青蒿琥酯用于艾滋病抗反转录病毒疗法后免疫功能重建不全的疗效特点  

Study on the therapeutic features of artesunate in the treatment of incomplete immune reconstitution after highly active antiretroviral therapy

作　　者：董继鹏[1] 陶庄 郭会军[3] 李鑫[4] 张伟[4] 谭行华[5] 杨玉琪[6] 马建萍 陈耀凯[8] 刘水青 冯全生[10] 刘颖[1] 邹雯[1] 高国建[1] 吴雪 马冲 王健[1] DONG Ji-peng;TAO Zhuang;GUO Hui-jun;LI Xin;ZHANG Wei;TAN Xing-hua;YANG Yu-qi;MA Jian-ping;CHEN Yao-kai;LIU Shui-qing;FENG Quan-sheng;LIU Ying;ZOU Wen;GAO Guo-jian;WU Xue;MA Chong;WANG Jian(Research Center of AIDS Treatment with Traditional Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;The First Affiliated Hospital of Henan University of CM,Zhengzhou 450008,China;infection Center of Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China;Guangzhou Eighth Peopled Hospital,Guangzhou 510060,China;Yunnan Institute of Traditional Chinese Medicine,Kunming 650223,China;TCM Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Chongqing Public Health Medical Center,Chongqing 400030,China;Guiyang Public Health Treatment Center,Guiyang 550001,China;l0Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)

机构地区：[1]中国中医科学院中医药防治艾滋病研究中心,北京100700 [2]中国中医科学院中医基础理论研究所,北京100700 [3]河南中医药大学第一附属医院,郑州450008 [4]首都医科大学附属北京地坛医院感染中心,北京100015 [5]广州市第八人民医院,广州510060 [6]云南省中医中药研究院,昆明650223 [7]新疆维吾尔自治区中医院,乌鲁木齐830000 [8]重庆市公共卫生医疗救治中心,重庆400030 [9]贵阳市公共卫生救治中心,贵阳550001 [10]成都中医药大学,成都610075

出　　处：《中华中医药杂志》2022年第7期4170-4175,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家“十三五”科技重大专项(No.2017ZX10205501)。

摘　　要：目的:探索青蒿琥酯用于艾滋病免疫功能重建不全的适宜人群、有效剂量和最佳疗程。方法:多中心、前瞻性队列研究设计,纳入符合研究标准的艾滋病抗反转录病毒疗法(ART)后免疫功能重建不全患者,在ART常规抗病毒治疗基础上加用青蒿琥酯片,疗程48周。其中,青蒿A组:50 mg/次,1次/d;青蒿B组:50 mg/次,2次/d;ART组:单纯ART;于基线及治疗24、48周评价3组T淋巴细胞亚群计数或比例情况。结果:3组比较:24周青蒿B组CD4^(+)计数显著高于其他两组(P<0.05);24、48周青蒿B组CD45RA^(+)计数显著高于其他组(P<0.05)。分层比较:CD4^(+)T>200 cells/μL亚组:24、48周青蒿B组CD4^(+)计数显著高于其他两组(P<0.05);48周青蒿B组CD45RA^(+)、CD45RO^(+)计数显著高于其他两组(P<0.05);48周青蒿A组CD4^(+)Ki67^(+)/CD4^(+)比值显著高于ART组(P<0.05);年龄≥40岁亚组:24周青蒿B组CD4^(+)、CD45RA^(+)计数显著高于其他两组(P<0.05);24周青蒿A组CD4^(+)Ki67^(+)/CD4^(+)比值显著高于其他两组(P<0.05),48周ART组CD4^(+)Ki67^(+)/CD4^(+)比值显著低于其他两组(P<0.05);48周青蒿A组CD8^(+)Ki67^(+)/CD8^(+)比值显著高于ART组(P<0.05)。结论:对基线CD4^(+)T>200 cells/μL和年龄≥40岁患者,高剂量、中短程(24周)应用青蒿琥酯可促进免疫重建。为避免T淋巴细胞激活,不建议低剂量下任何疗程以及长疗程下任何剂量使用。Objective: To explore the appropriate population, effective dose and optimal treatment course of artesunate for HIV/AIDS patients with incomplete immune reconstitution. Methods: A multicenter, prospective clinical trial was conducted to include HIV/AIDS patients with incomplete immune reconstitution after antiretroviral (ART) who met the research standard. All subjects received conventional antiviral treatment, furthermore, low-dose artesunate group (group A) received oral administration of artesunate tablets (50mg/time, qd, for 48 weeks), while high-dose artesunate group (group B) was given 50 mg/time twice a day for 48 weeks. Group ART received ART only. T lymphocyte subsets counts and distribution were evaluated at baseline, week 24 and 48 respectively. Results:Through comparison among these three groups, the following results were found. CD4^(+)T lymphocytes count of group B was significantly higher than that in group A and group ART at week 24 (P<0.05);CD45RA^(+)T subsets count of group B were significantly higher than those of the other groups at week 24 and 48 (P<0.05). Stratified comparison of baseline CD4^(+)T count: In the subgroup of CD4^(+)T>200 cells/μL, CD4^(+)T counts in group B were significantly higher than those of the other two groups at week 24 and 48 (P<0.05). The subsets counts of CD45RA^(+)T and CD45RO^(+)T of group B after 48 weeks were significantly higher than those of the other groups (P<0.05).The ratio of CD4^(+)Ki67^(+)/CD4^(+) in group A was significantly higher than that of group ART at week 48 (P<0.05). In the subgroup of age≥40 years old: The count of CD4^(+)T and CD45RA^(+) in group B was significantly higher than that of the other groups at week24 (P<0.05). The ratio of CD4^(+)Ki67^(+)/CD4^(+) in group A was significantly higher than those of the other groups at week 24 (P<0.05), and it was significantly lower in group ART than the other groups at week 48 (P<0.05). The ratio of CD8^(+)Ki67^(+)/CD8^(+) in group A was significantly higher than that of group ART at week 48 (P<0.

关 键 词：艾滋病 人类免疫缺陷病毒 抗反转录病毒疗法 免疫功能重建不全 青蒿琥酯 疗效特点 

分 类 号：R259[医药卫生—中西医结合]