The Characters Of Disease Pattern And Laboratory Findings Of AIDS Associated Chronic Diarrhea

Objectives:To explore the clinical characters of Acquired Immunodeficiency syndrome (AIDS)-Associated chronic Diarrhea (AACD) and make further study of it's regularities on symptoms, symptom factors, mechanism of disease etc. in TCM theory and laboratory findings based on the hypothesis of advisor.Methods:The integration of retrospective study and cross-sectional study was adopted.1 Retrospective study:With pre-formed questionnaire, medical data from patients with ARCBD and hospitalized at the Infection Department of The 8th Hospital of Guangzhou City from Jan 1,2006 to Dec 31,2008, contains demographics, symptoms, complications, laboratory findings, enteroscopy and histopathologic examination were retrospective analyzed.2 Cross-sectional study:With pre-formed questionnaire, medical data from patients received intervention at either In-department or Out-department of Infection Department and TCM Department to The 8th Hospital of Guangzhou City from Apr 1,2009 to Oct 31,2009, contains demographics, symptoms, symptom factors, and laboratory findings were analyzed. The eligable participants includes 3 groups divided into 7 subgroups, which contain CD4>350 cells/ul (High Concentration in the Asymptomatic Stage, HCAS), CD4≤350 cells/ul (Low Concentration in the Asymptomatic Stage, LCAS) in the stage I, CAAD, AIDS-Associated Fever (AAF), AIDS-Associated Cough (AAC), AIDS-Associated Maculopapular Rash (AAMR) in the stageⅡ-Ⅳ, and No AIDS-Associated Diarrhea (NAAD).3 Statistical Analysis:Using the Two-Independent-Samples T Test for data with normal distribution and Two-Independent-Samples Nonparametric Test (Mann-Whitney U) for data with nonnormal distribution between two groups, ANOVA for the comparison among different groups, chi-square statistics by 2X2 contingency tables for dichotomous variables, and RXC contingency tables for the disordered dependent variables. Variable with statistically results at a p-level<0.05 were considered as significantly. With EpiDate 3.02 and Spss13.0 software, the data entry and analysis were performed respectively.Results1 Retrospective study:A total of 66 patients were enrolled in the outcome analysis. Of these,51,34,28 patients with feces culture, enteroscopy and histopathologic examination, respectively.1.1 Subject Characteristics Of those 66 patients (Ages:39.227±10.171, Male: 80.3%), singlehood, married, loss of spouse, and dissociation were 27.3%, 68.2%,3.0%and 1.5%respectively, elementary school, primary school and high school education were 13.6%,74.2%and 12.1%, sell blood, blood transfusion, drug abuse through intravenous injection, sex and in nubibus reasons were 1.5%, 1.5%,39.4%,47.0%and 10.6%respectively in the routes of infection.1.2 Symptoms:According to the frequency, the former 5 symptoms were tofukasu analog in oral cavity (72.7%), chilly (71.2%), debilitation (68.2%), fever (59.1%), and anorexy (51.5%), which may accompany with cough, gasping, bellyache, nausea, vomiting etc..1.3 Complications:Complications with the frequency percentage≥10%contained oral thrush (72.7%), pneumonia infection (66.7%), virus hepatitis (51.5%), cachexia (42.4%), tuberculosis (31.8%), fungal infections (27.3%), electrolyte disturbances (24.2%), cytomegalovirus (18.2%), and septicemia (13.6%).1.4 Laboratory findings:26 (39.4%),37 (56.1%),50 (75.8%),12 (18.2%),42 (63.6%),0 (0), and 0(0) patients had lower WBC, RBC, HGB, PLT, LYM, AST, and ALT concentration than normal range respectively, contrarily,9 (13.6%),0 (0),0(0),14 (21.2%),0(0),18 (27.3%), and 41 (62.1%) patients had higher concentration respectively. CD4≤200 cells/ul for all patients, of these, 51 (77.3%) patients were≤50 cells/ul. And 10 (19.6%) patients had positive results in the feces culture, of these,7 (13.7%) were positively in the eumycete culture.1.5 enteroscopy and histopathologic examination:31 patients (91.2%) had hyperemia and edema in the lamina propria or mucosa of intestinal tract, which had occurred in the sigmoid colon and ascending colon (58.8%), and 18 patients (52.9%) were diagnosed as colonitis. In the histopathologic examination,22 patients (78.6%) had lymphocyte infiltration in the lamina propria or mucosa of intestinal tract, and 9 patients (32. 1%)were diagnosed as non-specificity colonitis.1.6 Hypothesis:(1) Because many symptom factors were involved, the reasons and mechanism of AIDS were complicated, and were variably among different subtypes of AIDS; (2) The reasons of CAAD was the invasion of Ai poison, and the mechanism of CAAD was the spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or congestion; (3) Patients with CAAD has own characters on symptoms and laboratory findings, which maybe different with other subtypes of AIDS.2 cross-sectional study:A total of 140 patients were enrolled in the outcome analysis. Of these,20 patients were divided in HCAS, LCAS, CAAD, AAF, AAC, AAMR and NAAD subgroup in average, respectively.2.1 Subject Characteristics:Of these 140 patients (Male:63.6%), male, HAN people, married or cohabitation, primary school education, farmer or laborer were the main characters. In addition, blood transfusion, sex