改善胸腺功能或是艾滋病治疗新思路
2011年10月14日07:56来源：健康报
本报讯 （特约记者段文利）在经过长期正规“鸡尾酒”治疗的艾滋病患者中，为何仍有少数患者的病情得不到理想控制，免疫功能无法重建？北京协和医院李太生教授等历时5年多完成的一项研究显示，艾滋病患者的免疫功能能否重建，主要取决于CD4+T细胞群中胸腺新生亚群的数量。这一发现解释了艾滋病“免疫学无应答”的发生机制，提示改善胸腺功能或可作为艾滋病治疗新思路。该研究相关论文近日发表在《临床传染病杂志》上。
研究发现，尽管在保证良好依从性前提下接受“鸡尾酒”治疗，血浆病毒载量较长时间控制在测不出的水平之下，但仍有5%~30%艾滋病患者的CD4+T免疫细胞数量未出现显著增长，研究者将这类患者定义为“免疫学无应答”者。此类患者的机会性感染发生率、艾滋病相关疾病发病率及病死率等均高于“免疫学应答良好”的患者。
北京协和医院研究组从病例库中筛选出经抗病毒治疗后“免疫学无应答”者17人和“免疫学应答良好”者13人作为研究对象，观察其CD4+T细胞的纯真亚群（这组细胞增多表明免疫力增强）、胸腺新生亚群（CD31）等5个细胞亚群的改变趋势。结果发现，无论是“免疫应答好”的患者，还是“免疫无应答”的患者，经典的“鸡尾酒”疗法对增加其胸腺新生亚群所起作用不大；胸腺新生亚群的数量与艾滋病患者的CD4+T淋巴细胞增长呈正相关，在艾滋病患者免疫功能重建中起决定作用，胸腺功能衰竭会导致“免疫学无应答”患者的CD4+T纯真细胞亚群无显著增长。
李太生介绍，这一发现的重要意义在于，通过早期检测艾滋病患者的CD4+T淋巴细胞计数和胸腺新生细胞比例，即可甄别出“免疫学无应答”者，而无需等到治疗一段时间后才能确定。针对此类患者，新治疗策略要在持续“鸡尾酒”治疗的同时，努力提高其胸腺功能。
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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AIDS treatment to improve thymic function or new ideas
At 07:56 on October 14, 2011 Source: Health News
WASHINGTON (special correspondent segment Manley) after long-term informal "cocktail" treatment of AIDS patients, why are there still a small number of patients with the disease are not ideal control, immune function can not be rebuilt? Beijing Union Medical College Hospital, Professor Li Taisheng lasted more than five years to complete such a study, the immune function of AIDS patients can rebuild, depending on the CD4 + T cell populations in the thymus, the number of new subgroups. This finding explains the AIDS "no immunological response" of the mechanism, suggesting that improved thymic function as an AIDS treatment or new ideas. The research-related papers recently published in "Clinical Infectious Diseases" on.
The study found that despite good compliance to ensure acceptance of the premise of "cocktail" therapy, plasma viral load control in a long time to levels that could not be determined, but there are still 5% to 30% of AIDS patients with CD4 + T cell immune increase the number does not appear significant, the researchers defined these patients as "non-immunological response" are. These patients the incidence of opportunistic infections, AIDS-related morbidity and mortality are higher than the "good immunological response" in patients.
Beijing Union Medical College Hospital research team from the case library was screened out by the anti-viral treatment, "Immunology, no response" in 17 and the "good immunological response" in 13 people for the study, to observe the purity of CD4 + T cell subsets ( This group of cells increased shows that enhanced immunity), neonatal thymus subsets (CD31) and other five cell subsets change the trend. The results showed that, whether it is "a good immune response," the patient, or "no immune response," the patient, the classic "cocktail" therapy for the thymus to increase its role is not new subgroups; thymus, the number of new subgroups of patients with AIDS growth of CD4 + T lymphocytes were positively related to immune reconstitution in HIV patients play a decisive role, thymus failure will result in "no immunological response" in patients with CD4 + T cell subsets in pure no significant growth.
Li Taisheng introduction, the significance of this finding is that early detection of AIDS patients by CD4 + T lymphocyte count and percentage of cells in newborn thymus, can be screened out "no immunological response," who, without having to wait for treatment can only be determined after a period of time . For such patients, new treatment strategies continue to be in the "cocktail" treatment at the same time, strive to improve their thymus function.
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