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目的探索人类免疫缺陷病毒(HIV)-1感染者外周血CD_8~+T淋巴细胞表面CD_(38)(CD_(38)~+/CD_8~+)、人类白细胞抗原DR(HLA-DR)(HLA-DR~+/CD_8~+)表达水平的变化及其与疾病进展的关系。方法选取2012年5-8月河南省淮阳县中医院、西平县中医院、驻马店驿城区中医院、泌阳县中医院、博爱县中医院收治的经河南省疾病预防控制中心确诊的HIV-1感染者409例为HIV-1感染组,河南中医学院第一附属医院体检健康者28例为对照组。采用流式细胞仪检测外周血CD_4~+、CD_8~+T淋巴细胞计数和百分比,计算CD_4~+/CD_8~+,实时荧光定量聚合酶链式反应(RT-PCR)法检测血浆病毒载量,应用全血染色、流式细胞术检测HIV-1感染者CD_(38)~+/CD_8~+、HLA-DR~+/CD_8~+。根据CD_4~+T淋巴细胞计数分为4组:<200 cells/μl组87例、200~<350 cells/μl组119例、350~<500 cells/μl组99例、≥500 cells/μl组104例,比较不同CD_4~+T淋巴细胞计数者间CD_(38)~+/CD_8~+、HLA-DR~+/CD_8~+。结果 HIV-1感染组CD_4~+T淋巴细胞计数、百分比低于对照组,CD_8~+T淋巴细胞计数、百分比高于对照组(P<0.001);HIV-1感染组CD_4~+/CD_8~+低于对照组(P<0.001)。HIV-1感染者血浆病毒载量为(38 415±1 067)copies/ml。Pearson相关分析表明,HIV-1感染者CD_4~+T淋巴细胞计数与血浆病毒载量呈负相关(r=-0.246,P<0.001);CD_(38)~+/CD_8~+与CD_4~+T淋巴细胞计数呈负相关(r=-0.260,P<0.001);CD_(38)~+/CD_8~+与血浆病毒载量呈正相关(r=0.409,P<0.001);HLA-DR~+/CD_8~+与CD_4~+T淋巴细胞计数呈负相关(r=-0.225,P<0.001);HLA-DR~+/CD_8~+与血浆病毒载量呈正相关(r=0.378,P<0.001)。200~<350 cells/μl组、350~<500 cells/μl组、≥500 cells/μl组CD_(38)~+/CD_8~+、HLA-DR~+/CD_8~+低于<200 cells/μl组(P<0.05)。结论 HIV-1感染者CD_4~+T淋巴细胞计数、百分比降低,CD_8~+T淋巴细胞计数、百分比升高,CD_(38)~+/CD_8~+、HLA-DR~+/CD_8~+与血浆病毒载量呈正相关。CD_4~+T淋巴细胞计数、CD_8~+T淋巴细胞计数结合CD_8~+T淋巴细胞的活化水平可以更全面地反映HIV-1感染者免疫功能受损的程度,HIV-1感染后CD_(38)~+/CD_8~+、HLA-DR~+/CD_8~+的变化可作为评价疾病进展的新指标。
Objective To explore the relationship between HLA-DR (HLA-DR) and CD_ (38) (CD 38 + CD_8 +) on the surface of CD_8 ~ + T lymphocytes in human immunodeficiency virus (HIV) -DR ~ + / CD_8 ~ +) expression and its relationship with disease progression. Methods From May to August in 2012, the cases of HIV-1 infection confirmed by Henan Provincial Center for Disease Control and Prevention in Henan Huaiyang County Hospital of Traditional Chinese Medicine, Xiping Hospital of Traditional Chinese Medicine, Zhumadian Station City Hospital of Traditional Chinese Medicine, Biyang County Hospital of Traditional Chinese Medicine, 1 infected 409 cases of HIV-1 infection group, the First Affiliated Hospital of Henan Medical College 28 cases of healthy control group. The counts and percentage of CD_4 ~ + and CD_8 ~ + T lymphocytes in peripheral blood were detected by flow cytometry, and the CD_4 ~ + / CD_8 ~ + concentration was calculated. The real-time fluorescent quantitative polymerase chain reaction The levels of CD_ (38) ~ + / CD_8 ~ +, HLA-DR ~ + / CD_8 ~ + in HIV-1 infected patients were detected by whole blood staining and flow cytometry. According to the CD_4 ~ + T lymphocyte count, there were 4 groups: 87 cases in <200 cells / μl group, 119 cases in 200 ~ <350 cells / μl group, 99 cases in 350 ~ <500 cells / μl group and ≥500 cells / μl group Among 104 cases, CD_ (38) ~ + / CD_8 ~ +, HLA-DR ~ + / CD_8 ~ + were compared among different CD_4 ~ + T lymphocyte counts. Results The percentage of CD_4 ~ + T lymphocytes in HIV-1 infection group was lower than that in control group, and the percentage of CD_8 ~ + T lymphocytes in HIV-1 infection group was higher than that in control group (P <0.001) + Lower than the control group (P <0.001). The plasma viral load of HIV-1 infected persons was (38 415 ± 1 067) copies / ml. Pearson correlation analysis showed that there was a negative correlation between CD_4 ~ + T lymphocyte count and plasma viral load in HIV-1 infected patients (r = -0.246, P <0.001); CD38 + CD8 + and CD4 + (R = -0.260, P <0.001). The positive rates of CD_ (38) ~ + / CD_8 ~ + were positively correlated with plasma viral load (r = 0.409, (R = -0.225, P <0.001). There was a positive correlation between HLA-DR + / CD8 + and plasma viral load (r = 0.378, P <0.001) ). CD_ (38) ~ + / CD_8 ~ + and HLA-DR ~ + / CD_8 ~ + less than 200 cells / μl in the group of 350 ~ <500 cells / μl group (P <0.05). Conclusions The counts and percentages of CD 4 + T lymphocytes in HIV-1 infected patients are lower than those in HIV-1 infected patients. The percentage of CD_8 ~ + T lymphocytes and the percentage of CD_ (38) ~ + / CD_8 ~ +, HLA-DR ~ + / CD_8 ~ Plasma viral load was positively correlated. CD_4 ~ + T lymphocyte count, CD_8 ~ + T lymphocyte count and CD_8 ~ + T lymphocyte activation level can more fully reflect the extent of immune function impairment in HIV-1 infected patients. CD_ (38) ) ~ + / CD_8 ~ +, HLA-DR ~ + / CD_8 ~ + changes can be used as a new indicator of disease progression.