人类免疫缺陷病毒与重叠丙型肝炎病毒感染者免疫指标比较

The investigation on the immunologic function of human immunodeficiency virus-specific T cell in human immunodeficiency virus/hepatitis C virus co-infected patients

目的分析HIV／HCV重叠感染人群与HIV单独感染人群治疗前临床特征及免疫功能的差异，探讨其可能的影响因素。方法以HIV／HCV重叠感染患者59例、HIV单独感染患者38例为研究对象，取患者治疗前外周血，检测其肝功能、血常规、外周血T细胞亚群（CD4^＋、CD8^＋）及HIV、HCV病毒载量，酶联免疫斑点法（ELISPOT）检测HIV特异性细胞毒性T淋巴细胞（CTL）的数量和功能。结果HIV／HCV重叠感染率达60．8％。重叠感染组ALT、AST均明显高于HIV组（49．8U／L比23．6U／L，49．1U／L比32．3U／L，P值分别为0．000、0．013）；重叠感染组PLT明显低于HIV组[（167．3±59．2）×100／L比（198．0±63．9）×100／L，P=0．040]。外周血T细胞亚群检测结果两组间差异无统计学意义。重叠感染组HIVRNA定量为（4．046±0．541）log10拷贝／mL，低于HIV组的（4．394±0．507）log10拷贝／mL（P=0．018）。重叠感染组对HIV-Gag全序列肽段的阳性孔斑点数（平均秩次30．85）较HIV组（平均秩次44．34）低，阳性孔数（4．60±5．52）低于HIV组（6．24±6．93），但两组比较差异无统计学意义。重叠感染组Alb与HCV病毒载量呈负相关（r=0．540），CD4^＋与PLT呈正相关（P=0．000）。结论单采血浆感染HIV患者中，有较高的HIV／HCV重叠感染率和较低的细胞免疫功能。

Objective To investigate clinical features and immunologic status in human immunodeficiency virus （HIV）/hepatitis C virus （HCV） co-infected and HIV mono-infected patients, and to assess the possible interactions between HCV and HIV. Methods Fifty-nine patients with HIV/HCV co-infection were enrolled. The control group was consisted of 38 patients with HIV monoinfection. The liver function, peripheral blood T cell subgroups （CD4^＋ and CD8^＋ ） cell count and HIV RNA level were compared between these two groups. Peripheral blood mononuclear cells （PBMCs） were analyzed by interferon-γ enzyme-linked immunospot （ELISPOT） using a panel of HIV antigens. Results The frequency of HIV/HCV co-infection was 60.8%. Both alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in HIV/HCV co-infection group were significantly higher than those in HIV mono-infection group （49.8 U/L vs 23.6 U/L, 49.1 U/L vs 32.3 U/L, P=0.000, 0. 013）. Platelet count was lower in HIV/HCV co-infection group than in HIV group [（167.3±59.2） × 109/L vs （198.0±63.9））〈 10^9/L, P=0. 040]. CD4^＋ cell and CD8^＋ cell counts were not significantly different between co-infection group and HIV group. The HIV RNA level was lower in HIV/HCV co-infection group than in HIV group [（4. 046 ± 0. 541） log10 copy/mL vs （4. 394 ± 0. 507） log10 copy/mL, P=0. 018]. The intensity of HIV-specific cytotoxic T lymphocyte （CTL） response to HIV- Gag overlapping peptides in HIV/HCV co-infection group （mean bank 30.85） was lower than HIV group （mean bank 44.34）. The number of the HIV-specific CTL cell in HIV/HCV co-infection group （4.60±5.52） was slightly lower than HIV group （6. 24 ± 6.93） without significant difference. Albumin was negatively correlated with HCV RNA in HIV/HCV co-infection group （r= -0. 540）. A positive correlation was found between platelet and peripheral blood CD4^＋ cell counts （P=0. 040）. No linear correlation was found between HCV viral load, HIV viral load and peripheral blood CD4^＋ cell counts. Conclusions The prevalence of HCV co-infection is relatively high. The cellular immunity status in these co-infected patients is relatively poor.