and drug abuse through intravenous injection were 9.2%,75%, and 9.2%respectively in the routes of infection.2.2 Symptoms:17 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, cough, expectoration, throat indisposition, anorexy, thirsty, abnormal taste, nausea and vomiting, lassitude, emaciation, light on face, light color on lip and nail, depression and bleeding in the asymptomatic stage had higher present percentage than patients in the stageⅡ-Ⅳ, but the headache and alopecie were lower. In the comparison between CAAD and other subtypes,12 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, debilitation, emaciation, light color on lip and nail, depression, chill and limb cold had higher present percentage than patients in the HCAS subgroup, but the aversion to wind and cold and headache were lower;10 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, nausea and vomiting, debilitation and emaciation had higher present percentage than patients in the LCAS subgroup, but the headache were lower; abdominal discomfort and abnormal stool had higher present percentage than patients in the AAF subgroup, but the fever was lower; abdominal discomfort and tinnitus had higher present percentage than patients in the AAMR subgroup, but the itch of skin was lower; abdominal discomfort was higher than patients in the AAC subgroup, but cough and expectoration was lower; 9 symptoms which include abnormal perspiration, cough, gasping, thirsty, tired, emaciation, light color on lip and nail, depression and tinnitus had higher present percentage than patients in the NAAD subgroup.2.3 symptom factors:In the comparison between CAAD and other subtypes,4 symptom factors include spleen, stomach, dampness and yang deficiency had higher present frequency than HCAS; spleen and dampness were higher than LCAS; spleen and stomach were higher but the septum pectorale was lower than AAF; spleen, stomach and yang deficiency had higher present frequency but the liver, skin and blood deficiency were lower than AAC; kidney, stomach and dampness were higher but the pneumonia was lower than AAMR; 5 symptom factors include pneumonia, spleen, kidney, qi deficiency and yang deficiency had higher present frequency but the small intestine and large intestine were lower than NAAD, and all the values of P<0.05.2.4 Laboratory findings:Concentration of HGB, RBC, LYM, CD4, CD8 and CD4/CD8 in the stageⅡ-Ⅳwere higher than patients in the asymptomatic stage. In the comparison between CAAD and other subtypes, HGB, RBC, PLT, CD4, CD8 and CD4/CD8 had significant difference in the analysis between subgroups, and in the multiple comparisons, RBC concentration in the LCAS was higher, and CD4 concentration and CD4/CD8 in the HCAS were higher than CAAD, but the HGB, PLT and CD8 concentration were nonsignificance.Conclusion1 The characters of symptom factors and mechanism of AACD1.1 The characters of symptom factors:The location of disease were main focused on spleen, kidney and stomach, and the nature of disease main focused on dampness, qi deficiency and yang deficiency mainly.1.2 The characters of reasons and mechanism The reasons of disease was the invasion of Ai poison, which effected by sex, mental health and iatrogenic lapsus etc.. The mechanism of disease was spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or stomach disharmony.1.3 The characters of reasons and mechanism were variably among different subtypes of AIDS.2 The symptoms characters of AACD2.1 Normal clinical symptoms:abdominal discomfort, watery stool, rotten stool, weary and heavy body, tofukasu analog in oral cavity, anorexy, nausea and vomiting, abnormal taste, thirsty, chill and limb cold, feeble on waist and knee, debilitation, light color on lip and nail, light on face, gasping, depression, chill, fever, abnormal perspiration, cough, throat indisposition, forgetful etc..2.2 The clinical symptoms of patients with CAAD were more severe than patients in the asymptomatic stage or with NAAD.2.3 The characters of symptoms were variably among different subtypes of AIDS.3 The characters of laboratory findings of AACD3.1 The characters of laboratory findings:Usually accompany with descent of RBC, HGB and CD4 especially, and heighten of AST. In the enteroscopy and histopathologic examination, morphology change of intestinal tract were the hyperemia and edema mainly, and usually had lymphocyte infiltration, which often occurred in the ileal valve, sigmoid colon, ascending colon, ileum and transverse colon.3.2 The characters of laboratory findings were variably among different subtypes of AIDS.4 The common demographics characters of AACDPeople with the following demographics characters may have high risks on the morbidity of AIDS or CAAD:male, middle aged, HAN people, married, primary school education, sex or drug abuse through intravenous injection or blood transfusion, and the occupation was farmer, or laborer, or commerce personnel, or unemployment.5 Approaches of reasons and mechanism of AACD studyThe integration of retrospective study and cross-sectional study was a suitable method for the reasons and mechanism of CAAD study, which may avoid the biases of the validity and the waste of research resources.