Research On Distribution/Evolvement Of Traditional Chinese Medicine Syndromes And Relationship Between Traditional Chinese Medicine Syndromes And T Cell Immune Activation Markers In HIV/AIDS

ObjectiveThis research is aims to search after the rule of distribution and evolvement of TCM syndromes in HIV/AIDS,while explore the relationship of TCM syndromes and T cell immune activation markers on peripheral blood in HIV/AIDS.MethodsProject 1 Research on distribution and evolvement of TCM syndromes inHIV/AIDS.The epidemiology and TCM examination information of 353 HIV/AIDS patients were investigated, CD4⁺ T lymphocyte count were tested. First, the distribution of TCM syndromes were characterized,and different people of AIDS ,different infection approach and different phase of disease were compared on the syndromes. At last, principal components analysis and discriminate analysis were used to explore the application value of smptoms and physical signs of HIV/AIDS on the quantitative diagnosis of AIDS syndromes.Project 2 Research on relationship of TCM syndromes and T cell immune activation markers in HIV/AIDS.T cell immune activation markers-level of sCD27 on peripheral blood, proportion of CD8⁺CD28⁺,CD4⁺CD28⁺, CD8⁺HLA-DR,CD8⁺CD38⁺ and CD4⁺T lymphocytes counts on PBMC was analysed in 105 HIV/AIDS samples. The correlation of T cell immune activation markers and T lymphocyte ,routine blood test ,liver function were analysed.Investigate the change of T cell immune activation level along with disease phase and CD4⁺ T lymphocytes counts and TCM syndromes.At last,28 HIV/AIDS were treated with combination therapy of traditional Chinese medicine Aikeqing Capsule and ART, the leukocyte differentiation antigen,cytokine, subgroup of T lymphocyte and viral load were detected before and after the therapy.To group the case by different therapy method and different response and compare effect of the leukocyte differentiation antigen and cytokine of different cohort.ResultsProject 1. Research on distribution and evolvement of syndromes in HIV/AIDS.12 TCM syndromes and 5 basic TCM syndromes were diagnosed.The leading syndrome of HIV/AIDS patient was "Qi and Yin Deficinecy&Lung and Kidney Deficiency", the leading basic syndrome of HIV/AIDS was "Deficiency Syndrome".In the phases of HIV infector,the main syndrome were "Stagnation of Liver-qi&Flaming-up of Liver-fire",while in the phase of AIDS, the main syndrome was "Qi and Yin Deficinecy&Lung and Kidney Deficiency". In the phase of HIV infector,the main syndrome were "Deficiency Syndrome"and "Heat Syndrome",while in the phases of AIDS, there were more patient appear syndrome of" Excess and Deficiency simultaneity Syndrome". With the decrease of CD4⁺ T lymphocyte count ,the patient appear different syndrome: patient with CD4⁺ T lymphocyte count> 350 /ul were more likely found to be syndrome of "Stagnation of Liver-qi&Flaming-up of Liver-fire", CD4⁺ T lymphocyte count between 201-350 /ul were more likely found to be syndrome of "Stagnation of Liver-qi&Flaming-up of Liver-fire"and"Qi and Blood Deficiency", while those between 51-200 /ul were more likely found to be syndrome of "Qi and Blood Deficiency"and "Qi and Yin Deficinecy&Lung and Kidney Deficiency" ,those<50/ul were more likely found to be syndrome of Accumulation of Phlegm-heat in lung"and "Qi and Yin Deficinecy&Lung and Kidney Deficiency". Totally,the TCM syndrome became complex with the progression of AIDS.There were more syndromes of "Qi and Yin Deficinecy&Lung and Kidney Deficiency"in male,while there were more syndromes of "Qi and Blood Deficiency" in female.Different syndromes educed different score of symptoms and physical signs. Patients with syndrome of "Accumulation of Phlegm-heat in lung" score highest in symptoms and physical signs,while those of "Phlegm-heat stagnation" score lowest.Patients with " Excess and Deficiency simultaneity Syndrome" score highest in symptoms and physical signs, while those with "stasis syndrome" score lowest. The correlation were significant between CD4⁺ T lymphocyte count and score of symptoms and physical signs.Discriminate analysis showed that the correlation between symptoms/physical signs and syndrome were closer than that of basic syndrome,the coefficient of vomit,cough,fever were highest in syndrome of "Accumulation of Phlegm-heat in lung", the coefficient of itch was highest in syndrome of "Dampness and Heat of Liver Channel", the coefficient of headache and arthrosis was highest in syndrome of "blood-stasis due to stagnation of qi and phlegm".To explore the application value of smptoms and physical signs of HIV/AIDS by principal components analysis, 20 index of smptoms and physical signs were reduced to 8 principal components and the first 8 principal components accumulatively accounted for 63.13% of the total variance,the 1^st principal component related to "lung and spleen" in TCM,and the 2^nd and 4^rd principal component related to "tri-energizer" in TCM ,the above 3 principal components accumulatively accounted for 33.5% of the total variance.Project 2 Research on relationship of TCM syndromes and T cell immune activation markers in HIV/AIDS.Level of sCD27 and percentage of CD8⁺HLA-DR and CD8⁺CD38⁺ increased significantly in patients of acquired immunodeficiency syndrome. The correlation were significant between these pairs hereinafter: 