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| 序贯治疗中ART启动时间对TB/HIV患者的免疫学影响分析 |
| Immunological effects of ART initiation time in sequential therapy of TB/HIV patients |
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| DOI：10.3969/j.issn.1007-8134.2021.05.007 |
| 中文关键词: TB/HIV 序贯治疗 ART启动时间 CD4+ T细胞 CD4/CD8比值 |
| 英文关键词: TB/HIV sequential therapy ART initiation time CD4+ T cells CD4/CD8 ratio |
| 基金项目:国家十三五科技重大专项儿童艾滋病适宜治疗和预防策略研究与应用（2018ZX10302-102）；国家科技重大专项项目艾滋病综合治疗方案的优化及推广应用研究（2017zx10202101-001-009） |
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| 中文摘要: |
| 目的 探讨抗反转录病毒治疗（antiretroviral therapy, ART）序贯抗结核治疗（antituberculosis therapy, ATT）中ART启动时间对结核病（tuberculosis, TB）/HIV患者CD4+ T、CD8+ T细胞计数及CD4/CD8比值的影响。方法 收集云南省传染病医院2014年1月—2017年12月间收治入院的TB/HIV患者病历资料。根据ART启动时间分为A组（ART基础上启动ATT）、B组（ATT 8周内启动ART）、C组（ATT 8周后启动ART）。分析比较48周随访期内3组的免疫学指标差异。结果 共收集TB/HIV患者193例，分为A组90例、B组77例和C组26例。基线时B组的CD4+ T细胞计数低于A组和C组（P均＜0.05）。3组患者在48周随访期内CD4+ T细胞计数、CD4/CD8比值均呈不同程度上升趋势（P均＜0.05）。A组和B组的CD4+ T细胞计数在序贯治疗后开始上升（P均＜0.05），而C组则延迟至24周开始上升（P＜0.05）。24周、48周时3组的CD4+ T细胞计数差异均无统计学意义（P均＞0.05），B组的CD4+ T细胞计数增幅高于A组和C组（P均＜0.05）。48周时，3组中仅少数患者的CD4+ T细胞计数恢复至≥500 cells/μl，以B组恢复最为明显（12.99%）。 24周和48周时，CD4+ T细胞计数≥500 cells/μl患者所占比例在3组之间差异均无统计学意义（P均＞0.05）。结论 尚未开始ART的TB/HIV患者应尽早接受ART，以恢复免疫功能，ATT 8周内启动ART，免疫重建效果最佳。 |
| 英文摘要: |
| Objective To explore the effects of antiretroviral therapy (ART) initiation time in antituberculosis therapy (ATT) on CD4+ T, CD8+ T cell counts and CD4/CD8 ratio in tuberculosis (TB)/HIV patients. Methods The medical records of TB/HIV patients admitted to Yunnan Provincial Infectious Disease Hospital from January 2014 to December 2017. According to the initiation time of ART, the patients were divided into group A (ATT plus ART), group B (ART within 8 weeks of ATT) and group C (ART after 8 weeks of ATT). The differences in immunological indicators of patients in the 3 groups during the 48-week follow-up period were analyzed and compared. Results A total of 193 TB/HIV patients were collected, including 90 cases in group A, 77 cases in group B and 26 cases in group C. The CD4+ T cell count of group B was lower than that of groups A and C at baseline (P＜0.05). During 48-week follow-up period, the CD4+ T cell count and CD4/CD8 ratio of patients in the 3 groups showed increasing trends to varying degrees (P＜0.05). CD4+ T cell counts of groups A and B began to increase after sequential therapy (P＜0.05), while that in group C began to increase at 24 weeks (P＜0.05). At 24 weeks and 48 weeks, there was no significant difference in CD4+ T cell count (P＞0.05), and the increment of CD4+ T cell count of group B was higher than that of groups A and C (P＜0.05). At 48 weeks, the CD4+ T cell counts in only a few patients of the 3 groups recovered to the level of ≥500 cells/μl, and the recovery was the most obvious in group B (12.99%). There were no significant differences in the proportion of patients with CD4+ T cell count ≥500 cells/μl between the 3 groups at 24 and 48 weeks (P＞0.05). Conclusions TB/HIV patients who have not yet initiated ART should receive ART as soon as possible to restore immune function. ART has the best immune reconstitution effect within 8 weeks of ATT. |
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