Wen Long, Shi Lei, Wan Shan-Shan, Xu Tao, Zhang Lei, Zhou Zhi-Guo
Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, The First Hospital of Changsha, Changsha, Hunan 410000, P.R. China.
Department of Nursing, The Fourth Hospital of Changsha, Changsha, Hunan 410000, P.R. China.
Exp Ther Med. 2023 Apr 21;25(6):271. doi: 10.3892/etm.2023.11970. eCollection 2023 Jun.
Tuberculosis (TB) is the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection and is one of the primary causes of death from AIDS. The increased accessibility to highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of patients with HIV infection. However, following ART, rapid restoration of the immune system leads to immune reconstitution inflammatory syndrome (IRIS). Oxidative stress and innate immunity play a role in TB-associated IRIS (TB-IRIS). The present study investigated the changes that occur in oxidative stress markers and T helper (Th)17/regulatory T (Treg) cell balance and their significance in IRIS patients with HIV-associated pulmonary TB. A total of 316 patients with HIV-associated pulmonary TB were treated with HAART and followed up regularly for 12 weeks. Those who developed IRIS were included in the IRIS group (n=60), while the remaining patients were included in the non-IRIS group (n=256). The changes in plasma oxidative stress markers superoxide dismutase (SOD) and malondialdehyde (MDA) were detected with the ELISA, and the ratio of Th17 to Treg cells in whole blood were analyzed before and after treatment through the flow cytometric assay. Following treatment, MDA and Th17 cells levels were significantly increased while SOD and Treg cells levels were decreased in the IRIS group (P<0.05) compared with before treatment. In the non-IRIS group, a non-significant decrease was observed in SOD levels (P>0.05), while the MDA levels significantly decreased compared with before treatment (P<0.05) and the Th17 and Treg cells levels were both significantly increased (P<0.05). After treatment, compared with the non-IRIS group, the IRIS group showed a significant increase in MDA and Th17 cells and decrease in SOD and Treg cells levels (P<0.05). In addition, Th17 cells levels were positively correlated with MDA but negatively correlated with SOD levels. Treg levels were negatively correlated with MDA and positively correlated with SOD levels (P<0.05). The area under the curve values of serum MDA and SOD, Th17 and Treg levels predicting the occurrence of IRIS were 0.738, 0.883, 0.722 and 0.719, respectively (P<0.05). These results indicated that the above parameters have certain diagnostic value for the occurrence of IRIS. The occurrence of IRIS in patients with HIV-associated pulmonary TB may be associated with oxidative stress and Th17/Treg cell imbalance.
结核病（TB）是人类免疫缺陷病毒（HIV）感染所致获得性免疫缺陷综合征（AIDS）患者中最常见的机会性感染，也是AIDS患者的主要死因之一。高效抗逆转录病毒疗法（HAART）可及性的提高显著改善了HIV感染患者的临床结局。然而，抗逆转录病毒治疗（ART）后，免疫系统的快速恢复会导致免疫重建炎症综合征（IRIS）。氧化应激和固有免疫在结核病相关的IRIS（TB-IRIS）中起作用。本研究调查了氧化应激标志物以及辅助性T（Th）17/调节性T（Treg）细胞平衡在HIV相关肺结核IRIS患者中的变化及其意义。共有316例HIV相关肺结核患者接受HAART治疗，并定期随访12周。发生IRIS的患者被纳入IRIS组（n = 60），其余患者被纳入非IRIS组（n = 256）。采用酶联免疫吸附测定（ELISA）检测血浆氧化应激标志物超氧化物歧化酶（SOD）和丙二醛（MDA）的变化，并通过流式细胞术分析治疗前后全血中Th17与Treg细胞的比例。治疗后，与治疗前相比，IRIS组的MDA和Th17细胞水平显著升高，而SOD和Treg细胞水平降低（P<0.05）。在非IRIS组中，SOD水平有不显著的下降（P>0.05），而MDA水平与治疗前相比显著下降（P<0.05），Th17和Treg细胞水平均显著升高（P<0.05）。治疗后，与非IRIS组相比，IRIS组的MDA和Th17细胞显著增加，SOD和Treg细胞水平降低（P<0.05）。此外，Th17细胞水平与MDA呈正相关，与SOD水平呈负相关。Treg水平与MDA呈负相关，与SOD水平呈正相关（P<0.05）。血清MDA和SOD、Th17和Treg水平预测IRIS发生的曲线下面积值分别为0.738、0.883、0.722和0.719（P<0.05）。这些结果表明上述参数对IRIS的发生具有一定的诊断价值。HIV相关肺结核患者IRIS的发生可能与氧化应激和Th17/Treg细胞失衡有关。
