接受长期抗病毒治疗的艾滋病患者免疫功能重建研究  

Immune reconstitution of Chinese HIV-1 infected patients after long-term combined antiretroviral therapy

作　　者：吕玮[1] 江华[2] 林逸骁 杨浩[2] 韩杨[1] 邱志峰[1] 谢静[1] 李雁翎[1] 宋晓憬 李太生[1] 

机构地区：[1]中国医学科学院北京协和医院感染内科,北京100730 [2]四川省医学科学院四川省人民医院创伤代谢组多学科实验室计算数学与生物统计学教研组,四川成都610072

出　　处：《中国临床医生杂志》2016年第8期19-24,共6页Chinese Journal For Clinicians

基　　金：国家"十二五"重大专项成人艾滋病治疗与免疫重建研究以及免疫抑制和根治策略研究(2012ZX10001003-001和2013ZX10001002-001-001);四川省卫生厅基金(110154)

摘　　要：目的探讨长期接受高效抗反转录病毒治疗(HAART)且依从性良好的艾滋病患者免疫功能重建规律。方法建立回顾性研究队列,纳入2000~2013年北京协和医院感染科长期随访(年限≥2年)、初治且依从性良好的HIV/AIDS患者。分析不同随访时间点下,患者外周血各淋巴细胞亚群变化规律。根据基线CD4^+T淋巴细胞计数进行分组,分析不同免疫功能受损情况下对患者免疫功能重建的影响。结果纳入病例数137例,平均(38.5±9.9)岁,中位随访时间4.5(四分位间距:3.5~7.2)年。基线中位CD4^+T淋巴细胞计数为125.0(36.0~231.0)cell/μl,第7年时上升至425.0(314.8~575.3)cell/μl(P<0.001),不同亚群各组间差异也随治疗而缩小,且在治疗达到一定时长时各组间无显著差异。CD8^+T淋巴细胞计数保持相对稳定。CD8^+CD38^+T淋巴细胞随治疗进行呈下降趋势,而CD8^+DR^+T淋巴细胞计数较为稳定。结论不论基线免疫受损程度如何,在保证依从性良好的前提下,我国HIV/AIDS患者经长期抗病毒治疗可获得理想的免疫功能重建。免疫重建规律为记忆CD4和纯真CD4淋巴细胞均增长,治疗早期以记忆CD4淋巴细胞增长为主。CD8激活亚群随治疗时间而逐渐下降,功能亚群保持稳定。Objective To investigate characteristics of immune reconstitution of Chinese HIV-1 infected patients after long-term antiretroviral therapy. Method From 2000 to 2013,HIV-1 infected patients treated regularly in Peking Union Medical College Hospital for more than 2 years with good adherence（ 95%） to HAART were included in this retrospective study. The changes of viral load and T lymphocyte subpopulations were measured. The differences of immune reconstitution of patients grouped according to their baseline CD4^＋T lymphocyte counts were analyzed. Result 137 patients with an average age of 38. 5 ± 9. 9 were regularly followed up for 4. 5（ 3. 5- 7. 2） years. The median CD4^＋ T lymphocyte rose up to 425. 0（ 314. 8- 575. 3） cell / μl at the 7-（th） year from 125. 0（ 36. 0- 231. 0） cell / μl at baseline（ P〈 0. 001） along with the rapidly decrease of viral load,and the differences among groups also narrowed over time. The CD8^＋ T lymphocyte remained stable and CD8^＋CD38^＋T、CD8^＋DR^＋T lymphocyte trended downwards. Conclusion Our study indicates that the reconstitution of immunity of HIV-1 infected patients will eventually be achieved after long-term HAART even in the case of late-stage AIDS patients.

关 键 词：艾滋病 联合抗反转录病毒治疗 免疫重建 

分 类 号：R511[医药卫生—内科学]