有效抑制HIV复制下AIDS患者CD4+T淋巴细胞的动态变化

Dynamics of T Lymphocyte Subsets in HAART Treated AIDS Patients with Successful Suppression of HIV Replication and Different CD4+T Cell Restoration

目的研究强效抗逆转录病毒治疗（HAART）持续有效抑制HIV复制下AIDS患者的T淋巴细胞免疫动态变化。方法45例AIDs患者予以2年以上HAART治疗，在治疗前（D0），治疗第3、6、12、18和24个月（M3、M6、M12、M18和M24）时用bDNA病毒定量检测仪检测血浆病毒载量，流式细胞仪检测外周血T淋巴细胞亚群，分析CD4＋、CD8＋ T淋巴细胞及其相关亚群的动态变化。结果45例患者中有24例（53．3％）在治疗6个月后血浆病毒载量持续低于500copies／ml，按M24时（与D0相比）CD4＋T淋巴细胞计数的增量分为A组（〈100／mm^3）、B组（100—200／mm^3）和C组（〉200／mm^3）。与D0时相比，所有患者M3、M6、M12、M18和M24时的CD4＋T淋巴细胞计数、CD4＋纯真细胞计数和CD4＋CD28＋亚群的比例均有不同程度升高，CD8＋CD38＋激活亚群的比例则下降。3组相比，C组变化最显著，其D0时血浆病毒载量最高而CD4＋T淋巴细胞计数最低，经过24个月治疗后，不仅CD4＋T淋巴细胞数量增加最明显，CD4＋纯真细胞数量和CD4＋CD28＋功能亚群比例的增加也明显高于A组和B组（P〈0．05）。结论HAART能有效地重建AIDS患者的T淋巴细胞免疫。CD4＋CD28＋和Naive CD4＋亚群的不同动态变化可能对CD4＋T淋巴细胞数量和功能上的恢复有重要作用。

Objective To study the dynamic changes of T lymphocyte subsets of AIDS patients during more than 24 months of highly active antiretrovirus therapy （HAART） with successful suppression of HIV replication and different CD4 ＋ T cell restoration. Methods Totally 45 AIDS patients who had received HAART for more than 24 months were included. During HAART （including D0, M3, M6, M12, M18, and M24）, the number of plasma HIV-1 RNA was measured quantitatively using the hDNA assay, and T lymphocyte subsets including CD3 ＋ CD4 ＋ cells, CD3 ＋ CD8 ＋ cells, naive CD4 ＋ cells （ CD4 ＋ CD45RA ＋ CD62L ＋ ）, CD4 ＋ CD28 ＋ cells , and CD8 ＋ CD38 ＋ cells were detected with flow cytometer. Results Among 45 patients, 24 patients （53.3%） whose plasma viral load decreased to less than 500 copies/ml at M6 and maintained to M24 were classified into three groups according to the CD4 ＋ T cell count increments on M24 （compared with DO ） ： group A （ 〈 100/mm^3） , group B （ 100-200/mm^3） , and group C （〉200/mm^3）. After the initiation of HAART, T lymphocyte response, including CD4 ＋ T cell counts, naive CD4 ＋ cell counts, percentages of CD4 ＋ CD28 ＋ cells in these patients were improved gradually, while CD8 ＋ CD38 ＋ percentage decreased. The improvement of T lymphocyte response in group C was most remarkable even with highest plasma viral load and lowest CD4 T cell count on DO. Compared with group A and B, group C had significantly better improvement not only in the quantities of CD4 ＋ T cell, but also in the CD28 ＋ expression and naive CD4 ＋ T cell populations. Conclusions T lymphocyte response of AIDS patients can be effectively reconstituted by HAART. Different dynamics of CD4 ＋ CD28 ＋ and naive CD4 ＋ populations may considerably contribute to the quantity and cellular function restoration of CD4 ＋ T lymphocyte.