抗巨细胞病毒治疗对获得性免疫缺陷综合征合并巨细胞病毒血症患者外周血凋亡相关因子水平的影响

发布时间：2018-03-19 09:45

本文选题：获得性免疫缺陷综合征　切入点：巨细胞病毒血症　出处：《中国现代医学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨抗巨细胞病毒(CMV)治疗对获得性免疫缺陷综合征(简称艾滋病)合并CMV血症患者的外周血凋亡相关因子水平的影响。方法选取2014年1月1日~12月31日中国医科大学附属第一医院确诊住院的外周血CMVIgG阳性的男性艾滋病患者(CD4+T200个/μl)共34例(排除合并CMV视网膜炎者)。非随机对照分为3组,阴性CMV血症组(n=11)、阳性CMV血症非抗CMV组(n=11)、阳性CMV血症抗CMV组(n=12)。同时设立性别、年龄匹配的12例健康人做对照。同时全部入组患者于第3周末接受高效抗逆转录病毒治疗。在随访12月末时,评价各组CD4~+T细胞计数、CMV视网膜炎的发生率;评价外周血凋亡相关因子浓度的变化及组间差异。结果与健康对照比较,艾滋病患者Fas、FasL、TRAIL、TNF-α水平升高(t=-3.369、-2.683、-4.321和-5.321,P=0.012、0.033、0.009和0.003),而Bcl-2水平降低(t=-4.321,P=0.001)。基线时3组年龄、HIVRNA载量、CD4~+T细胞计数、WHO临床分期差异无统计学意义;非抗CMV组与抗CMV组CMVDNA载量差异无统计学意义。与非抗CMV组比较,抗CMV组与阴性CMV血症组12个月时CD4~+T细胞计数升高(F=4.260,P=0.013和0.020);外周血Bcl-2(F=3.621,P=0.009和0.006)、FasL(F=2.891,P=0.024和0.002)、TNF-α浓度降低(F=4.912,P=0.003和0.001);而抗CMV组与阴性CMV血症组组间未见差异。与基线水平比较,艾滋病患者随访12个月时Fas、FasL和TRAIL水平下降(t=2.579、2.194和2.274,P=0.015、0.035和0.030)。观察期内无CMV视网膜炎发生,无死亡病例,无HIV病毒学反弹发生。结论抗CMV治疗促进艾滋病合并CMV血症患者的CD4~+T细胞计数增长,这可能与外周血Bcl-2、FasL和TNF-α浓度降低有关。此外,高效抗逆转录病毒治疗本身也可以降低Fas、FasL和TRAIL水平。
[Abstract]:Objective to investigate the effect of anti-cytomegalovirus (CMV) therapy on the levels of apoptosis-related factors in peripheral blood of patients with acquired immunodeficiency syndrome (AIDS) associated with CMV. A total of 34 male AIDS patients with CMVIgG positive peripheral blood confirmed in the first affiliated Hospital of Medical University (excluding patients with CMV retinitis) were divided into 3 groups. In the negative CMV group, in the positive CMV group, in the non-anti CMV group, in the positive CMV group, in the anti CMV group, in the same time, the sex was established. All the patients were treated with high effective antiretroviral therapy at the end of the third week. At the end of 12 months follow-up, the incidence of CMV retinitis was evaluated by CD4T cell count and CMV retinitis. The changes of apoptosis-related factors in peripheral blood and the differences between groups were evaluated. The levels of Fas-Fas-FasL TRAILTNF- 伪 increased in patients with AIDS. The levels of Fas-3.369- 2.683C- 4.321 and -5.321 ~ 0.033 ~ 0. 009 and 0. 003 / 1 respectively, while the levels of Bcl-2 decreased. There was no significant difference in Bcl-2 load and CD4- T cell count between the three groups at baseline (P < 0. 05). There was no significant difference in CMVDNA load between non anti CMV group and anti CMV group, but there was no significant difference between non anti CMV group and non anti CMV group. The number of CD4T cells increased at 12 months in the anti CMV group and the negative CMV group, but there was no significant difference between the anti CMV group and the negative CMV group, but there was no significant difference between the anti CMV group and the negative CMV group, but there was no significant difference between the anti CMV group and the negative CMV group. After 12 months follow-up, the levels of FasL and TRAIL in patients with AIDS decreased by 2.579U 2.194 and 2.274P, 0.015, 0.035 and 0.030, respectively. There were no cases of CMV retinitis and no death during the observation period. Conclusion Anti CMV therapy can promote the increase of CD4T cell count in patients with CMV, which may be related to the decrease of Bcl-2 FasL and TNF- 伪 concentrations in peripheral blood. High effective antiretroviral therapy can also reduce FasL and TRAIL levels.
【作者单位】：中国医科大学附属第一医院传染科;
【基金】：辽宁省自然科学基金(No:2013021013)
【分类号】：R512.91;R511

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