新发现解释艾滋病“免疫学无应答”发生机制
2011年10月18日 09:14 来源：科技日报
为什么经过长期正规“鸡尾酒”治疗的艾滋病患者中，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等经过五年多时间完成的一项研究显示，艾滋病患者免疫功能能否重建，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为艾滋病治疗新思路。相关论文发表在近日出版的国际著名《Clinical Infectious Diseases》(临床传染病杂志)上,上世纪90年代科学家关于艾滋病研究领域最重要的成就在于找到“鸡尾酒疗法”和提出艾滋病人免疫功能重建理论，使降低艾滋病发生率、病死率成为可能。但随着研究深入和治疗时间延长，人们发现，在保证良好依从性的前提下接受“鸡尾酒治疗”后，血浆病毒载量较长时间控制在测不出的水平之下，仍有约5%—30%的患者CD4+T免疫细胞数量未出现显著增长，研究者们将这类艾滋病患者定义为“免疫功能重建不全”或“免疫学无应答”，其机会性感染发生率、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。因此，艾滋病抗病毒治疗后的“免疫学无应答”的发生机制是国际上艾滋病领域近年来的研究热点。
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。
李太生介绍说，这一发现的重要意义在于，通过早期检测艾滋病患者CD4+T淋巴细胞计数和胸腺新生比例，即可甄别出免疫功能重建不全者，而无需等到治疗一段时间后才能确定。针对免疫功能重建不全患者，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。中药研发可沿着提高胸腺功能的思路展开。(段文利)
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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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New findings explain AIDS "no immunological response" mechanism of
At 09:14 on October 18, 2011 Source: Science and Technology Daily
Why after a long regular "cocktail" treatment of AIDS patients, the patient's condition is still not ideal for a small number of control, immune function can not be rebuilt? Beijing Union Medical College Hospital, Li Taisheng more than five years after completion of such a study, AIDS patients can rebuild the immune function, depending on CD4 + T cell populations in the thymus, the number of new subgroups, this finding explains the AIDS "Immunology No Answer "the mechanism, suggesting that improved thymic function or new ideas for AIDS treatment. Relevant papers published in a recent issue of the internationally renowned "Clinical Infectious Diseases" (Clinical Infectious Diseases), the 1990s, scientists on the field of AIDS research is to find the most important achievement "cocktail therapy" and made immune reconstitution in AIDS theory, to reduce HIV incidence, mortality is possible. But with the study in-depth and prolonged treatment, it was found to ensure good adherence to accept the premise of "cocktail treatment", the plasma viral load control in a long time to levels that could not be determined, there are still about 5% -30% of patients the number of CD4 + T immune cells does not appear significant growth in this type of AIDS researchers have defined as "incomplete immune reconstitution" or "no immunological response", the incidence of opportunistic infections, AIDS-related diseases morbidity and mortality are higher than the "good immunological response" in patients. Therefore, anti-viral treatment of AIDS, "no immunological response," the mechanism is the field of international AIDS research focus in recent years.
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.
Litai Sheng said the significance of this finding is that early detection of AIDS patients by CD4 + T lymphocyte count and percentage of students thymus, immune reconstitution can be screened out incomplete without having to wait until the treatment can only be determined after a period of time. Failure for patients with immune reconstitution, new treatment strategies to continue to "cocktail" treatment at the same time, strive to improve their thymus function. Chinese R & D can enhance thymus function along the idea to start. (Section Wen-Li)
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