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目的探讨长期接受高效抗反转录病毒治疗(HAART)且依从性良好的艾滋病患者免疫功能重建规律。方法建立回顾性研究队列,纳入2000~2013年北京协和医院感染科长期随访(年限≥2年)、初治且依从性良好的HIV/AIDS患者。分析不同随访时间点下,患者外周血各淋巴细胞亚群变化规律。根据基线CD4~+T淋巴细胞计数进行分组,分析不同免疫功能受损情况下对患者免疫功能重建的影响。结果纳入病例数137例,平均(38.5±9.9)岁,中位随访时间4.5(四分位间距:3.5~7.2)年。基线中位CD4~+T淋巴细胞计数为125.0(36.0~231.0)cell/μl,第7年时上升至425.0(314.8~575.3)cell/μl(P<0.001),不同亚群各组间差异也随治疗而缩小,且在治疗达到一定时长时各组间无显著差异。CD8~+T淋巴细胞计数保持相对稳定。CD8~+CD38~+T淋巴细胞随治疗进行呈下降趋势,而CD8~+DR~+T淋巴细胞计数较为稳定。结论不论基线免疫受损程度如何,在保证依从性良好的前提下,我国HIV/AIDS患者经长期抗病毒治疗可获得理想的免疫功能重建。免疫重建规律为记忆CD4和纯真CD4淋巴细胞均增长,治疗早期以记忆CD4淋巴细胞增长为主。CD8激活亚群随治疗时间而逐渐下降,功能亚群保持稳定。
Objective To investigate the regulation of immune function in patients with AIDS who have received long-term effective antiretroviral therapy (HAART) and have good compliance. Methods A retrospective cohort was established and included HIV / AIDS patients who were initially treated with good compliance and who were followed up for a long term (≥ 2 years) in the Department of Infectious Diseases, Peking Union Medical College Hospital from 2000 to 2013. The changes of lymphocyte subsets in peripheral blood of patients at different time points were analyzed. According to the baseline CD4 ~ + T lymphocyte count grouping, analysis of immune function impaired cases of immune function reconstruction. Results A total of 137 cases were included in the study, with an average of (38.5 ± 9.9) years and a median follow-up of 4.5 years (quartiles: 3.5 to 7.2 years). The median CD4 ~ + T lymphocyte count was 125.0 (36.0 ~ 231.0) cell / μl at baseline and increased to 425.0 (314.8 ~ 575.3) cell / μl at 7th year (P <0.001). The differences among different subgroups With the treatment and narrowing, and in the treatment of a certain length of time no significant difference between the groups. CD8 ~ + T lymphocyte count remained relatively stable. CD8 ~ + CD38 ~ + T lymphocytes decreased with the treatment, while CD8 ~ + DR ~ + T lymphocyte counts were relatively stable. Conclusion Regardless of the extent of baseline immune compromise, under the premise of good compliance, HIV / AIDS patients in our country can obtain ideal immunological function after long-term antiviral therapy. Immune reconstruction of memory CD4 and CD4 lymphocytes were pure growth, early treatment of memory CD4 lymphocyte growth-based. The CD8 activation subpopulation decreased gradually with the time of treatment, and the functional subgroup remained stable.