HIV感染者的免疫学功能变化及其与病程发展的关系

Change of Immune Function among Primary HIV Infections and AIDS Patients and Its Relationship of Disease Progression

目的 分析HIV感染者/AIDS病人体内病毒复制和免疫功能变化及其与病程发展的关系。方法 应用定量RT-PCR、流式细胞计数和定量ELISA 方法分析55例HIV感染者（n=42）和AIDS病人（n=13）外周血血浆病毒载量、T淋巴细胞亚群和细胞因子浓度。结果 HIV感染者和 AIDS病人CD4细胞和血浆IL-2浓度低于正常人群（P<0.001）,血浆 sIL-2R、TNF-α、NPT浓度高于正常人群（P<0.01）;AIDS病人CD4细胞和IL-2浓度明显低于HIV感染者（P<0.001）,而血浆病毒载量、sIL、-2R、TNF-α、sTNFR-I、NPT浓度明显高于HIV感染者（P<0.01）,且随着CD4细胞水平降低呈明显上升趋势。CD4细胞、CD4/CD8比值和血浆IL-2水平随感染时间延长而不断下降,不同感染时间之间差异明显;机体感染HIV后CD4细胞年平均下降43/mm3,血浆sIL-2R、sTNFR-I、NPT年平均上升幅度分别为59.03pg/ml、38.69pg/ml、2.11ng/ml。各因素相关性分析显示:CD4细胞、CD4/CD8比值与感染时间,CD3、CD4、CD8细胞变化分别与血浆病毒载量、sTNFR-I、NPT之间有高度负直线相关性;而血浆sIL-2R分别与IL-6（P<0.001）、IL-10（P<0.001）、TNF-α（P<0.001）、sTNFR-I（P<0.005）、NPT（P<0.002）浓度变化间,以及IL-6与TNF-α（P<0.001）、NPT与IL-10（P<0.05）和 sTNFR-I（P<0.001）,?

Objective To analyze HIV replication, immune function change among HIV infectors and AIDS patients and the association with disease progression. Methods T cell subsets, plasma cytokine concentration and viral load from 42 primary HIV infections and 13 AIDS patients were analyzed by FCM, quantitative ELISA and RT - PCR, respectively. Results CD4 cell numbers and plasma IL- 2 in HIV infections and AIDS patients were less than normal control subjects signif-icantly(P<0.001), but the concentration of plasma sIL - 2R, TNF - a, Neopterin was higher than that in them(P<0. 01). Further analysis shown that CD4 cell counts and plasma IL - 2 among AIDS patients were also less than HIV infections (P<0.001). Plasma sIL - 2R, TNF - α, sTNFR- I, and Neopterin level, which were significantly increasing with decreasing CD4 cell counts, were higher than HIV infections (P < 0. 01) . CD4 cell counts, the ratio of CD4 to CD8 and plasma IL-2 level were decreasing with development of infection period, and a significantly difference between different infection periods was observed. CD4 cell counts declined with an average of 43/mm3 per year. By contrast, the concentration of plasma sIL - 2R, sTNFR- I, Neopterin increased with an average of 9.03pg/ml, 8.69pg/ml, 2. 11mg/ml per year, respectively. Furthermore, a significantly reverse linear correlation was observed between CD4 cell counts, the ratio of CD4 to CDg with infection time, and changes of CD3, CD4, CD8 with plasma level of sTNFR- I, Neopterin, HIV load. A positive linear correlation was also noted between plasma sIL - 2R level and changes of plasma IL-6 level(P<0. 001), IL - 10(P<0.001), TNF - α(P<0.001), sTNFR - I(P<0. 005), Neopterin(P< 0. 002), and between IL - 6 and TNF - α (P< 0. 001), Neopterin and IL - 10(P<0.05), sTNFR-I(P<0.001), plasma viral load and sTNFR-I(P< 0.01), Neopterin(P< 0.002). Conclusion These findings suggest a closely relationship between immune activation HIV replication and disease progression in primary HIV infections and AIDS patients. Declining of CD4 cell counts and plasma IL - 2 level, and increasing significantly of plasma HIV load, sIL - 2R, TNF - α, sTNFR - I, Neopterin might be considered as important predictors of the HIV infection to AIDS.