1^st , sCD27, CD4⁺CD28⁺ , CD8⁺CD28⁺ and CD4 T lymphocytes; 2^nd, CD8⁺HLA-DR and CD4/CD8 ;3^rd, CD8⁺HLA-DR , CD8⁺CD28⁺ and CD8⁺CD38⁺;4^th, sCD27 and erythrocyte , haemoglobin , lymphocytes , haematoblast ;5^th, CD4⁺CD28⁺ and erythrocyte, haemoglobin ;6^th, sCD27 and total bilirubin , albumin , glutamic oxaloacetic transaminase.Research on T cell immune activation and disease progression showed that level of sCD27 in the phase of C3 was higher than that of B3,while percentage of CD8⁺CD28⁺, CD8⁺CD38⁺and CD8⁺HLA-DR was higher in the patients of CD4T lymphocytes>200/ul than those <200/ul group.T cell immune activation marks showed diversity in different infection approach, sCD27,CD8⁺CD38⁺ were higher in the case infect from drug abuse and blood transfusion than those from isomerism sex behavior, while CD4⁺CD28⁺ was higher in the case infect from blood transfusion than the others. AIDS patient combining the other infection would affect the T cell immune activation:CD8⁺CD38⁺ increased in the case with tuberculosis or fungus infection; CD8⁺HLA-DR was higher in case with superficial fungus infection than that with deep fungus infection; CD8⁺CD28⁺ and CD8⁺HLA-DR were not so high in the case with Penicillium Marneffei infection than the others; sCD27 was higher in the case with central nervous system infection ;sCD27,CD8⁺HLA-DR and CD8⁺CD38⁺ increased significantly in the case with viral hepatitis; sCD27 and CD8⁺CD38⁺ were increased in the case with pneumonia infection,while CD8⁺CD28⁺ and CD8⁺HLA-DR were higher in the case with single pathogen infection than that with multiple pathogen infection。Research on T cell immune activation and TCM syndromes showed that the correlation were significant between sCD27, CD8⁺HLA-DR,CD8⁺CD38⁺ and score of symptom and physical sign . sCD27 was higher in the case with syndrome of rentention of dampness &spleen and Kidney Deficiency" than that of "blood-stasis due to stagnation of qi and phlegm "; CD8⁺CD28⁺ was higher in the case with syndrome of" Qi and Yin Deficinecy&Lung and Kidney Deficiency" than that of "Dampness and Heat of Liver Channel"; CD8⁺CD38⁺ was higher in the case with syndrome of "Qi and Yin Deficinecy&Lung and Kidney Deficiency"than that of "blood-stasis due to stagnation of qi and phlegm ". CD4⁺CD28⁺ was higher in the case with "Deficiency Syndrome" than that of " Excess and Deficiency simultaneity Syndrome"; CD8⁺CD28⁺ was higher in the case with "Deficiency Syndrome" than that of "Heat syndrome"; CD4/CD8 was higher in the case with "Deficiency Syndrome" than that of "Heat syndrome"and " Excess and Deficiency simultaneity Syndrome";CD4⁺CD28⁺,CD8⁺CD28⁺ and CD4/CD8 were higher in the case of "Deficiency Syndrome" than the others.Research on effect of traditional Chinese medicine intervening on immunological index showed that after therapy with Aikeqing capsule,HIV/AIDS patients got early stage of immune rebuild that CD45RO rose ,and the cohort of combination therapy of Aikeqing capsule and HAART rose significantly. Expression of CD28 vary in PBMC of HIV/AIDS patients, it was higher in phase of AIDS than those of HIV infector,and it came close after therapy. Evolvement of CD28 vary in different cohort, it droped after combination therapy of Aikeqing capsule and HAART while rose after therapy of Aikeqing capsule; it droped in the cohort of better curative effect while rose in those of no effect.Conclusion1.The syndrome of HIV/AIDS was change from simpleness to complexity with disease progression.In early and middle phases of HIV infector,the leading syndrome were "Excess Syndrome" and "Deficiency Syndrome",while in the phases of AIDS, there were more syndrome of Excess and Deficiency simultaneity Syndrome",2. Coefficient of discriminate regression equation showed the significance of symptom and physical sign to the TCM syndrome. It could provide some evidence for evaluate the diagnostic value of the symptoms.3. Score of symptoms and physical signs change with disease progression. The correlation are significant between score of symptoms/physical signs and T cell immune activation marks , the same are score of symptoms/physical signs and CD4/CD8. Therefore score of symptoms/physical signs may be the important index of diagnosis and evaluation of curative effect on AIDS.4.The TCM syndrome were distributed differently according to CD4⁺ T lymphocyte count, therefore CD4⁺ T lymphocyte count may be one of the impersonality index of TCM syndrome.5. T cell immune activation marks-level of sCD27 and percentage of CD8⁺HLA-DR and CD8⁺CD38⁺ increased significantly in patients of acquired immunodeficiency syndrome,while percentage of CD28 shows no linearity change with disease progression. T cell immune activation level is higher in the patients of CD4 T lymphocytes>200/ul than those <200/ul group. T cell immune activation marks increase in AIDS patient combining the other infection.HIV and other pathogen facilitate the activation of T lymphocyte.6.There are some correlation between TCM syndrome and T cell immune activation. CD4⁺CD28⁺ CD8⁺CD28⁺ and CD4/CD8 rate have correlation with "Deficiency Syndrome" that they may be one of the impersonality index of TCM syndrome.7.CD45RA,CD45RO and CD28 have some value on evaluation of curative effect of traditional Chinese Medicine that they may be one of the impersonality index of evaluation of curative effect.