HIV合并TB感染患者免疫重建炎性综合征危险因素及Th17/Treg变化

目的探讨获得性免疫缺陷病毒(Human immunodeficiency virus,HIV)合并结核菌(HIV/TB)感染患者免疫重建炎性综合征(Immune reconstitution inflammatory syndrome,IRIS)发生危险因素及辅助性T细胞17(Th17)与调节性T细胞(Treg)水平变化。方法选取青海省第四人民医院呼吸科2018年1月-2020年1月收治HIV合并TB感染患者120例作为研究对象,并根据高效抗逆转录病毒治疗(Highly active antiretroviral therapy,HAART)期间是否发生IRIS分为IRIS组23例及非IRIS组97例。采用单因素及多因素Logistic回归分析HIV合并TB感染患者发生IRIS的危险因素;比较两组患者HAART当天、开始后12周、24周HIV RNA载量、CD₄⁺T绝对计数水平,分析两组及IRIS组治疗后不同转归患者炎症因子水平。结果多因素Logistic回归分析结果显示,开始HAART时CD₄⁺T细胞计数<50个/μl、有机会性感染史、存在淋巴结受累是HIV合并TB感染患者发生IRIS的独立危险因素(P<0.05);两组患者基线、治疗12周、治疗24周HIV RNA水平差异无统计学意义,IRIS组CD₄⁺T绝对计数低于非IRIS组,差异具有统计学意义(P<0.05);IRIS组患者血清中IL-17、IL-23表达水平高于非IRIS组,IFN-γ、TGF-β表达水平低于非IRIS组P<0.05);治疗好转组患者血清中IL-17、IL-23表达水平低于无效组,IFN-γ、TGF-β表达水平高于无效组(P<0.05)。结论开始HAART时CD₄⁺T细胞计数水平、有机会性感染史、存在淋巴结受累是HIV合并TB感染者发生IRIS的独立危险因素,临床中应进行针对性预防,Th17/Treg失衡与IRIS的发展及治疗效果存在关联。

Risk factors for immune reconstitution inflammatory syndrome and change of Th17/Treg in patients with HIV/TB coinfection

OBJECTIVE To explore the risk factors for immune reconstitution inflammatory syndrome(IRIS)in the patients with co-infection of human immunodeficiency virus(HIV)and tuberculosis(TB)and observe the changes of helper T cells 17(Th17)and regulatory T cells(Treg).METHODS Totally 120 patients with co-infection of HIV and TB who were treated in respiratory department of the Fourth People′s Hospital of Qinghai Province from Jan 2018 to Jan 2020 were recruited as the study objects and were divided into the IRIS group with 23 cases and the non-IRIS group with 97 cases according to the status of emergence of IRIS during the highly active antiretroviral therapy(HAART).Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for IRIS in the patients with coinfection of HIV and TB.The HIV RNA load,absolute counts of CD₄⁺T were compared between the two groups of patients at the beginning of HAART and after the HAART for 12 and 24 weeks,and the levels of inflammatory factors of the patients with different treatment outcomes were observed.RESULTS The result of multivariate logistic regression analysis showed that the CD₄⁺T cell counts less than 50 cells/μl at the beginning of HAART,history of opportunistic infection and presence of lymph node involvement were the independent risk factors for the IRIS in the patients with coinfection of HIV and TB(P<0.05).There were no significant differences in the levels of HIV RNA between the two groups of patients at the beginning and after the treatment for 12 and 24 weeks,the absolute counts of CD₄⁺T of the IRIS group were less than those of the non-IRIS group,and there was significant difference(P<0.05).The levels of serum IL-17 and IL-23 of the IRIS group were higher than those of the non-IRIS group,while the levels of IFN-γand TGF-βof the IRIS group were significantly lower than those of the non-IRIS group(P<0.05).The levels of serum IL-17 and IL-23 of the improved treatment group were significantly lower than those of the ineffective group,while the levels of IFN-γand TGF-βof the improved treatment group were significantly higher than those of the ineffective group(P<0.05).CONCLUSION The CD₄⁺T cell counts at the beginning of HAART,opportunistic infection history and presence of lymph node involvement are the independent risk factors for the IRIS in the patients with coinfection of HIV and TB.It is necessary for the hospital to take targeted prevention measures,and the Th17/Treg imbalance is associated with the progression of IRIS and therapeutic effect.