EB病毒潜伏感染的HIV/AIDS患者临床特点及免疫特征分析  

Clinical and immune characteristics of HIV/AIDS patients with latent EBV infection

作　　者：王大刚 李韦杰 金方方 宋淑静[1] 郭晶晶[1] 刘颖[1] 李晓慧 王雅杰 WANG Dagang;LI Weiie;JIN Fangfang;SONG Shujing;GUO Jingjing;LIU Ying;LI Xiaohui;WANG Yajie(Department of Clinical Laboratory,Beijing Ditan Hospital,Capital Medical University,Beiing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院检验科,北京100015

出　　处：《中国艾滋病性病》2023年第4期383-387,共5页Chinese Journal of Aids & STD

基　　金：新发突发传染病研究北京市重点实验室2019年度开放课题(DTKF201902)。

摘　　要：目的 通过分析HIV/AIDS患者EB病毒(EBV)潜伏感染的临床特点和免疫特征,探讨EBV潜伏感染对HIV/AIDS患者的影响。方法 收集确诊HIV/AIDS患者的血液标本进行检测,并回顾性分析患者的临床资料。EBV DNA的检测分别采用全血标本和血清标本进行实时定量PCR检测,血清EBV抗体的检测采用酶联免疫吸附法,淋巴细胞亚群的检测采用流式细胞分析,EB病毒编码RNA(Epstein-Barr virus-encoded RNA,EBERs)检测采用原位杂交的方法。结果 共收集168例患者的血清和全血标本,所有患者的血清EBV DNA载量均<400 copies/mL,但HIV RNA≥20copies/mL的患者全血EBV DNA阳性率显著高于HIV RNA<20copies/mL的患者(71.79%vs. 28.21%,χ^(2)=15.986,P<0.01)。血清EBV抗体检测发现全部患者EBV-CA-IgG均为阳性,但只有血清EBV-EA-IgG抗体的阳性率在全血EBV DNA阳性患者和阴性患者中表现出显著性差异(25.64%vs. 3.92%,χ^(2)=10.866,P=0.01)。CD4细胞计数<200个/μL的患者全血EBV DNA的阳性率明显高于CD4细胞≥200个/μL的患者(81.25%vs. 54.17%,χ^(2)=16.62,P<0.01),并且EBV DNA高载量(>103copies/mL)的患者占比为68.99%。全血EBV DNA阳性患者的CD4细胞数量、CD4/CD8细胞比值均显著低于全血EBV DNA阴性患者(P<0.01,P<0.05)。168名患者中有4例确诊淋巴瘤,其中3例EBERs原位杂交结果阳性且同时具有较高的全血EBV DNA载量。结论 全血标本EBV DNA高载量的HIV/AIDS患者免疫功能更为低下,潜伏感染的EBV更容易再激活,并可能增加艾滋病相关淋巴瘤的发生风险。Objective To explore the effect of EBV latent infection on the clinical and immune characteristics of people living with HIV(PLWHs). Methods Blood specimens from HIV infected patients were collected for testing. The clinical data of the patients were collected retrospectively. EBV DNA was detected by real-time quantitative PCR in whole blood and serum samples respectively. EBV serological antibodies were detected by enzyme-linked immunosorbent assay.The lymphocyte subsets were detected by flow cytometry. The Epstein-Barr virus-encoded RNA(EBERs) was tested by the method of in-situ hybridization. Results A total of 168 patients' blood specimens were collected. All serum EBV DNA loads were less than 400 copies/mL. The proportion of patients with whole blood EBV DNA positive was significantly higher among patients with HIV RNA ≥ 20 copies/mL than those with HIV RNA 20 copies/mL(71.79% vs.28.21%, χ^(2)=15.986, P<0.01). Serum EBV antibody detection indicated that all patients' EBV-CA-IgG were positive. The EBV-EA-IgG antibody level was significantly different between patients with positive and negative EBV DNA(25.64 %vs. 3.92%, χ^(2)=10.866, P=0.01). The whole blood EBV DNA positive rate of patients with CD4+ T cells 200 cells/μL was significantly higher than that of patients with CD4^(+) T cells ≥ 200 cells/μL(81.25% vs. 54.17 %, χ^(2)=16.62, P<0.01), and the proportion of the patients with EBV DNA high loads( 103 copies/mL)accounted for 68.99%. The number of CD4^(+) T lymphocytes and CD4/CD8 ratio of patients with whole blood EBV DNA positive were significantly lower than those of patients with whole blood EBV DNA negative(P<0.01, P<0.05). Moreover, there were 4 cases of lymphoma were diagnosed, of which 3 cases had positive EBER in-situ hybridization results, and also had higher whole blood EBV DNA load. Conclusions PLWHs with high loads of EBV DNA in whole blood have more severe immunodeficiency. Thus the latently infected EBV is more likely to be reactivated and may promote the risk of AIDS-related lymph

关 键 词：EB病毒 艾滋病病毒 CD4淋巴细胞 淋巴瘤 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]