HIV合并TB感染患者IRIS发生情况调查及与Th17/Treg、CD4^(+)T淋巴细胞水平的关系  

Investigation on the incidence of IRIS in HIV patients with TB infection and its relationship with Th17/Treg,CD4^(+)T lymphocyte levels

作　　者：邓超 赵玄 杜清 任利红 冉启惠 陈红 Deng Chao;Zhao Xuan;Du Qing;Ren Lihong;Ran Qihui;Chen Hong(Second Ward of Severe Disease,Public Health Clinical Center of Chengdu,Chengdu 610066,China)

机构地区：[1]成都市公共卫生临床医疗中心重症二病区,成都610066

出　　处：《中国医师杂志》2023年第6期855-858,863,共5页Journal of Chinese Physician

基　　金：四川省医学青年创新科研课题计划项目(Q19068);成都市卫生健康委员会科研项目(2022264)。

摘　　要：目的调查人类免疫缺陷病毒(HIV)合并结核菌(TB)感染患者免疫重建炎症综合征(IRIS)发生情况,并分析Th17/Treg细胞因子、CD4^(+)T淋巴细胞水平与IRIS的关系。方法选择2020年6月至2022年6月成都市公共卫生临床医疗中心收治的HIV合并TB感染患者,按照高效抗反转录病毒治疗(HAART)后是否发生IRIS分为IRIS组(31例)和非IRIS组(93例),比较两组人口学资料、临床资料、实验室指标。多因素logistic回归分析HIV合并TB感染患者发生IRIS的影响因素。结果两组患者人口学资料比较差异无统计学意义(均P>0.05)。IRIS组和非IRIS组机会性感染史差异有统计学意义(χ^(2)=5.194,P<0.05)。IRIS组HIV RNA、IL-17、IL-23水平高于非IRIS组(均P<0.05),γ干扰素(IFN-γ)、转化生长因子-β(TGF-β)水平、基线CD4^(+)T淋巴细胞计数低于非IRIS组(均P<0.05)。多因素logistic回归分析结果显示IL-17(OR:1.266,95%CI:1.095~1.464)、IL-23(OR:1.384,95%CI:1.120~1.710)、TGF-β(OR:0.589,95%CI:0.436~0.797)是HIV合并TB感染患者发生IRIS的影响因素(均P<0.05)。结论对于高IL-17水平、高IL-23水平和低TGF-β水平的HIV合并TB感染患者应尽早进行临床防控,警惕IRIS的出现。Objective To investigate the incidence of immune reconstitution inflammatory syndrome(IRIS)in patients with HIV(HIV)and tuberculosis(TB)infection,and analyze the relationship between Th17/Treg cytokines,CD4^(+)T lymphocytes and IRIS.Methods HIV patients with TB infection admitted to Public Health Clinical Center of Chengdu from June 2020 to June 2022 were divided into IRIS group(31 cases)and non IRIS group(93 cases)according to whether IRIS occurred after highly active antiretroviral therapy(HAART).The Demography data,clinical data and laboratory indicators of the two groups were compared.Multivariate logistic regression analysis was conducted to investigate the influencing factors of IRIS in HIV patients with TB infection.Results There was no significant difference in Demography data between the two groups(P>0.05).There was a statistically significant difference in the history of opportunistic infection between the IRIS group and the non IRIS group(χ^(2)=5.194,P<0.05).The levels of HIV RNA,interleukin(IL)-17,and IL-23 in the IRIS group were higher than those in the non IRIS group(all P<0.05).The levels of theγinterferon(IFN-γ),the transforming growth factor-β(TGF-β)and baseline CD4^(+)T lymphocyte count were lower than those in the non IRIS group(all P<0.05).The results of multivariate logistic regression analysis showed that IL-17(OR:1.266,95%CI:1.095-1.464),IL-23(OR:1.384,95%CI:1.120-1.710),and TGF-β(OR:0.589,95%CI:0.436-0.797)were influencing factors for the occurrence of IRIS in HIV patients with TB infection(all P<0.05).Conclusions For patients with high IL-17 levels,high IL-23 levels,and low TGF-βlevel of HIV complicated with TB infection,clinical prevention and control should be carried out as soon as possible to prevent the occurrence of IRIS.

关 键 词：HIV 结核 免疫重建炎症综合征 Th17细胞 T淋巴细胞 调节性 CD4阳性T淋巴细胞 

分 类 号：R512.91[医药卫生—内科学] R52[医药卫生—临床医学]