有效的高效抗反转录病毒治疗后低CD4/CD8比值HIV/AIDS患者免疫学特征分析  

Immunological characteristics of HIV/AIDS patients with low CD4/CD8 ratio after receiving highly active antiretroviral therapy effectively

作　　者：张钰[1] 田云飞[1] 肖江[1] 韩宁[1] 杨涤[1] 刘维[1] 赵红心[1] 

机构地区：[1]北京大学地坛医院教学医院感染一科,100015

出　　处：《传染病信息》2015年第6期357-361,共5页Infectious Disease Information

基　　金：2014年首都卫生发展科研专项项目(2014-2-2173);国家自然科学基金(81371804)

摘　　要：目的对比研究有效的高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)后低CD4/CD8比值组与高CD4/CD8比值组患者相关免疫学特征。方法选择接受HAART≥96周、CD4^+T淋巴细胞≥500/μl、HIV载量低于检测值下限的HIV感染者/AIDS患者(HIV/AIDS患者)109例,从中选出CD4/CD8比值≥0.82的患者28例及CD4/CD8比值≤0.48的患者28例,对比分析2组T淋巴细胞上CD38、人类白细胞抗原DR(HLA-DR)、CD27、CD28、CD45RA及CD31的表达,进而分析2组外周血T淋巴细胞的免疫活化与免疫老化状况。结果①低CD4/CD8比值组的基线CD4^+T淋巴细胞计数和基线CD4/CD8比值较高CD4/CD8比值组低(P<0.05);②低CD4/CD8比值组HLA-DR^+CD8^+T淋巴细胞频率、处于中期分化阶段(CD27^-CD28^+)的CD4^+T淋巴细胞频率及处于晚期分化阶段(CD27^-CD28^-)的CD4^+和CD8^+T淋巴细胞频率高于高CD4/CD8比值组(P均<0.05),而处于早期分化阶段(CD27^+CD28^+)的CD4^+和CD8^+T淋巴细胞频率低于高CD4/CD8比值组(P均<0.05);③低CD4/CD8比值组纯真CD4^+和与CD8^+T淋巴细胞频率以及CD31^+纯真CD8^+T淋巴细胞的频率低于高CD4/CD8比值组(P均<0.05)。结论①低基线CD4^+T淋巴细胞计数和低基线CD4/CD8比值HIV/AIDS患者有效HAART后CD4/CD8比值仍然相对较低,应及早起始HAART,预防CD4/CD8低比值持续的发生;②有效HAART后低CD4/CD8比值的HIV/AIDS患者表现出更为严重的免疫活化和免疫老化现象,针对这些免疫紊乱应给予除HAART外新的干预措施。Objective To compare immunological characteristics between HIV/AIDS patients with low CD4/CD8 ratio after receiving highly active antiretroviral therapy（HAART） effectively and those with high CD4/CD8 ratio.Methods Among 109 HIV/AIDS patients with CD4^＋ T lymphocyte count ≥500 /μl and undetectable viral load after more than 96 weeks of HAART,28 patients with CD4/CD8 ratio ≥0.82 were selected as high CD4/CD8 ratio group,and 28 with CD4/CD8 ratio ≤0.48 as low CD4/CD8 ratio group.The expressions of CD38,HLA-DR,CD27,CD28,CD45 RA and CD31 on T lymphocytes of peripheral blood were compared between the two groups,and the immune activation and immunosenescence of the two groups were analyzed.Results Low CD4/CD8 ratio group showed significantly lower baseline CD4^＋ T lymphocyte count and baseline CD4/CD8 ratio than high CD4/CD8 ratio group（P0.05）.Low CD4/CD8 ratio group showed significantly higher frequency of HLA-DR^＋ cells of CD8^＋ T lymphocytes,higher frequency of CD4^＋ T lymphocytes in intermediate stage（CD27-CD28^＋）,higher frequency of CD4^＋ or CD8^＋ T lymphocytes in late differentiation stage（CD27^-CD28^-）（P0.05）,and lower frequency of CD4^＋ or CD8^＋ T lymphocytes in early differentiation stage（CD27^＋CD28^＋） than high CD4/CD8 ratio group（P0.05）.Besides,low CD4/CD8 ratio group had significandy lower frequency of naive CD4^＋ and CD8^＋ T lymphocytes and lower frequency of CD31^＋ naive CD8^＋ T lymphocytes than high CD4/CD8 ratio group（P0.05）.Conclusions HIV/AIDS patients with low baseline CD4^＋ T lymphocyte count and low baseline CD4/CD8 ratio are inclined to have relatively low CD4/CD8 ratio after receiving effective HAART,thus an early initiation of HAART is necessary to prevent the occurrence of consistendy low CD4/CD8 ratio.HIV/AIDS patients with low CD4/CD8 ratio after effective HAART show more serious T lymphocyte immune activation and immunosenescence,so in addition to HAART,novel interventions should be given for ongoing immune dysfunction i

关 键 词：获得性免疫缺陷综合征 HIV 淋巴细胞计数 T-淋巴细胞亚群 

分 类 号：R512.91[医药卫生—内科学]