li Zi-Yu, Fan Rui-Fang
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001138
摘要
Background:
Acute myeloid leukemia (AML) is a malignant hematological disease, originating from hematopoiesis stem cell differentiation obstruction and clonal proliferation. New reagents or biologicals for the treatment of AML are urgently needed, and exosomes have been identified as candidate biomarkers for disease diagnosis and prognosis. This study aimed to investigate the effects of exosomes from bone marrow mesenchymal stem cells (BMSCs) on AML cells as well as the underlying microRNA (miRNA)-mediated mechanisms.
Methods:
Exosomes were isolated using a precipitation method, followed by validation using marker protein expression and nanoparticle tracking analysis. Differentially expressed miRNAs were identified by deep RNA sequencing and confirmed by quantitative real-time polymerase chain reaction (qPCR). Cell proliferation was assessed by the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt method, and cell cycle progression and apoptosis were detected by flow cytometry. Functional gene expression was analyzed by qPCR and Western blotting (WB). Significant differences were determined using Student’s t test or analysis of variance.
Results:
BMSCs-derived exosomes effectively suppressed cell proliferation (both P < 0.0001 at 10 and 20 μg/mL) and cell cycle progression (P < 0.01 at G0-G1 stage), and also significantly enhanced cell apoptosis (P < 0.001) in KG-1a cells. There were 1167 differentially expressed miRNAs obtained from BMSCs-derived exosomes compared with KG-1a cell-derived exosomes (P < 0.05). Knockdown of hsa-miR-124-5p in BMSCs abrogated the effects of BMSCs-derived exosomes in regulating KG-1a such as the change in cell proliferation (both P < 0.0001 vs. normal KG-1a cell [NC] at 48 and 72 h). KG-1a cells treated with BMSCs-derived exosomes suppressed expression of structural maintenance of chromosomes 4 (P < 0.001 vs. NC by qPCR and P < 0.0001 vs. NC by WB), which is associated with the progression of various cancers. This BMSCs-derived exosomes effect was significantly reversed with knockdown of hsa-miR-124-5p (P < 0.0001 vs. NC by WB).
Conclusions:
BMSCs-derived exosomes suppress cell proliferation and cycle progression and promote cell apoptosis in KG-1a cells, likely acting through hsa-miR-124-5p. Our study establishes a basis for a BMSCs-derived exosomes-based AML treatment.
Clinical Guideline
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中国人类免疫缺陷病毒暴露前预防共识声明Xu Jun-Jie, Huang Xiao-Jie, Liu Xin-Chao, Wang Li-Ming, Chen Yao-Kai, Wang Hui, Zhang Fu-Jie, Wu Hao, Li Tai-Sheng, Han Meng-Jie 等
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001181
摘要
尽管全球人类免疫缺陷病毒（HIV）疫情已得到有效遏制，但在高危人群中预防和管理HIV感染仍然具有挑战性。[
Consensus Statement
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2019冠状病毒病患者实施床旁超声心动图和远程会诊的中国建议Echocardiography Group of Ultrasound Medicine Society of Chinese Medical Association, Cardiovascular Imaging Group of Cardiovascular Society of Chinese Medical Association, Echocardiography Society of Chinese College of Cardiovascular Physician of Chinese Medical Doctor Association, Ultrasound Medicine Committee of Chinese Medicine Education Association
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001222
摘要
研究发现，一些2019冠状病毒病（COVID-19）患者存在临床相关的心脏损伤，据报道，在中国武汉，COVID-19患者心肌炎的发病率在医院为12%，在重症监护室为32%。[
Review Article
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HIV传播网络研究进展Dong Zhi-Long, Gao George Fu, Lyu Fan
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001155
摘要
Transmission network analysis is a crucial evaluation tool aiming to explore the characteristics of the human immunodeficiency virus epidemic, develop evidence-based prevention strategies, and contribute to various areas of human immunodeficiency virus/acquired immunodeficiency syndrome prevention and control. Over recent decades, transmission networks have made tremendous strides in terms of modes, methods, applications, and various other aspects. Transmission network methods, including social, sexual, and molecular transmission networks, have played a pivotal role. Each transmission network research method has its advantages, as well as its limitations. In this study, we established a systematic review of these aforementioned transmission networks with respect to their definitions, applications, limitations, recent progress, and synthetic applications.
