【摘要】 目的研究T细胞第二信号受体-CD28分子在人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者中的异常改变,探讨其临床意义。方法采用流式细胞术检测HIV/AIDS患者外周血CD4+T细胞表面CD28分子的表达,对278例未接受过高效抗逆转录病毒治疗(HAART)的患者进行横断面研究,对其中59例接受规律HAART的患者于开始治疗前,治疗后第1、3、6、9、12月末进行随访。以56例健康献血员作为正常对照。结果HIV/AIDS患者外周血CD4+T细胞表面CD28分子表达显著下调(P<0.001),且CD28分子表达比例与其CD4+T细胞计数呈正相关(r=0.484,P<0.001),与血浆病毒载量呈负相关(r=-0.300,P<0.001)。给予HAART1个月后CD4+T细胞的CD28表达比例中位数由75%快速恢复至90%(P<0.001)。HAART期间6个时间点的CD28表达比例中位数与病毒载量中位数呈负相关(r=-0.829,P=0.042),与CD4+T细胞计数中位数之间未发现显著相关性。结论HIV/AIDS患者外周血CD4+T细胞表面CD28分子表达明显减少,HAART可有效重建CD4+T细胞功能亚群(CD4+CD28+T)的数量,HAART后CD28表达上调可能与病毒载量的控制密切相关。更多还原

【Abstract】 Objective To study the alteration of the expression of CD28 on CD4+ T cells in HIV/AIDS patients and observe the dynamics of CD28 expression under highly active antiretroviral therapy(HAART).Methods The expression of CD28 on CD4+ T cells,CD4 counts,and plasma viral load were measured by flow cytometry and bDNA assays in 278 treatment-nave HIV/AIDS patients and 56 healthy controls.In addition,the evolution of these parameters was assessed in 59 patients who initiated HAART and were followed for 12 months in regular 3-month visits.Results The median level of CD28 on CD4+ T cells decreased dramatically in treatment-nave HIV-positive individuals than in HIV-negative controls(P<0.001).The expression rate of CD28 molecule was positively correlated with CD4 counts(r=0.484,P<0.001),and negatively correlated with plasma viral load(r=-0.300,P<0.001).In patients who had received one month of standard HAART,the level of CD28 on CD4+ T cells increased rapidly from 75.0% to 90.0%(P<0.001).Moreover,there was a negative correlation between the median CD28 expression and the median viral load(r=-0.829,P=0.042).Conclusions The level of CD28 expression on CD4+T cells is down-regulated in treatment-nave HIV/AIDS patients.HAART can successfully restore the lymphocyte subsets of CD4+CD28+T cells.The up-regulation of CD28 expression after HAART may be closely correlated with the suppression of the viral replication.更多还原