中医药对接受HAART疗法艾滋病患者免疫重建胸腺近期输出功能的影响

HAART (Highly Active Antiretroviral Therapy) has its limitations in HIV/AIDS immune function reconstitution. For example, only 60% patients can realize the reconstitution of immune function after receiving treatment and whether they can return to the normal level is unproved; the regenerated CD4+CD45RA+T cells are completely inhibited by antiviral drugs during the replication of HIV; and this means that the patients may encounter the dilemma of no cure. Therefore, the hotspot for current international AIDS research is to search new strategies and new methods for immune function reconstitution. By observing the influence on recent output function of thymus through the immune reconstitution of AIDS patients and on utilization characteristics of TCR Vβspectrum through the combination of traditional Chinese medicine and western medicine, this research aims to discuss the action mechanism of traditional Chinese medicine and western medicine for immune system in the human body from the recent output function of thymus and the immunity enhancement, find out the possible targets for improving the immune function of AIDS patients through the combination of traditional Chinese medicine and western medicine and provide basic support for clinical application of the combination of traditional Chinese medicine and western medicine for AIDS treatment; explore the internal relations between the change of thymus and the disease process; provide data support for AIDS treatment in China; and provide theoretical basis for developing immunological indicators for the evaluation of HIV/AIDS curative effect.

HAART治疗对艾滋病免疫功能重建有其局限性，如治疗后只有60%病人可以做到免疫功能重建，而是否能恢复到正常水平尚未证实；再生的CD4+CD45RA+T细胞甚至在HIV复制时就被抗病毒药完全抑制；这意味着病人可能出现无药可用的境地。因此，寻找免疫重建的新策略和新方法成为目前国际艾滋病研究的热点。本研究通过观察中医药联合HAART疗法对艾滋病患者免疫重建胸腺近期输出功能和TCR Vβ谱系利用特点的影响，从改善胸腺近期输出功能和提高免疫力的角度出发探讨中医药在人体内对免疫系统的作用机制，找出中西医结合改善艾滋病患者免疫功能的可能靶点，为中西药合用治疗艾滋病提供临床应用的基础支持；探索胸腺功能的改变和疾病进程的内在联系；为我国艾滋病的治疗提供数据支持；为开发艾滋病疗效评价免疫学指标提供理论依据。

HAART治疗对艾滋病免疫功能重建有其局限性，如治疗后只有60%病人可以做到免疫功能重建，寻找免疫重建的新策略和新方法成为目前国际艾滋病研究的热点。本研究通过观察服用HAART、HAART+康爱保生丸12月、24月后对艾滋病患者免疫重建TRECs含量的影响，进而评价胸腺近期输出功能，同时定期检测、评价患者的TCR Vβ基因谱系、T淋巴细胞、CD4+CD45RA+T细胞计数、血浆病毒载量、免疫功能重建率，分析胸腺近期输出功能与相关指标间的相关性。结果发现：HAART与康爱保生丸可能不是通过增加CD3+、CD8+T淋巴细胞计数而发挥治疗作用。康爱保生丸联合HAART较单纯HAART治疗可有效增加患者CD4+、CD4+CD45RA+T淋巴细胞计数，升高患者sjTRECs/106 CD4+T、sjTRECs/106 CD8+T含量，有效的改善CD4+、CD8+T细胞部分TCRVβ基因寡克隆，降低患者血浆病毒载，并在一定程度上提高患者免疫重建成功率。sjTRECs/106 CD4+T与CD4+、CD8+、CD4+CD45RA+T细胞计数、TCRVβ4、5.2呈正相关，与HIV血浆病毒载量呈负相关；sjTRECs/106 CD8+T与CD8+T细胞计数呈正相关。通过本项目的研究，我们发现结合T细胞亚群、TCRVβ基因谱系和胸腺近期输出功能等指标,对HAART后的细胞免疫重建进行监测，能够更为确切地评价HAART治疗后细胞免疫重建情况。同时，研究表明：长期服用HAART+康爱保生丸较单纯服用HAART可有效改善患者免疫重建状况，更好地促进HAART后患者的免疫重建。研究结果为中医药联合HAART疗法治疗艾滋病提供临床应用的基础支持，为拓展艾滋病疗效评价免疫学指标提供理论依据。