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HIV感染者无症状隐球菌抗原血症的研究进展Xu Xiao-Lei, Zhao Ting, Harypursat Vijay, Lu Yan-Qiu, Li Yan, Chen Yao-Kai
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001134
摘要
The prevalence of asymptomatic cryptococcal antigenemia (ACA) in human immunodeficiency virus (HIV) infected individuals has been observed to be elevated. The prevalence of ACA ranges from 1.3% to 13%, with different rates of prevalence in various regions of the world. We reviewed studies conducted internationally, and also referred to two established expert consensus guideline documents published in China, and we have concluded that Chinese HIV-infected patients should undergo cryptococcal antigen screening when CD4+ T-cell counts fall below 200 cells/μL and that the recommended treatment regimen for these patients follow current World Health Organization guidelines, although it is likely that this recommendation may change in the future. Early screening and optimized preemptive treatment for ACA is likely to help decrease the incidence of cryptococcosis, and is lifesaving. Further studies are warranted to explore issues related to the optimal management of ACA.
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HIV-1潜伏库的异质性Zhao Jia-Cong, Deng Kai
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001085
摘要
Antiretroviral therapy (ART) can effectively inhibit human immunodeficiency virus-1 (HIV-1) replication, but is not curative due to the existence of a stable viral latent reservoir harboring replication-competent proviruses. In order to reduce or eliminate the HIV-1 latent reservoir, characteristics of the latently infected cells need to be intensively studied, and a comprehensive understanding of the heterogenous nature of the latent reservoir will be critical to develop novel therapeutic strategies. Here, we discuss the different cell types and mechanisms contributing to the complexity and heterogeneity of HIV-1 latent reservoirs, and summarize the key challenges to the development of cure strategies for acquired immunodeficiency syndrome (AIDS).
Medical Progress
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梅毒患者治疗后血清Fast状态的预测因素Liu Xiao-Ke, Wang Zhong-Shuai, Li Jun
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001175
摘要
梅毒是一种性传播感染(STI)，由梅毒螺旋体梅毒仍然是世界范围内的主要公共卫生问题。对梅毒治疗的阳性反应由治疗后非密螺旋体滴度降低四倍或血清逆转来指示。大约5%至41%的梅毒患者对治疗无反应，并保持血清反应迟钝[
Viewpoint
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HIV感染者无症状神经梅毒可能需要早期干预Chen Hong-Jie, Yu Tao, Peng Jie
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001143
摘要
梅毒是由螺旋体引起的性传播感染梅毒螺旋体(T.苍白球），具有全球和历史意义。由于病原体获取方式重叠，HIV（PLWH）感染者经常合并感染梅毒。神经梅毒可以发生在梅毒感染的任何阶段，PLWH在早期和晚期潜伏梅毒（包括无症状中枢神经系统（CNS）感染）中比没有HIV感染的人更有可能发生神经梅毒。部分神经梅毒患者表现为脑膜炎、脑卒中、脑神经功能障碍、听觉或眼科异常、精神状态急性改变等神经系统表现。然而，PLWH的一些神经梅毒病例缺乏中枢神经系统感染的体征或症状。无症状神经梅毒是在没有神经体征或症状的情况下诊断的，并且只能在存在指示CNS感染的脑脊液（CSF）异常的情况下检测到，包括单核红细胞增多症、蛋白质浓度增加和/或反应性CSF性病研究实验室（VDRL）测定。这引起了人们的担忧，即T.苍白球尽管在中枢神经系统中无症状，但可能导致PLWH的治疗失败和神经系统后遗症。神经梅毒甚至在感染数年后可能导致脑神经麻痹、梅毒性脑膜炎、全身轻瘫和背侧麻痹。因此，PLWH无症状神经梅毒可能需要早期干预。
