T淋巴因子变化对免疫重建炎性综合征发生的影响  

The study on clinical manifestations and T lyphokine levels of HAART associated immune reconstitution inflammatory syndrome

作　　者：周国强[1] 郑煜煌[1] 刘猛[1] 王敏 肖钢 何艳[1] 周华英[1] 谌资[1] 

机构地区：[1]中南大学湘雅二医院感染科,长沙410011 [2]长沙市第一医院

出　　处：《中国医师杂志》2010年第9期1158-1161,共4页Journal of Chinese Physician

基　　金：国家十五攻关课题基金资助（2004BA719A10）

摘　　要：目的 了解HIV/AIDS启动高效抗逆转录病毒治疗（HAART）后免疫重建炎性综合征（IRIS）发生基本情况,观测代表Th1/Th2平衡间的主要淋巴因子在HAART前及HAART启动后的基础及变化水平,探索IRIS可能的免疫病理机制.方法 采用前瞻性研究,对进行高效抗逆转录病毒治疗（HAART）的HIV/AIDS进行为期6个月跟踪随访观察,确立IRIS组及非IRIS组,并进行代表Th1/Th2平衡关系的主要T淋巴因子：IL-2、INF-γ、IL-4、IL-10的检测,与健康组对照同时并对HAART前、HAART启动后1、3和6个月时变化水平进行比较.结果 一共观察HAART初始启动的病例共212例.HAART启动6个月内共诊断IRIS59例,IRIS中位发生时间在启动HAART后第21天（四分位间距时间为19 d）.发生的疾病谱主要包括结核病、疱疹病毒感染、肺胞子菌肺炎等.不论是在IRIS组还是在非IRIS组,代表Th1/Th2平衡关系的主要淋巴因子IL-2、INF-γ与IL-4、IL-10的水平,其HAART前基础值均较正常人群检测值分别有降低与增加,差异有统计学意义（P＜0.05）,在HAART启动后则分别表现出逐步增高与下降而恢复平衡的趋势,两组HAART6个月后的值较HAART前基础值差异均有统计学意义（P＜0.05）.而IRIS组HAART前上述淋巴因子的基础值与正常对照变化程度较非IRIS组更加明显,在HAART启动后1个月（IRIS高发阶段）,IL-2、INF-γ的增高水平[（11.68±2.89）pg/ml vs（8.52±2.26）pg/ml;（22.19±6.22）pg/ml vs（18.34±5.35）pg/ml]与IL-10的下降水平[（19.21±4.03）pg/mlvs（23.19±5.92）pg/ml]在两组间比较,差异有统计学意义（P＜0.05）.结论 （1）本研究中HIV/AIDS在启动HAART 6个月内的IRIS发生率为27.8%,多发生于HAART启动后1个月内,最常见疾病谱为结核病、疱疹病毒感染等感染性疾病.（2）IRIS组及非IRIS组在HAART前均存在Th1/Th2的失衡,前者的失衡趋向更明显,在HAART开始后都有恢复平衡的趋势,其中Th1的代表因子IL-2、INObjective To determine the incidence, clinical manifestation and part of lymphokines which represent the balance of Th1 and Th2 in the role of the immunologic mechanisms for IRIS（immune restoration inflammatory syndromes）in patients initiating HAART（Highly Active Antiretroviral Therapy）.Methods A prospective study of all patients initiating HAART was performed. A period of six months tracking initiating HAART was performed. The incidence of IRIS, time of occurrence and clinical disease spectrum were recorded. The main T lymphokines including IL-2, INF-γ, IL-4, IL-10 which on behalf of the balance of Th1 and Th2 were detected. To explore the immunopathologic mechanisms for IRIS, the levels of T lymphokines at pre-HAART, initiating HAART for 1 month, 3months and 6 months were compared in IRIS group and non-IRIS group, healthy group. Results A total of 212 patients were enrolled in this study. 59 patients were diagnosed as IRIS at a median of 21 days after HAART initiation （QR 19 days）.The main disease spectrum included tuberculosis, herpes virus infections, pneumocystis jirovecii pneumonia. No matter in the IRIS group or non-IRIS group, the main lymphokines baseline of IL-2, INF-γ reduced and IL-4, IL-10 increased before HAART compared to healthy group （P 〈 0. 05）, which had the tendency to restore balance relations initiating HAART. The lymphokines levels had significant difference between baseline and 6 months initiating HAART （P 〈 0. 05）. The changed levels of lymphokines between IRIS group and non-IRIS group before HAART had significant difference compared to healthy group. IL-2, INF-γ increased level[（11.68 ± 2. 89） pg/ml vs （8.52 ±2.26） pg/ml; （22. 19 ± 6. 22） pg/ml vs （18.34 ±5. 35） pg/ml] and IL-10 decreased level [（19. 21 ± 4. 03） pg/ml vs （23. 19 ± 5.92） pg/ml] had significant difference between IRIS group and non-IRIS group initiating HAART I month（P 〈0. 05）. Conclusions The incidence of IRIS during 6 months initiating HAART in HIV/AIDS was 2

关 键 词：淋巴因子/代谢 免疫重建炎症综合征/代谢 抗逆转录病毒治疗 高效/副作用 猫获得性免疫缺陷综合征/药物疗法 

分 类 号：R512.91[医药卫生—内科学]