艾滋病合并结核病对CD8^(+)T淋巴细胞的影响  

Effect of AIDS and tuberculosis co-infection on CD8^(+)T lymphocytes

作　　者：聂静敏 杜翔 喻园园 田黎 桑俊 孙伟[1] NIE Jingmin;DU Xiang;YU Yuanyuan;TIAN Li;SANG Jun;SUN Wei(Department of Infection and Hepatology Banan Hospital of Chongqing Medical University,Chongqing 401320,China)

机构地区：[1]重庆医科大学附属巴南医院感染肝病科,重庆401320 [2]重庆市公共卫生医疗救治中心

出　　处：《中国感染与化疗杂志》2024年第4期390-394,共5页Chinese Journal of Infection and Chemotherapy

基　　金：重庆市科卫联合项目(2024MSXM098)。

摘　　要：目的探讨艾滋病(AIDS)合并结核病(TB)对CD8^(+)T淋巴细胞的影响。方法将单纯人类免疫缺陷病毒(HIV)感染者、单纯TB患者、HIV感染合并TB者各200例分别作为HIV组、TB组、HIV/TB组,分析各组血清CD8^(+)T细胞及CD4^(+)T细胞变化。结果三组CD8^(+)T细胞水平比较呈现HIV组>HIV/TB组>TB组,且组间差异有统计学意义(χ2=128.779,P<0.001)。HIV/TB组、HIV组CD8^(+)T细胞水平较正常水平升高(ZHIV/TB=8.343,PHIV/TB<0.001;ZHIV=7.988,PHIV<0.001),而TB组CD8^(+)T细胞较正常水平明显下降(ZTB=8.682,PTB<0.001)。三组CD4^(+)T细胞水平均较正常下降(ZHIV=11.088,PHIV<0.001;ZTB=5.562,PTB<0.001;ZHIV/TB=12.077,PHIV/TB<0.001)。按照CD4^(+)T细胞计数进行分层分析发现,当CD4^(+)T细胞计数≤100 cells/μL时,三组CD8^(+)T细胞水平比较:HIV组>TB组,HIV组>HIV/TB组,且HIV/TB组CD8^(+)T细胞水平较正常显著下降(Z0-100=1.604,P0-100=0.109);当CD4^(+)T细胞≥101 cells/μL时,CD8^(+)T细胞三组比较:HIV/TB组>TB组,HIV组>TB组;当CD4^(+)T细胞>500 cells/μL,三组CD8^(+)T细胞水平均在正常范围内。三组CD8^(+)T细胞与CD4^(+)T细胞变化趋势的差异分析结果提示,以HIV组为参照,随着CD4^(+)T细胞计数的下降,TB组、HIV/TB组的CD8^(+)T细胞均比HIV组下降趋势更明显,差异有统计学意义(斜率分别为0.344和0.216,P<0.001)。结论随着CD4^(+)T细胞的下降,HIV感染合并TB和TB均可导致CD8^(+)T细胞下降,且TB的CD8^(+)T细胞下降更加显著。Objective To investigate the effects of AIDS and tuberculosis(TB)co-infection on CD8^(+)T lymphocytes.Methods Serum CD8^(+)T cells and CD4^(+)T cells were analyzed and compared between human immunodeficiency virus(HIV)alone patients(n=200),TB alone patients(n=200),and HIV/TB co-infection patients(n=200).Results CD8^(+)T cells were significantly higher in HIV alone group compared to HIV/TB co-infection group and TB alone group(χ2=128.779,P<0.001).The level of CD8^(+)T lymphocytes in HIV/TB co-infection group and HIV alone group was higher than normal level(ZHIV/TB=8.343,PHIV/TB<0.001,ZHIV=7.988,PHIV<0.001).The CD8^(+)T cells in TB alone group decreased significantly compared with normal levels(ZTB=8.682,PTB<0.001).The levels of CD4^(+)T cells in the three groups of patients were all lower than normal(ZHIV=11.088,PHIV<0.001,ZTB=5.562,PTB<0.001,ZHIV/TB=12.077,PHIV/TB<0.001).The stratified analysis of CD8^(+)T cell levels by CD4^(+)T cell counts,showed that when CD4^(+)T cell count was≤100 cells/μL,the level of CD8^(+)T cells in HIV alone group was higher than that in TB alone group.HIV alone group had higher CD8^(+)T cells than HIV/TB co-infection group,and the level of CD8^(+)T cells in HIV/TB co-infection group was significantly lower than normal(Z0-100=1.604,P0-100=0.109).When CD4^(+)T cells≥101 cells/μL,HIV/TB co-infection group had higher CD8^(+)T cells than TB alone group.HIV alone group had higher CD8^(+)T cells than TB alone group.When CD4^(+)T cells>500 cells/μL,CD8^(+)T cell levels were within the normal range in all three groups of patients.Taking the HIV alone group as a reference,with the decrease of CD4^(+)T cell count,the CD8^(+)T cell count decreased more significantly in TB alone group and HIV/TB co-infection group than in HIV alone group(slope was 0.344 and 0.216,respectively,P<0.001).Conclusions With the decline of CD4^(+)T cells,both HIV/TB co-infection and TB alone are associated with decrease in CD8^(+)T cells,and the decrease in the TB alone group is more prominent.

关 键 词：人类免疫缺陷病毒 结核病 CD8^(+)T淋巴细胞 合并感染 

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