HIV感染者/AIDS患者的不同治疗方案对CK、CK-MB、T细胞及HIV-RNA的影响  

Effects of different treatment regimens on CK,CK-MB,T cells,and HIV-RNA in patients with HIV infection/AIDS

作　　者：宋春丽 龙海 符燕华 何娟 杨兴林 左丽 SONG Chunli;LONG Hai;FU Yanhua;HE Juan;YANG Xinglin;ZUO Li(Department of Immunology,School of Basic Medicine,Guizhou Medical University Guiyang,Guizhou550004,China;Infectious Disease Department,Guiyang Public Health Clinical Center,Guiyang;Clinical Laboratory,Guiyang Public Health Clinical Center,Guiyang)

机构地区：[1]贵州医科大学基础医学院免疫学教研室,贵州贵阳550004 [2]贵阳市公共卫生救治中心感染科 [3]贵阳市公共卫生救治中心检验科

出　　处：《中国病原生物学杂志》2023年第7期759-764,共6页Journal of Pathogen Biology

摘　　要：目的分析拉米夫定(3TC)^(+)替诺福韦(TDF)^(+)依非韦伦(EFV)、3TC^(+)TDF^(+)洛匹那韦/利托那韦(LPV/r)、3TC^(+)TDF^(+)多替拉韦(DTG)治疗HIV感染者/AIDS患者后,对肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、CD3^(+)CD4^(+)T细胞计数绝对值、CD3^(+)CD4^(+)/CD3^(+)CD8^(+)细胞比值、HIV病毒载量(HIV-RNA)指标变化的影响,为临床治疗提供参考。方法回顾性分析贵阳市公共卫生救治中心2017年11月至2021年09月感染科门诊随诊HIV感染者/AIDS患者150例。治疗方案分别是:(1)3TC^(+)TDF^(+)EFV;(2)3TC^(+)TDF^(+)LPV/r;(3)3TC^(+)TDF^(+)DTG。分析对比不同药物方案治疗HIV感染者/AIDS患者前后CK、CK-MB、CD3^(+)CD4^(+)T细胞计数绝对值、CD3^(+)CD4^(+)/CD3^(+)CD8^(+)细胞比值、HIV-RNA的差异。结果总共纳入150例患者。EFV方案组患者中,男性为主(占66.67%),年龄46(21-75)岁,汉族占81.67%。LPV/r方案组患者中,男性为主(占59.26%),年龄43(24-67)岁,汉族占70.37%。DTG方案组患者中,男性为主(占71.43%),年龄39(22-69)岁,汉族占73.02%。药物治疗前,CD3^(+)CD4^(+)T细胞计数<200 c/μL患者中,HIV-RNA≥100000 copies/mL(n=67)与CK-MB呈正相关,差异有统计学意义(P<0.05)。在CD3^(+)CD4^(+)T细胞计数≥200 c/μL患者中,经药物治疗半年后CK-MB升高的差值比较,差异有统计学意义(P<0.01);CD3^(+)CD4^(+)T细胞计数<200 c/μL患者中,经药物治疗半年后HIV-RNA下降log数差值比较,差异有统计学意义(P<0.01)。结论人类免疫缺陷病毒感染者中,CD3^(+)CD4^(+)T细胞计数低及病毒载量高相对CK-MB值高。在CD3^(+)CD4^(+)T细胞计数≥200 c/μL患者中,治疗半年后,EFV及DTG方案组更容易使CK-MB升高。治疗半年后,三组治疗方案均能使免疫功能恢复、有效控制病毒,使用DTG方案组治疗CD3^(+)CD4^(+)T细胞计数<200 c/μL患者,在快速降低病毒载量方面更有优势。Objective To analyze the effects of 3TC^(+)TDF^(+)EFV,3TC^(+)TDF^(+)LPV/r and 3TC^(+)TDF^(+)DTG on the changes in CK,CK-MB,CD3^(+)CD4^(+)T cell count absolute values,CD3^(+)CD4^(+)/CD3^(+)CD8^(+)cell ratio,and HIV-RNA viral load after treatment of HIV infected patients/AIDS patients,and providing reference for clinical treatment.Methods This was a retrospective analysis conducted on 150 patients with HIV infection/AIDS who were followed up in the outpatient department of the Infectious Diseases Department of Guiyang Public Health Clinical Center between November 2017 and September 2021.Patients were treated with 3TC^(+)TDF^(+)EFV,3TC^(+)TDF^(+)LPV/r,and 3TC^(+)TDF^(+)DTG.We analyzed and compared the differences in CK,CK-MB,CD3^(+)CD4^(+)T cell count absolute value,CD3^(+)CD4^(+)/CD3^(+)CD8^(+)cell ratio,and HIV-RNA viral load before and after treatment with different drug regimens in these patients.Statistical analyses were performed using SPSS version 26.0.Results A total of 150 patients were included in this study.Among the patients in the EFV regimen group,males were the majority(66.67%)with a median age of 46 years(IQR,21-75 years),and the Han nationality accounted for 81.67%.The LPV/r regimen group was predominantly male(59.26%),with a median age of 43 years(IQR,24-67 years),and the Han nationality accounted for 70.37%.Based on DTG regimen group,the majority were males(71.43%),aged 39(22-69)years old,the Han nationality accounted for 73.02%.Before treatment,HIV-RNA≥100000 copies/mL(n=67)was positively correlated with CK-MB in patients with CD3^(+)CD4^(+)T cell count<200c/μL,and the difference was statistically significant(P<0.05).Among patients with CD3^(+)CD4^(+)T cell count≥20oc/μL,CK-MB increased after six months of treatment,and the difference was statistically significant(P<0.01).Among patients with CD3^(+)CD4^(+)T cell count<200 c/μL,HIV-RNA logs decreased after six months of drug treatment,and the difference was statistically significant(P<o.01).Conclusion In people infected with HIV,low CD3^(+

关 键 词：人类免疫缺陷病毒 艾滋病 依非韦伦 洛匹那韦/利托那韦 多替拉韦 

分 类 号：R512.91[医药卫生—内科学]