未经高效抗逆转录病毒治疗的HIV感染者血管内皮损伤及血浆脂肪细胞因子的研究

摘要

目的 研究未经高效抗逆转录病毒治疗(HAART)的HIV感染者血管内皮损伤、血浆脂肪细胞因子及血栓形成因子的水平,以探讨单纯HIV感染者体内是否存在心血管病高危因素.方法 收集2009年2-10月在我中心就诊的HIV感染者43例和17例同期院内正常体检者的一般资料并采集外周静脉血,ELISA法检测血浆瘦素、脂联素、可溶性细胞间黏附分子1(sICAM-1)、D-二聚体水平,在两组人群中比较这4项指标及TC、TG、空腹血糖等指标.流式细胞仪检测病例组CD4+T淋巴细胞计数、CD8+CD38+/CD8+、CD8+HLA-DR+/CD8+,用病毒定量检测仪和分支DNA技术检测HIV病毒载量,两组人群中有统计学差异的指标与CD4+T淋巴细胞计数、CD8+CD38+/CD8+、CD8+HLA-DR+/CD8+、HIV病毒载量进行Spearman相关性分析.结果 43例HIV感染者CD4+T淋巴细胞为(133±82)个/μl,HIV RNA为(4.42±0.66)lg拷贝/ml,瘦素[11.41(7.91,14.53)μg/L]、脂联素[1.79(1.40,4.00)mg/L]水平显著低于对照组[55.31(16.49,229.65)μg/L,3.36(2.92,4.18)mg/L,P值均＜0.005],sICAM-1[1.71(1.11,2.40)mg/L]显著高于对照组[0.69(0.57,0.80)mg/L,P=0.0000],并且sICAM-1与HIV病毒载量及免疫激活指标CD8+ CD38+/CD8+显著正相关(r=0.3378,P=0.0267和r=0.3904,P=0.0096).结论 未经HAART治疗的HIV感染者体内存在某些心血管病高危因素的显著变化,应进一步研究其内在机制,寻求预防和处理方法.%Objectives To investigate the markers of endothelial injury, adipocytokine and thrombotic activity and explore whether there are cardiovascular disease risk factors in antiretroviral-naive HIV patients. Methods Clinical data and venous blood samples were collected from 43 anti-retroviral naive HIV-infected patients during February -October 2009 in our center, and compared with 17 healthy subjects.Plasma leptin, adiponectin, soluble intercellular adhesion molecule-1 ( sICAM-1 ), D-dimer were measured by ELISA. Four markers and cholesterol, triglyceride, fasting plasma glucose were compared between the two groups. The CD4+ T cells and percentages of CD38, HLA-DR on CD8+ T were determined by flow cytometry and plasma HIV copies were detected with bDNA analyzer among HIV-infected participants.Spearman correlations between the significant markers and CD4+ T cells, CD8+ CD38+/CD8+, CD8+ HLA-DR +/CD8+, HIV viral load were examined among HIV-infected participants. Analyses were conducted by using Stata version 7. Results Thirty-eight of the 43 patients were sexually infected by HIV and the median absolute CD4+ T cell count was ( 133 ± 82 ) cells/μl, HIV RNA was (4. 42 ± 0. 66 ) lg copies/ml. HIV-infected patients, compared with healthy subjects, had lower leptin [11.41 (7.91,14. 53 )μg/L vs 55.31( 16. 49,229.65 ) μg/L, P= 0. 0005], adiponectin [1.79 ( 1.40,4. 00 ) mg/L vs 3.36 ( 2. 92,4. 18 ) mg/L,P =0. 003] and higher sICAM-1 [1.71 (1.11,2.40) mg/L vs 0. 69 ( 0. 57, 0. 80 ) mg/L, P = 0. 0000].No significant differences exist in cholesterol, triglyceride, fasting plasma glucose. For HIV-infected participants, sICAM-1 tended to correlate with CD8+ CD38+/CD8+ and HIV viral load ( r= 0.3378, P= 0.0267;r = 0.3904,P = 0.0096). Conclusion Patients with untreated HIV infection have lower leptin, adiponectin and higher sICAM-1 levels and the relationship of these markers to HIV-mediated atherosclerotic risk requires further study.