无症状期虚性体质HIV感染者的中医药疗效观察及相关性分析  

Efficacy of Traditional Chinese Medicine and Correlation among HIV-Infected Patients with Deficiency Constitution in Asymptomatic Stage

作　　者：兰燕玲 张毅[2] 杨欣怡 彭鑫 刘晶晶[2] 杨琴 王玉璐 苗丁山 苏琛[2] LAN Yanling;ZHANG Yi;YANG Xinyi;PENG Xin;LIU Jingjing;YANG Qin;WANG Yulu;MIAO Dingshan;SU Chen(Chengdu University of Traditional Chinese Medicine,Chengdu 611137;Sichuan Academy of Chinese Medical Sciences,Chengdu 610041)

机构地区：[1]成都中医药大学,成都611137 [2]四川省中医药科学院,成都610041

出　　处：《中药药理与临床》2024年第4期15-21,共7页Pharmacology and Clinics of Chinese Materia Medica

基　　金：国家“十三五”科技重大专项(编号:2017ZX10205502-001-005);四川省中医药管理局科学技术研究专项课题(编号:2023MS224)。

摘　　要：目的:探讨中医药联合高效抗逆转录病毒联合疗法(High active antiretroviral therapy,HAART)辨体治疗无症状期虚性体质HIV感染者的临床疗效及相关性分析。方法:采用随机、双盲、模拟剂对照的研究方法,选取2019年3月至2020年10月期间西昌市疾病预防控制中心和攀枝花市第四人民医院的HIV感染者60例。按1∶1比例随机分为治疗组和对照组各30例,根据入组辨体情况,治疗组分别给予益艾康胶囊(脾弱质)、健艾康浓缩丸(阳虚质)联合HAART,对照组相应体质分别给予对应的模拟剂联合HAART,疗程均为12个月。观察治疗前后的中医证候积分、免疫指标、病毒载量及肠道菌群等情况。结果:治疗组中医证候总积分及主要证候积分在治疗后均明显下降(P<0.05),且低于对照组(P<0.05),主要表现在脾弱质倦怠乏力、神疲懒言以及阳虚质畏寒肢冷整体上证候表现消失;阳虚质治疗组有效率明显高于对照组(P<0.05),脾弱质血清CD4^(+)T、CD4^(+)/CD8^(+)、CD4^(+)CD45RO^(+)T、CD4^(+)CD45RA^(+)T、CD4CCR5细胞计数以及阳虚质血清CD4^(+)/CD8^(+)、CD4^(+)CD45RO^(+)T、CD4CCR5细胞计数在治疗后明显升高(P<0.05),阳虚质CD8^(+)细胞计数明显降低(P<0.05);患者病毒载量整体上在治疗前后均在检测限以下,治疗组与对照组比较均无差异(P>0.05),治疗前后两组均未发生明显不良反应;相关性分析得出脾弱质血清IL-4与倦怠乏力,血清IL-17、TNF-α与神疲懒言呈负相关,IFN-γ与自汗呈正相关,阳虚质血清CD4^(+)CD45RO^(+)T、CD4^(+)CD45RA^(+)T、CD4CCR5、CD4CXCR4与CD4^(+)T细胞计数呈正相关;肠道菌群结果显示脾弱质治疗组拟杆菌属、扭链胃球菌属相对丰度以及阳虚质普雷沃氏菌属、巨单胞菌属、瘤胃球菌属UCG-002相对丰度在治疗后均明显高于对照组(P<0.05)。结论:益艾康胶囊和健艾康浓缩丸联合HAART能改善虚性体质HIV感染者相应的中医临床证候,并促进虚性体质向Objective:To observe the clinical efficacy and correlation of traditional Chinese medicine(TCM)combined with highly active antiretroviral therapy(HAART)in the treatment of human immunodeficiency virus(HIV)-infected patients with deficiency constitution in the asymptomatic stage based on constitution differentiation.Methods:A randomized,double-blind,and simulant-controlled study was conducted,and 60 cases of HIV-infected patients admitted to Xichang City Disease Prevention and Control Centre and Panzhihua City No.4 People's Hospital from March 2019 to October 2020 were selected.They were randomly divided into a treatment group and a control group in a ratio of 1∶1.According to the results of constitution differentiation,the treatment group was given Yiaikang(益艾康)Capsules(spleen-weak type)and Jianaikang(健艾康)Condensed Pills(yang-deficiency type),combined with HAART,and corresponding simulants combined with HAART were given to the corresponding constitution in the control group.The treatment lasted for 12 months.The TCM symptom scores,immunological indexes,viral loads,and intestinal flora before and after treatment were observed.Results:The total TCM symptom scores and the main symptom scores of the treatment group decreased significantly after treatment(P<0.05)and were lower than those of the control group(P<0.05).The symptoms such as lassitude,mental exhaustion,and fewer words of spleen-weak type,as well as fear of cold and cold limbs of yang-deficiency type disappeared.The effective rate of yang-deficiency type in the treatment group was higher than that in the control group(P<0.05).The CD4^(+)T,CD4^(+)/CD8^(+),CD4^(+)CD45RO^(+)T,CD4^(+)CD45RA^(+)T,and CD4CCR5 cell counts of spleen-weak type,as well as the CD4^(+)/CD8^(+),CD4^(+)CD45RO^(+)T,and CD4CCR5 cell counts of yang-deficiency type were significantly improved after treatment(P<0.05),and the CD8^(+)cell counts of yang-deficiency type were significantly reduced after the treatment(P<0.05).There was no significant difference between the treatment

关 键 词：艾滋病 无症状期 高效抗逆转录病毒联合疗法 脾弱质 阳虚质 肠道菌群 T细胞亚群 

分 类 号：R259[医药卫生—中西医结合]