难辨梭菌A/B毒素检测在AIDS患者中的应用

Application of Clostridium Difficile A/B Toxin Detection in AIDS Patients

目的对AIDS合并慢性腹泻的患者测定难辨梭菌A&B毒素(CDAB),了解其免疫状况及疾病进展情况,对及时进行难辨梭菌性腹泻治疗提供依据。方法对60名AIDS腹泻患者用法国梅里埃mini VIDAS专用试剂盒测定难辨梭菌A&B毒素,并采集患者全血样本以四色荧光抗体进行标记,用BECKMAN FC500流式细胞仪测定淋巴细胞亚群CD4^+T百分比和绝对数,测定调节性T细胞(Treg)、辅助性T细胞(Th17)的百分比;选择20例健康体检者为对照组。结果60例AIDS患者合并感染CDAB有8例阳性为双重感染者,阳性率为13.3%,阴性52例为单纯AIDS组。双重感染组CD4^+T绝对数均数为(325.6±93.8)个/μL,单纯AIDS组为(502.3±125.4)个/μL,上述各组均明显低于健康对照组(965.4±137.6)个/μL(P<0.01),双重感染组明显低于单纯AIDS组(P<0.05)。Treg细胞在CD4^+T细胞中的百分比为双重感染组(7.35±1.91)%、单纯AIDS组(5.12±1.24)%,均高于健康对照组(3.89±0.97),P<0.05,双重感染组明显高于单纯AIDS组(P<0.05)。Thl7细胞在CD4^+T细胞中的百分比为双重感染组(1.32±0.47)%;单纯AIDS组(3.23±0.58)%,均低于健康对照组(5.26±0.65),P<0.05;双重感染组明显低于单纯AIDS组(P<0.05)。结论HIV感染导致Th17和CD4^+T细胞下降、Thl7和Treg细胞失衡,免疫系统严重受损,造成各种机会性感染增加。AIDS腹泻患者测定CDAB,对判断病情和评估疗效有重要的临床价值,可监测疾病进展并及时给予治疗。

Objective To determine clostridium difficile A&B toxin(CDAB)in AIDS patients with chronic diarrhea,to understand their immune status and disease progression,and to provide evidence for timely treatment of clostridium difficile diarrhea.Me thods Sixty AIDS patients with diarrhea were tested for Clostridium difficile A&B toxin by mini VIDAS(BIOMERIEUX,France)The whole blood samples of the patients were labeled with four-color fluorescent antibodies.The percentage and absolute number of CD4^+T lymphocyte subsets and the percentage of regulatory T cells(Treg)and helper T cells(Th17)were measured with BECKMAN FC500 flow cytometry.Twenty healthy people were selected as the control group.Re s ults Among the 60 AIDS patients with CDAB infection,8 were positive for co-infection,with a positive rate of 13.3%,while 52 were negative for single AIDS group.The average absolute number of CD4^+T in the co-infection group was(325.6±93.8)μL,and(502.3±125.4)μL in the single AIDS group.The average absolute numbers of these groups were significantly lower than(965.4±137.6)μL of the healthy control group(P<0.01),and the average absolute number of co-infection group was significantly lower than that of the single AIDS group(P<0.05).The percentage of Treg cells in CD4^+T cells was(7.35±1.91)%in the co-infection group and(5.12±1.24)%in the single AIDS group,both of which were higher than 3.89±0.97%in the healthy control group(P<0.05),while those in the co-infection group were significantly higher than those in the single AIDS group(P<0.05).The percentage of Th17 cells in CD4^+T cells was 1.32±0.47%in the co-infection group,3.23±0.58%in the single AIDS group,both of which were significantly lower than 5.26±0.65%in the healthy control group(P<0.05).The percentage of Th17 cells in CD4^+T cells in co-infection group was significantly lower than that in the simple AIDS group(P<0.05).Conclus ion HIV infection leads to a decrease of Th17 and CD4^+T cells,imbalance of Th17 and Treg cells,severe damage to the immune system and the increase of various opportunistic infections.Measuring CDAB in AIDS diarrhea patients is not only important in judging the disease condition and evaluating the curative effects,but also beneficial for monitoring the disease progress and giving timely treatment.