长期高效抗反转录病毒疗法对HIV-1感染者免疫重建作用研究  

Immune reconstitution in HIV-1 infected individuals with long-term highly active antiretroviral therapy

作　　者：冯磊[1] 寿春晖[2] 靳昌忠[3] 董明清 金元昊[5] Norbert Brockmeyer 吴南屏[3] 严杰[1] 

机构地区：[1]浙江大学医学院病原生物学系,杭州310058 [2]浙江大学医学院临床医学系,杭州310058 [3]浙江大学医学院附属第一医院传染病诊治国家重点实验室 [4]浙江省青春医院感染科 [5]浙江大学竺可桢学院巴德年医学班 [6]德国鲁尔大学约瑟夫艾滋病研究中心

出　　处：《中华临床感染病杂志》2010年第4期200-203,共4页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的 探讨长期高效抗反转录病毒疗法（highly active antiretroviral therapy,HAART）对HIV-1感染者免疫重建的作用.方法 收集42例HIV-1感染者作为研究对象,将其分为HAART治疗组（25例）和未治疗组（17例）,另选15名健康人群作为对照,采用流式细胞仪检测受试者外周血CD4＋T细胞、CD8＋T细胞、CD8/人白细胞DR抗原（HLADR）＋T细胞、CD8/CD38＋T细胞计数,以及CD127在CD3＋T细胞的表达情况,采用酶联免疫吸附试验（ELISA）检测HAART治疗组外周血IL-7浓度.样本均数采用t检验.结果 HAART治疗组治疗前CD4＋T细胞计数明显低于健康对照组（t=9.12,P＜0.01）,CD8＋T细胞、CD8/HLADR＋T细胞和CD8/CD38＋T细胞计数明显高于健康对照组（t=4.48、4.89和3.88,P值均＜0.01）.HAART治疗7年后,HIV-1感染者CD4＋T细胞计数明显上升,CD8＋T细胞计数明显下降,但均未达到正常水平（t=2.66和2.43,P值均＜0.05）,CD8/HLADR＋T细胞和CD8/CD38＋T细胞则逐渐降至正常水平（t=0.86和1.39,P值均＞0.05）.治疗前HIV-1感染组外周血IL-7显著高于健康对照组（t=5.31,P＜0.01）,经HAART治疗,IL-7水平逐年下降,但仍高于健康对照组（t=2.81,P＜0.05）.未治疗组患者CD3＋CD8＋T细胞表面CD127表达明显低于健康对照组（t=6.01,P＜0.05）,HAART治疗组CD3＋CD8＋T细胞表面CD127表达高于未治疗者（t=2.32,P＜0.05）,但仍低于健康对照组（t=4.49,P＜0.05）;处女型（CD45RA＋）CD3＋CD8＋T细胞表面CD127表达基本接近健康对照组（t=0.28,P＞0.05）,而记忆型（CD45RO＋）CD3＋CD8＋T细胞表面CD127的表达仍然明显低于健康对照组（t=4.86,P＜0.05）.结论 长期有效的HAART能使HIV-1感染者淋巴细胞亚群在数量和功能上得到一定程度的恢复,体内的异常免疫激活得到明显抑制.Objective To evaluate the immune reconstitution of HIV-1 infected individuals after long-term highly antiretroviral therapy （HAART）. Methods Twenty-five HIV-1 infected individuals receiving HAART, 17 without HAART and 15 healthy controls were included in the study. CD4 ＋T, CD8 ＋T,CD8/human leukocyte antigen DR （HLADR） ＋ T, CD8/CD38 ＋T cells, and the expression of CD127 on CD3 ＋T cells from peripheral blood samples were measured by flow cytometry. IL-7 in peripheral blood was measured by enzyme-linked immunosorbort assay （ELISA） in HAART group. t test was performed to compare the measurement data among the groups. Results Before HAART, the count of CD4 ＋ T cells in HIV-1 infected group was lower than that of the healthy control （t =9. 12, P 〈0. 01 ）, while the counts of CD8 ＋ T,CD8/HLADR＋T, and CD8/CD38 ＋T cells were higher than those of the healthy control （t = 4.48, 4.89 and 3.88, P〈0. 01 ）. Ater 7 years＇ antiviral therapy, CD4 ＋T cells increased, CD8 ＋T cells decreased, but both of them didn＇ t reach to the normal levels （ t = 2.66 and 2.43, P 〈 0.05 ）. While the counts of CD8/HLADR＋T cells and CD8/CD38 ＋T cells almost reached to the normal levels （t = 0. 86 and 1.39, P 〉0.05）. Before HAART, the concentration of IL-7 in HIV-1 infected group was higher than that in healthy controls （t =5.31, P 〈0.01 ）. It decreased with HAART, but was still higher than the normal level （t =2. 81, P 〈 0. 05 ）. The expression of CD127 on CD3 ＋ CD8 ＋ T cells in non-HAART group was significantly lower than that in healthy control （ t =- 6.01, P 〈 0.01 ）, while that in HAART group was higher （ t = 2.32,P 〈0.05）, but still not reached to the normal level （ t = 4.49, P 〈 0. 05 ）. CD127 expression on （ CD45RA ＋ ） CD3 ＋ CD8 ＋ T cells almost increased to the normal level （ t= 0. 28, P 〉 0. 05 ）, while that on （ CD45RO ＋ ） CD3 ＋ CD8 ＋ T cells was still remarkably lower than the normal （ t = 4. 86, P 〈 0. 05 ）.

关 键 词：人免疫缺陷病毒1型 高效抗反转录病毒疗法 免疫重建 

分 类 号：R51[医药卫生—内科学]