HIV/AIDS相关性肾脏疾病患者免疫功能变化及预后分析  

Changes of immune function and prognosis of patients with HIV/AIDS-associated nephropathy

作　　者：兰玲鲜[1] 苏春雄[1] LAN Ling-Xian;SU Chun-Xiong(Guangxi AIDS Clinical Treatment Center,the Fourth People′s Hospital of Nanning,Nanning 530023,China)

机构地区：[1]广西艾滋病临床治疗中心南宁市第四人民医院

出　　处：《中国免疫学杂志》2019年第18期2258-2261,2266,共5页Chinese Journal of Immunology

基　　金：南宁市科学研究与技术开发计划项目(20163013);南宁市兴宁区科学研究与技术开发计划项目(2017A07)

摘　　要：目的:探讨HIV/AIDS相关性肾脏疾病患者免疫功能变化及预后。方法:选取本院住院治疗的58例HIV相关性肾病(HIVAN)患者临床资料进行回顾性分析,作为HIVAN组,另选取同期入院体检的60例健康者作为对照组。HIVAN组患者采用高效抗逆转录病毒(HAART)治疗。比较两组T细胞亚群及免疫球蛋白水平,HIVAN组治疗前后肾功能、T细胞亚群变化情况以及预后。结果:HIVAN组CD4^+T细胞数量为(285.93±110.46)个/μl,CD4^+/CD8^+数值为0.54±0.09,均低于对照组,差异有统计学意义(P<0.05),HIVAN组CD8+T细胞数量为(534.14±223.76)个/μl,高于对照组,但差异无统计学意义(P>0.05);HIVAN组IgG、IgA和IgE水平分别为(17.74±7.21)g/L、(4.15±2.24)g/L和(623.94±118.53)U/ml,均高于对照组,差异有统计学意义(P<0.05),HIVAN组IgM水平为(1.24±0.63)g/L,高于对照组,但差异无统计学意义(P>0.05);HIVAN组经治疗,胱抑素C(CysC)和血清肌酐(Scr)水平分别为(2.63±0.41)mg/L和(177.53±33.91)μmol/L,均较治疗前降低,差异有统计学意义(P<0.05),CD4^+T细胞数量为(543.32±184.31)个/μl,较治疗前升高,差异有统计学意义(P<0.05);治疗后1、3、5年累计生存率分别为88%、78%和74%。结论:HIVAN患者CD4^+T细胞数量减少,IgG、IgA和IgE等免疫球蛋白水平升高,HARRT治疗可改善患者肾功能及免疫功能,延缓疾病进展。Objective:To investigate the changes of immune function and prognosis of patients with HIV/AIDS-associated nephropathy.Methods:The clinical data of 58 patients with HIV-associated nephropathy(HIVAN)in the hospital were retrospectively analyzed,and they were included in the HIVAN group.60 healthy subjects who were examined in the hospital during the same period were selected as the control group.Patients in the HIVAN group were treated with highly active antiretroviral therapy(HAART).The T cell subsets and immunoglobulin levels were compared between the two groups.Changes of renal function and T cell subsets in the HIVAN group before and after treatment and the prognosis were observed.Results:The CD4^+T cell amount and CD4/CD8 in the HIVAN group[(285.93±110.46)cell/μl,(0.54±0.09)]were lower than those in the control group(P<0.05),while the CD8^+T cell amount[(534.14±223.76)cell/μl]was higher than the control group(P>0.05).The levels of IgG,IgA and IgE in the HIVAN group[(17.74±7.21)g/L,(4.15±2.24)g/L,(623.94±118.53)U/ml]were higher than those in the control group(P<0.05),and the IgM level[(1.24±0.63)g/L]was also higher than that in the control group(P>0.05).The levels of cystatin C(Cys C)and serum creatinine(Scr)in the HIVAN group after treatment[(2.63±0.41)mg/L,(177.53±33.91)μmol/L]were lower than those before treatment(P<0.05),and the CD4^+T cell amount[(543.32±184.31)cell/μl was significantly higher than that before treatment(P<0.05).After treatment,the cumulative survival rates of 1,3 and 5 years were 88%,78%and 74%.Conclusion:CD4^+T cells are decreased,and the levels of immunoglobulins such as IgG,IgA and IgE are elevated in patients with HIVAN.HARRT can improve the renal function and immune function,delay disease progression.

关 键 词：HIV/AIDS 肾脏疾病 HIVAN 免疫功能 预后 

分 类 号：R512.91[医药卫生—内科学]