获得性免疫缺陷综合征患者房水中细胞因子的检测

Cytokine analysis of aqueous humor in AIDS patients

目的 探讨不同眼部表现的获得性免疫缺陷综合征（AIDS）患者房水中细胞因子的含量变化情况.方法 病例对照研究.选取2013年12月至2015年7月在首都医科大学附属北京佑安医院感染中心及眼科确诊的AIDS患者38例,男性37例,女性1例,平均（33.7±10.0）岁.按眼部表现分为巨细胞病毒视网膜炎（CMVR）组（16例）、人类免疫缺陷病毒（HIV）视网膜病变组（14例）、眼部正常组（8例）,分别进行视力（logMAR）、眼压、眼底照相眼科常规检查,同时检测血液中CD4^＋T细胞数目,分别对3个组进行前房穿刺抽液,采用Luminex 200液相芯片分析仪测定各组房水中细胞因子的含量.眼压比较采用单因素方差分析.视力、CD4^＋T细胞数、细胞因子含量采用Kruskal-Wallis检验,Mann-Whitney U检验比较两组间差异,组间比较行Bonferroni校正.结果 38例患者视力为1.000（0.000,1.000）,3个组视力之间的差别具有统计学意义（χ^2=9.963,v=2,P=0.007）,CMVR组明显高于视网膜病变组和眼部正常组.3个组患者的眼压为（13.82±3.91）mmHg（1mmHg=0.133 kPa）,3个组眼压的差异无统计学意义（F=0.830,P=0.444）.3个组CD4^＋T细胞数目58（4,550）个/μ1,组间比较差异有统计学意义（χ^2=6.106,v=2,P=0.047）,眼部正常组的CD4^＋T细胞数明显高于CMVR组和视网膜病变组,CMVR组和视网膜病变组CD4^＋T细胞数差异无统计学意义.巨噬细胞炎性蛋白1b（MIP-1b）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、血管内皮生长因子（VEGF）、白细胞介素8（IL-8）、单核细胞趋化蛋白1（MCP-1）、干扰素诱导蛋白10（IP-10）的含量在3个组之间的差异有统计学意义,且CMVR组上述7个因子含量明显高于HIV视网膜病变组和眼部正常组.结论 较之于AIDS眼部正常患者和HIV视网膜病变患者,AIDS患者的CMVR严重影响患者视力,3个组在细胞因子MIP-1b、IL-6、TNF-α 、VEGF、IL-8、MCP-1、IP-10的含量不同可能与单核巨噬细胞系统（趋化因子、炎症因子、血管内皮因子）和Th1细胞反应活跃有关.

Objective To explore the Cytokine of aqueous humor in AIDS patients with different eye diseases.Methods A case-control study including 38 patients who was diagnosed as acquired immunodeficiency syndrome（AIDS） at Infectious Center and Department of Ophthalmology in Beijing You＆#39;an Hospital,Capital Medical University.And 16 cases of 38 patients were cytomegalovirus retinitis （CMVR）,14cases were HIV-related retinal disease,and 8 cases presented as normal.A series of tests were performed including vision acuity check,intraocular pressure,fundus photography,blood cell count of CD4^＋ T lymphocyte and the content of cytokines in aqueous humor by Luminex 200TM liquid chip analyzer.Intraocular pressure was analyzed by one-way ANOVA,visual acuity,CD4^＋ T lymphocyte count and cytokines were analyzed by Kruskal-Wallis test,the differences between the two groups were compared by Mann-Whitney U test corrected with Bonferroni.Results Of the 38 AIDS patients [mean age （33.7± 10.0）year],37 were males and 1 was female.The mean visual acuity of 38 patients is logMAR 1.00（0.000,1.000）.The difference of visual acuity among three groups was statistically significant （χ^2=9.963,P=0.007）.The visual acuity in CMVR group was significantly higher than that in HIV-related retinal disease group and AIDS-normal eye group.There was no statistically significant difference of intraocular pressure among three groups （F=0.830,P 〈 0.05）.The mean CD4^＋ T lymphocyte count was 58（4,550）/μl and the difference was statistically significant among three groups（χ^2=6.106,P=0.047）.The CD4^＋ T lymphocyte count in AIDS-normal eye group was significantly higher than that in CMVR group and HIV-related retinal disease group.There was no statistically significant difference in CD4^＋ T lymphocyte count between HIV-related retinal disease group and CMVR group.The following cytokines in CMVR group were significantly higher than the other two groups with statistically significant differences：MIP-1b,IL-6,TNF-α,VEGF,IL-8,MCP-1,IP-10.Conclusions In patients who was diagnosed as AIDS,cytomegalovirus retinitis would damage vision acuity seriously.The elevated cytokines＆#39; level in aqueous humor such as MIP-1b,IL-6,TNF-α,VEGF,IL-8,MCP-1,IP-10,compared with HIV-related retinal disease and AIDS-normal eye cases,may be related to the activity of Th1 cell and monocyte-macrophages system including chemokines,inflammatory factors,and vascular endothelial factors.