Clinical Observation
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脑代偿机制促进Rasmussen脑炎儿童患者的康复：一例16年随访Long Han-Chun, Liu Chun-Feng, Chu Lan
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001083
摘要
致编辑：Rasmussen脑炎（RE）是一种原因不明的慢性炎症性疾病，通常累及大脑的一个半球。[
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中国房颤住院患者的当代特征、管理和预后：来自中国房颤登记处真实世界研究的结果Zhao Qing-Yan, Shi Shao-Bo, Huang He, Jiang Hong, Yang Bo, Wu Gang, Bao Ming-Wei, Liu Yu, Tang Yan-Hong, Wang Xi 等
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001151
摘要
在流行病学从传染性疾病向非传染性疾病转变的背景下，心房颤动（AF）是一个日益严重的公共卫生问题，在中国住院死亡患者中发现AF的高患病率。[
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一期修复在自发性食管破裂治疗中的作用：一个中心几十年的经验Li Bao-Zhong, Xu Xin-Jian, Zhu Hui, Chen Xin, He Ming
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001153
摘要
自发性食管破裂，或Boerhaave综合征，是一种罕见但潜在致命的疾病，在文献中死亡率为20%至30%。[
Rapid Report
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获得性免疫缺陷综合征进行性多灶性白质脑病患者John Cunningham多瘤病毒DNA的测序与分析Hu Cai-Qin, Su Jun-Wei, Wang Meng-Yan, Guo Yong-Zheng, Xu Li-Jun, Tao Ran, Xie Yi-Rui, Huang Ying, Zhu Biao
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001225
摘要
约翰·坎宁安（JC）多瘤病毒于1971年首次在一名患有进行性多灶性白质脑病（PML）的患者中发现。PML的诊断包括明确（病因）诊断和推定（临床）诊断。病因诊断包括脑脊液（CSF）确认的PML（CSF中JC多瘤病毒的证据）和组织确认的PML（脑组织中JC多瘤病毒的证据）。PML的临床诊断被定义为典型的临床和磁共振成像（MRI）发现的证据。[
Correspondence
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加强当前人类免疫缺陷病毒/乙型肝炎和人类免疫缺陷病毒/丙型肝炎病毒合并感染管理Huang Zhan-Lian, Chen Da-Biao, Gao Zhi-Liang, Lin Bing-Liang
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001149
摘要
致编辑：慢性乙型肝炎病毒（HBV）感染在全球人类免疫缺陷病毒（PLWH）感染者中很常见（7.4%），据报道，撒哈拉以南非洲和亚洲的患病率最高。[
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在人类免疫缺陷病毒阳性骨折患者中，elvitegravir/cobicistat/恩曲他滨/替诺福韦艾拉酚胺方案术前快速抑制病毒载量可显著减少术后并发症Ma Rui, Zhang Qiang, Zhang Yao-Shen, Xu Biao, Tong Zhi-Wen, Zhao Chang-Song, Zhao Ru-Gang
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001185
摘要
致编辑：中国有125万人类免疫缺陷病毒（HIV）（PLWH）感染者，2018年新增确诊病例超过13.5万例。[
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改良细针穿刺结合细胞阻滞诊断中国人免疫缺陷病毒/获得性免疫缺陷综合征患者卡波西肉瘤Sun Lei, Zhang Liang, Yang Kun, Chen Jia-Min, Chen Xiang-Mei, Li Man, Zhou Xin-Gang, Ma Zhi-Yuan, Qi Li-Ming, Wang Peng
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001137
摘要
致编辑：卡波西肉瘤（KS）是一种低度血管肿瘤，是获得性免疫缺陷综合征（AIDS）患者中最常见的肿瘤之一。根据流行病学和临床特征，已报道了四种类型的KS：经典KS、地方性KS（在赤道非洲）、艾滋病相关KS（AIDS-KS）和医源性KS。临床上，KS的表现可能是可变的，有可能在皮肤和粘膜上出血或溃疡的深色或棕色斑块、斑块或结节。此外，淋巴结和一些内脏器官也可能在疾病的更晚期受累。
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达比加群致食管损伤1例Zhang Jing-Rui, Li Chang-Yi, Li Song-Nan, Dong Jian-Zeng, Ma Chang-Sheng
中华医学杂志英文版2020年 133卷 23期
DOI: 10.1097/CM9.0000000000001173
摘要
致编辑：心房颤动（AF）是中风的主要危险因素之一，与中风发病率增加五倍相关。多年来，华法林一直被用于降低房颤患者的血栓形成风险。然而，由于华法林的挑剔性质（即，不可预测的药代动力学、频繁的国际标准化比值检测、复杂的食药相互作用等），已逐渐被多种直接口服抗凝剂（DOACs）所取代。达比加群是一种直接靶向凝血酶的强效、竞争性和可逆的DOAC，于2010年被美国食品药品监督管理局批准作为非瓣膜性房颤的替代抗血栓选择。虽然长期抗凝治疗随机评估（RE-LY）试验（一项比较华法林与达比加群在房颤患者中的非劣效性试验）显示达比加群在预防卒中或全身栓塞方面与华法林一样成功，但其不良反应也需要关注。[
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