不同中医体质HIV/AIDS患者细胞免疫功能状态研究

Effect of Constitutions of Chinese Medicine on Immune Damage in HIV/AIDS Patients

目的分析并总结不同分期的HIV/AIDS患者中医体质分布情况,进一步探讨不同中医体质类型的HIV/AIDS患者细胞免疫功能状态。方法收集并分析68例HIV/AIDS患者病例资料。依据《2011年中国艾滋病诊疗指南》将HIV感染者分为急性期、无症状期和艾滋病期。依据《中医体质分类与判定》标准对患者中医体质做出评判,采用流式细胞仪进行CD4^+T淋巴细胞计数检测。结果急性期患者(3例)均为单一体质,2例气虚质、1例阳虚质;无症状期(30例)、艾滋病期(35例)兼夹体质居多,按各体质出现频次排列,无症状期前3位依次为:气虚质(12例次)、痰湿质(7例次)、湿热质(7例次),艾滋病期前3位依次为:气虚质(15例次)、阳虚质(8例次)、阴虚质(7例次);气虚质均排在首位;虚性体质组(气虚质、阳虚质、阴虚质、特禀质)较实性体质组(痰湿质、湿热质、血瘀质、气郁质)CD4^+T淋巴细胞水平更为低下(P<0.01),在无症状期及艾滋病期,气虚质与其他虚性体质(包括阳虚质、阴虚质及特禀质)比较,CD4^+T淋巴细胞更为低下(P<0.01)。结论不同中医体质分型的HIV/AIDS患者细胞免疫损伤程度不同,气虚贯穿HIV/AIDS发病的始终,虚性体质尤其气虚体质HIV/AIDS患者细胞免疫损伤更常见。

Objective To observe the effect of constitutions of Chinese medicine （CM） on immune damage process of HIV/AIDS patients, thus providing reference for treatment of HIV/AIDS with CM. Methods Sixty-eight HIV/AIDS patients＇ data were collected and analyzed. HIV infection patients were staged as acute period, asymptomatic period, and AIDS period by 2011 AIDS Diagnosis and Treatment Guidance in China. Their constitutions of CM were judged by Classification and Judgment of Constitutions of Chinese Medicine. CD4 ＋T lymphocyte count was detected using flow cytometry. Results Patients in acute stage of HIV infection （3 cases） were of single constitution （2 cases with Qi deficiency and 1 case with Yang deficiency）. Complex constitution displayed during asymptomatic period （30 cases） and AIDS period （35 cases）. The top 3 constitutions in asymptomatic period were qi deficiency constitution （12 cases）, phlegm dampness constitution （7 cases）, and damp heat constitution （7 cases） according to frequency of occurrence. The top 3 constitutions in AIDS stage were Qi deficiency constitution （15 cases）, Yang deficiency constitution （8 cases）,Yin deficiency constitution （7 cases） according to frequency of occurrence. Qi deficiency constitution occupied the top judged either by frequency of occurrence or higher score of differentiation. Patients with deficiency syndrome had lower CD4 ＋T lymphocyte count, as compared with those with excess syndrome （P 〈0.01 ）. CD4 ＋T lymphocyte count was lower in Qi deficiency constitution than other deficiency constitutions （P 〈0.01 ）. The range of CD4 ＋T lymphocyte count declined form asymptomatic period to AIDS period was larger in Qi deficiency constitution than in other deficiency constitutions （P 〈0.05）. Conclusions Patients with different CM constitutions had various degrees of cellular immune damage. Qi deficiency runs throughout the process of HIV/AIDS. Cellular immunity damage was more common seen in HIV/AIDS patients with deficiency constitution, especially with Qi deficiency constitution.