外周血炎症因子和T淋巴细胞激活在抗人类免疫缺陷病毒感染治疗中的变化  

Changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus infected patients during anti-retroviral therapy

作　　者：许振宇[1] 高佳师 何艳[1] 周华英[1] 谌资 贺波[1] 郑煜煌[1] Xu Zhenyu;Gao Jiashi;He Yan;Zhou Huaying;Chen Zi;He Bo;Zheng Yuhuang(Department of Infectious Diseases,Second Xiangya Hospital,Central-South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院感染科,长沙410011

出　　处：《中华传染病杂志》2022年第9期538-544,共7页Chinese Journal of Infectious Diseases

基　　金：湖南省自然科学基金(2019JJ50886)。

摘　　要：目的探索人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/艾滋病患者外周血炎症因子和T淋巴细胞激活在抗HIV治疗中的变化。方法选取2017年1月至2019年12月在长沙中南大学湘雅二医院感染科门诊接受抗反转录病毒治疗(anti-retroviral therapy,ART)的HIV感染/艾滋病患者共206例,为HIV感染组,定期随访并收集治疗前,治疗后6、12、24个月的血液标本;另选取同期进行体格检查者52名,为健康对照组,留取血液标本。采用酶联免疫吸附试验检测血浆白细胞介素(interleukin,IL)-6、超敏C反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子(tumor necrosis factor,TNF)-α。以流式细胞术检测外周血CD3+CD4^(+)T淋巴细胞计数、外周血单个核细胞中CD4^(+)CD38^(+)和CD8^(+)CD38^(+)T淋巴细胞百分比。采用实时荧光定量聚合酶链反应法检测血浆HIV RNA载量。统计学方法采用配对t检验和皮尔逊相关分析。结果HIV感染组治疗前血浆IL-6、超敏CRP和TNF-α分别为(13.42±2.35)pg/mL、(4012.46±1012.35)μg/L和(51.78±11.32)μg/L,分别高于健康对照组的(6.14±0.78)pg/mL、(707.21±305.76)μg/L和(19.01±6.48)μg/L,差异均有统计学意义(t=12.56、16.79、13.45,均P<0.001);启动ART后,HIV感染组IL-6、超敏CRP和TNF-α水平均逐渐下降,治疗后24个月恢复正常。HIV感染组治疗前CD3+CD4^(+)T淋巴细胞计数为(256.00±65.32)/μL,HIV RNA载量为(4.467±4.244)lg拷贝/mL,两者呈负相关(r=-0.625,P=0.041)。HIV感染组治疗前,治疗后12、24个月的CD8^(+)CD38^(+)T淋巴细胞百分比均高于健康对照组,差异均有统计学意义(t=3.85、6.84、2.57,均P<0.050);治疗前CD8^(+)CD38^(+)T淋巴细胞百分比与HIV RNA载量呈正相关(r=0.768,P=0.026)。HIV感染组治疗前,治疗后12、24个月的CD4^(+)CD38^(+)T淋巴细胞百分比均低于健康对照组,差异均有统计学意义(t=6.80、1.10、2.11,均P<0.050)。结论HIV感染可致机体免疫功能受损,同时导致异常免疫激活,但Objective To explore the dynamic changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)patients during anti-retroviral therapy(ART).Methods Two hundred and six HIV/AIDS patients with ART at clinic of the Department of Infectious Diseases in Second Xiangya Hospital,Central-South University between January 2017 and December 2019 were selected as HIV infection group.They were followed up regularly and the blood samples before treatment and at month 6,month 12,month 24 of treatment were collected.Meanwhile,52 healthy cases were enrolled in the healthy control group and their blood samples were collected.Enzyme-linked immunosorbent assay was used to detect the plasma concentrations of interleukin(IL)-6,hypersensitive C-reactive protein(hsCRP)and tumor necrosis factor(TNF)-α.Flow cytometry was used to detect the CD3+CD4^(+)T lymphocytes count and the percentage of CD4^(+)CD38^(+)T lymphocytes and CD8^(+)CD38^(+)T lymphocytes in the peripheral blood mononuclear cells.Plasma HIV RNA viral load was determined using a quantitative real-time polymerase chain reaction technique.Statistical methods used paired t test and Pearson correlation analysis.Results The concentrations of IL-6,hsCRP and TNF-αin HIV infection group were(13.42±2.35)pg/mL,(4012.46±1012.35)μg/L and(51.78±11.32)μg/L,respectively,which were higher than those in healthy control group((6.14±0.78)pg/mL,(707.21±305.76)μg/L and(19.01±6.48)μg/L,respectively).The differences were all statistically significant(t=12.56,16.79 and 13.45,respectively,all P<0.001).They decreased gradually after initiation of ART in HIV infection group,and returned to normal levels at month 24 of ART.CD3+CD4^(+)T cells count was(256.00±65.32)/μL and HIV RNA viral load was(4.467±4.244)lg copies/mL before ART in HIV infection group,which were negatively correlated(r=-0.625,P=0.041).The percentages of CD8^(+)CD38^(+)T lymphocytes before treatment and at month 12 or mont

关 键 词：抗逆转录病毒治疗 高效 白细胞介素6 C反应蛋白质 肿瘤坏死因子α CD38 免疫激活 

分 类 号：R512.91[医药卫生—内科学]