儿童HIV感染者及AIDS患者高效抗反转录病毒治疗前后T淋巴细胞及亚群的变化

目的 观察儿童HIV感染者或AIDS患者接受高效抗反转录病毒治疗(HAART)前后T淋巴细胞及亚群的变化.方法 选取2006年5月至2009年4月在广西壮族自治区疾病预防控制中心AIDS抗病毒治疗门诊接受HAART的儿童作为研究对象,共招募99例儿童HIV感染者或AIDS患者.分别在治疗前(D0),治疗后第3、6、12、18、24、30、36个月(M3、M6、M12、M18、M24、M30、M36)时随访调查并采集2 ml静脉血,应用四色荧光标记流式细胞术检测外周血CD3+、CD4+、CD8+T淋巴细胞绝对数及CD3比率、CD4比率、CD8比率、CD4/CD8比值.结果 99例研究对象的治疗方案为:拉米夫定(3TC)/齐多夫定(AZT)/奈韦拉平(NVP),65例(65.66%);3TC/司他夫定(D4T)/NVP,16例(16.16%);3TC/AZT/依非韦伦(EFV),8例(8.08%);3TC/AZT/克力芝(LPV/r),10例(10.10%).CD4/CD8比值的中位数在M3、M6、M12、M18、M24、M30、M36时分别为0.39、0.51、0.61、0.65、0.70、0.73、0.76,与D0时(0.19)比较,均有明显提高(Z值分别为-5.158、-7.375、-9.078、-8.853、-8.373、-5.845、-5.844,P值均＜0.000).CD4比率的中位数在M3、M6、M12、M18、M24、M30、M36时分别为16.92%、22.70%、25.54%、26.66%、27.99%、30.36%、29.30%,与D0时(9.92%)比较,均有明显提高(Z值分别为-5.268、-7.568、-9.496、-9.171、-8.760、-6.190、-5.964,P值均＜0.000).CD4+T淋巴细胞绝对数的中位数在M3、M6、M12、M18、M24、M30、M36时分别为631、813、1050、946、1057、1166、894个/mm3,与D0时(382个/mm3)比较,均有明显提高(Z值分别为-3.318、-5.288、-6.661、-5.886、-5.801、-4.110、-3.600,P值均＜0.000).CD8比率的中位数在M3、M6、M12、M18、M24、M30、M36时分别为47.25%、43.01%、43.04%、42.60%、41.37%、40.83%、3 8.31%,与D0时(53.17%)比较,均有明显降低(Z值分别为-3.082、-4.697、-5.282、-5.846、-5.757、-3.883、-4.380,P值均＜0.001).结论 T淋巴细胞及亚群的变化具有一定规律,可用于评价和指导HAART.

The changes and significance of T lymphocytes and subsets before and after receiving highly active anti-retroviral therapy in children infected with HIV or AIDS patients

Objective To investigate the changes of the T lymphocytes and their subsets before and after receiving highly active anti-retroviral therapy (HAART) in children who were infected with HIV or AIDS patients. Methods Ninety-nine children met the criteria were recruited. All of them had received HAART in Guangxi Center for Disease Control and Prevention from May 2006 to April 2009. Peripheral blood of 2 milliliter was collected before treatment (D0) and after 3,6,12,18,24,30, and 36 months ( M3, M6,M12,M18, M24, M30 and M36), respectively. Four-color fluorescence flow cytometry was used for the detection of the absolute numbers of CD3 +, CD4+, CD8 + T lymphocytes in peripheral blood. And then, the percentages of CD3 +, CD4+, CD8 + T lymphocytes in the CD45 + cells and the ratio of CD4/CD8 were calculated. Results Sixteen-five ( 65. 66% ) cases were treated with lamivudine ( 3TC )/zidovudine (AZT) /nevirapine ( NVP), and 16 ( 16. 16% ), 8 ( 8. 08% ) and 10 ( 10. 10% ) cases were treated with 3TC/stavudine ( D4T)/NVP,3TC/AZT/efavirenz (EFV) and 3TC/AZT/Ipv-rtv(LPV/r), respectively. The median of the ratio of CD4/CD8 were 0. 39,0. 51,0. 61,0. 65,0. 70,0. 73 and 0. 76 in M3,M6,M12,M18,M24, M30 and M36, respectively which were significantly higher than that in D0(0.19) ( Z values were -5. 158, -7. 375, - 9. 078, - 8. 853, - 8. 373, - 5. 845 and - 5.844 respectively, P ＜ 0.000). The median of CD4% were 16. 92% ,22.70% ,25.54% ,26. 66% ,27.99% ,30. 36% and 29. 30% respectively in M3, M6, M12, M18, M24, M30 and M36 respectively,which were also higher significantly than that in D0 (9.92%) (Zvalues were -5.268, -7.568, -9.496, -9.171, - 8.760, -6.190 and -5.964 respectively, P＜0.000 ) . In addition, the median of the absolute numbers of CD4+ T lymphocytes in peripheral blood were 631,813,1050,946, 1057,1166 and 894 cells/mm3 respectively in M3, M6, M12,M1 8, M24, M30 and M36, which were higher significantly than that of D0 (382 cells/mm3) (Z values were -3.318, -5. 288, -6. 661, -5. 886, -5. 801, -4.110 and -3. 600 respectively,P ＜0. 000). However,the median of CD8% were 47.25%, 43.01%, 43.04%, 42.60%, 41.37%, 40.83% and 38.31% respectively in M3, M6, M12, M18, M24, M30 and M36, which were lower significantly than that of D0 (53.17%) (Zvalues were -3.082, -4.697, -5.282, -5.846, -5.757, -3.883 and -4.380 respectively, P＜0.001 ). Conclusion There is certain rules for the changes of T lymphocytes and their subsets ,which may play important roles in the evaluation of the therapeutic effect and the clinical application guidance of HAART.