| Background and Purpose:Pneumocystis pneumonia (PCP) remains the most frequent opportunistic infections in patients with HIV/AIDS, which results in high mortality. However, serum testing of the indicators for early prediction of the severity and evaluation of the prognosis about this disease have not been established. The aim of this study was to investigate the changes of the immune molecules, cytokines and the components (including angiotensin converting enzyme and angiotensin) of renin-angiotensin-system(RAS) in AIDS PCP patients, by which to analysis the value for early prediction of the severity and assessment of the prognosis in AIDS PCP patients.Methods:We enrolled 82 HIV-infected patients with PCP and 30 pure HIV-infected patients from March 2013 to November 2015 in infectious department of the first affiliated hospital College of Medicine, Zhejiang University. Then we obtained clinical information and hematologic parameters within 12 hours on admission, including CRP, ESR, PCT, WBC, LDH, HBDH, D-dimer, ferritin. The HIV-1 RAN level was measured by fluorescence quantitative PCR. The level of the plasma cytokines and immune molecules were measured by the commercially available enzyme-linked immunosorbent assay kits:IL1β, IL4, IL6, IL8, IL10, IL12, IL17a,IL18, IFNy,MCP1, ACE2, ACE, AngⅡ, Angl-7. We studyed the genes expression of some major target genes IL2, IL4,IL6, IL8, IL17a, IL12β in PBMC of AIDS PCP patients through fluorescence quantitative PCR, and explored the aracteristics of these genes. According to the results of dynamic monitoring of blood gas analysis testing:PaO2/FiO2, patients were divided into mild group (> 200 mmHg) and severe group (≤200 mmHg); According to the clinical outcome, patients were divided into survival group and death group. Statistical analysis was performed using SPSS version 19.0 version and Graphpad Prism version 5.0 software.Results:The results of immune molecules and biomarkers in 32 HIV-infected patients with PCP (including 20 cases in mild group and 12 cases in severe group) at time admission were that blood levels of IL6, IL8, IL6/IL10 ratio, HBDH and Ferritin were all significantly higher in patients with PaO2/FiO2≤200mmHg than in those with PaO2/FiO2> 200mmHg, and had significant correlation with oxygenation index and PST, revealing that they are associated with the disease severity of AIDS PCP and may potentially predict mortality. The area under the ROC curve (AUC) of serum IL6, IL8, IL6/IL10, HBDH and Ferritin were higher than 0.8, among which the Youden’s index of IL6/IL10 ratio and Ferritin were 0.717 and 0.733, suggesting that their predictive value were much better. The genes expression of IL4, IL6, IL8, IL17a of PBMC were in AIDS PCP patients with PaO2/FiO2≤200mmHg (p<0.05).The results of components(angiotensin converting enzyme and angiotensin) of renin-angiotensin-system(RAS) in 50 HIV-infected patients with PCP and 30 pure HIV-infected patients were that the difference among plasma levels of ACE, ACE2 and ACE2/ACE ratio were significant. Increased plasma ACE level (87.96±29.51VS 139.30±41.90 p=0.024) and decreased blood ACE2 level (152.59±14.66 VS 121.43±38.56 p=0.047) were found in the PaO2/FiO2≤200mmHg group compared with>200mmHg group of AIDS PCP patients, markedly reducing the ACE2 over ACE ratio (2.08±1.50 VS 0.95±0.40 p=0.017). Plasma levels of ACE, ACE2 and ACE2/ACE ratio demonstrated high and significantly linear correlation with PST (p=0.0035, r=0.4051; p=0.0012, r=0.4464; p=0.0012, r=0.3643)Conclusion:1. IL8, IL6/IL10 ratio could be as immune molecules in early evaluation the severity and predicting fatal outcomes of the patients admitted with AIDS PCP; 2.The value of plasma ferritin level is higher than that of HBDH, LDH as biomarkers for early prediction of the severity and prognosis of AIDS complicated with PCP disease; 3. Early testing of plasma ACE2, ACE levels and ACE2/ACE ratio can predict the severity and prognosis of AIDS patients with PCP. |
PDF Full Text Request