长期抗病毒治疗HIV/AIDS患者CD4/CD8比值变化分析

Analysis of the change of CD4/CD8 ratio in patients with HIV/AIDS with long-term antiviral therapy

目的探讨HIV/AIDS患者长期ART后外周血淋巴细胞及CD4/CD8比值的长期变化趋势,CD4/CD8比值正常化的影响因素。方法选取云南省参加国家艾滋病免费ART,且在云南省传染病医院接受治疗60个月,病毒载量持续低于最低检测值的HIV/AIDS患者资料,分析ART 0、12、24、36、48、60个月CD4细胞、CD8细胞、CD4/CD8比值变化情况及CD4/CD8比值正常化的影响因素。结果研究共纳入80例患者。随着ART时间推进,CD4细胞、CD8细胞呈进行性和相反的方向变化,ART后24个月之前的变化斜率大于24个月之后。CD4/CD8比值绝对数持续上升,但随着ART时间的推进,增长变缓;不同基线CD4细胞组,CD4/CD8比值绝对数均呈增长趋势。CD4/CD8比值绝对数的增加与CD4细胞呈正相关(相关系数r_(A)=0.58,r_(B)=0.48,P<0.0001),与CD8细胞呈负相关(r_(C)=-0.67,r_(D)=-0.42,P<0.0001);基线CD4细胞≤350个/μL组患者中,CD4/CD8比值的增加主要与CD4细胞增长有关(|r_(A)|>|r_(C)|),基线CD4细胞>350个/μL组患者中,CD4/CD8比值的增加主要与CD8细胞减少有关(|r_(B)|<|r_(D)|)。广义估计方程(GEE)显示,基线CD4细胞、ART持续时间是CD4/CD8比值正常化的影响因素,基线CD4细胞越高、治疗持续时间越长,CD4/CD8比值正常化比例越高。结论ART可以促进CD4细胞的增长和CD4/CD8比值正常化。对HIV/AIDS患者应早治疗并保证良好的服药依从性。

Objective To investigate the long-term trend of the peripheral blood lymphocytes and the rate of CD4/CD8,and the influencing factors of the normalization of CD4/CD8 ratio in patients living with HIV(PLWH)after long-term antiviral therapy(ART).Methods The data of PLWH who participated in national AIDS-free ART in Yunnan Province and received treatment in Yunnan infectious disease hospital for 60 months,and whose viral load continued to be lower than the lowest detection value were selected to analyze the changes of CD4 cell count,CD8 cell count,CD4/CD8 ratio and the influencing factors of normalization of CD4/CD8 ratio after ART.Results A total of 80 PLWH were included in the study.The CD4 cell and CD8 cell changed in a progressive and opposite direction after ART,and the slope of change within 24 months post-ART was greater than that after 24 months post-ART.The absolute number of CD4/CD8 ratio continued to rise after ART,but the increase declined over time after ART.The absolute number of CD4/CD8 ratio all showed an increasing trend in groups with different baseline CD4 cells.The increase of the absolute number of CD4/CD8 ratio was positively correlated with the CD4 cell count and negatively correlated with the CD8 cell count(r_(A)=0.58,r_(B)=0.48,r_(C)=-0.67,r_(D)=-0.42,P<0.0001).The increase of CD4/CD8 ratio was mainly related to the increase of CD4 cell counts in patients with baseline CD4≤350 cells/μL and to the decrease of CD8 cells in patients with baseline CD4>350 cells/μL(|r_(A)|>|r_(C)|,|r_(B)|<|r_(D)|).The Generalized Estimation Equation(GEE)shows that the baseline CD4 cell count and ART duration were factors influencing the normalization of the CD4/CD8 ratio.The higher the baseline CD4 cells and the longer the treatment duration,the better the normalization of the CD4/CD8 ratio.Conclusion ART could promote the growth of CD4 cells and the normalization of the CD4/CD8 ratio.PLWH should be treated promptly with good medication compliance.