摘要: 目的 研究静脉药瘾者(IDU)血源性病毒感染及重叠感染状况、T细胞亚群变化与多重病毒感染的关系。 方法 以406名无肝炎病史的静脉药瘾者为研究对象, 用酶联免疫吸附法、免疫层析法和多聚酶链反应检测血源传播的常见病毒的感染标志物, 用免疫荧光法检测T细胞; 用ELISA和放射免疫法检测诱生的细胞因子和血清的细胞因子。选取同一地区102名健康体检者作对照。 结果 在406例静脉药瘾者中, 乙肝病毒(HBV)、丙肝病毒(HCV)、人类免疫缺陷病毒(HIV)、丁肝病毒(HDV)、戊肝病毒(HGV)和血源传染病毒(HCMV)感染率分别为36.45%, 69.7%, 47.3%, 2.22%, 1.97%和3.45%, 均明显高于对照组, 静脉药瘾者(61.81%)存在2种以上病毒感染。HIV易重叠HCV和HBV等病毒感染, 重叠感染率为83.85%。对照组仅存在HBV感染17.65%(18/102)。静脉药瘾者的CD3⁺和CD4⁺细胞比例减少, CD8⁺细胞比例无明显变化, 单个核细胞诱生的IL-4、IFN-γ以及血清IL-2减少, 血清IL-4增高(P < 0.01)。发生HIV感染或HIV重叠HCV/HBV病毒感染时, 诱生的IFN-γ和CD4⁺细胞比例进一步降低。HIV合并HBV感染的静脉药瘾者, 51.72%表现HBV-DNA阳性和37.93%的HBeAg阳性; 但无HIV感染时, HBV-DNA阳性率仅为1.68%。 结论 静脉药瘾者易出现多种病毒感染, 主要是HIV、HCV和HBV的感染。静脉药瘾者Th1细胞功能减弱, 出现HIV感染或重叠感染使Th1/Th2细胞平衡紊乱, 进一步证实了HIV可能通过减弱Th1细胞功能, 促进HBV的复制。

Abstract: Objective To investigate the features of various blood-borne virus infection and co-infection in intravenous drug users (DU).The correlation of Tlymphocyte subsets and virus co-infection was exam fined. Methods A study population of 406 DU consisted of 383 males and 23 females.All subjects had no clinical manifestation of hepatitis HBV-DNA and HCV-RNA were identified by fluorescence quantitative polymerase chain reaction HBsAg, HBeAg, anti-HCV, HDV-Ag, anti-HCV, anti-HIV, and HCM V-IgM were assayed by enzym e-linked immunosorbent assay (ELISA) and immunochrom atogmphic tests.The levels of cytokines of Th1 and Th2 were measured by EL ISA and radioactive immune assay (RIA).Tlymphocyte subpopulation was detected by means of fluorescence immunoassay.The indices taken from 102 healthy persons served as control. Results The infection rate of the vims among DU was 36.45% for HBV, 69.70 for HCV, 47.3% for HIV, 2.22% forHDV, 1.97% for HGV, and 3.45% for HCMV, respectively.The co-infection rate of blood-borne virus was detected in 255 of 406 (61.81%) subjects Triple infection and fourfold infectionwere detected in the study.More than 80%(161/192) of subjects infected with HIV were co-infected with the other virus (HBV or HCV).In contrast, among the controls, the infection rate was 17.65% for HBV and 0% for other vimses Therewas a profound decrease in the proportion of CD4/CD8 and the percentage of CD3 and CD4, but no decrease in the percentage of CD8 The levels of PHA-induced cytokines (IFH-γ and 1-4) and the level of seaun 1-4 were obviously decreased in DU.On the other hand, the level of seaun 1-4 was increased The level of IFH-γand the percentage of CD4 were continuously decreased when the DU was infected with HIV or HIV co-infection DU with HIV and HBV co-infection was 15.1% and 51.72%.37.93% of the subjects were HBV-DNA positive and HBeAg positive when there was HIV and HBV co-infection Only 1.68% (2/119) of DU without HIV infection were HBV-DNA positive. Conclusion HCV, HBV and HIV infection were comm on in DU.The co-infection led to a high incidence of inpaired Th1 cytokine levels and CD4 lymphyocyte DU with HIV and HBV/HCV co-infection showed both lower expression of Th1 cytokine and enhancement of the Th2 response HIV may be a reason causing HBV rep lication through decreasing Th1 function.