|
中医药治疗艾滋病的三个切入点
发布日期：2010-10-21 来源：健康报
在日前召开的国际中医药防治艾滋病大会上，来自中、西医界的专家齐聚一堂，共同商讨中医防治艾滋病的切入点。“从艾滋病的免疫发病机制来看，目前至少在3个方面，西医仍无很好的解决办法。中医不妨从这些方面入手。”北京协和医院艾滋病诊疗中心主任、卫生部艾滋病临床专家组副组长李太生的建议，引起与会专家的强烈共鸣。
中国中医科学院中医药防治艾滋病研究中心常务副主任、科技部中医治疗艾滋病课题组负责人王健在接受记者采访时说，“我们的工作不能‘大而全’，需要沿着一条明确的思路找准切入点，有针对性地发挥作用。西医强的地方，我们不要碰或者少碰，尽量做一些‘雪中送炭’的工作。”
切入点一：感染早期的治疗
为病程进展“踩刹车”
据李太生介绍，人感染艾滋病病毒后，主要病理过程是T淋巴细胞免疫系统的受损，尤其是CD4免疫细胞遭到损害，而导致各种机会性感染和肿瘤。所以，划分艾滋病4个时期（急性感染期、无症状HIV感染期、艾滋病前期和艾滋病期）的主要依据就是CD4免疫细胞的数量。
健康人的CD4免疫细胞约为800个/立方毫米。在急性感染期，艾滋病病毒载量急剧上升，CD4免疫细胞数量相应下降。但大多数感染者不经治疗CD4免疫细胞即可回升至正常或接近正常水平。
随后进入无症状感染期，CD4免疫细胞持续缓慢减少。在未治疗的情况下，无症状期每立方毫米CD4免疫细胞每年下降50~60个。大多数感染者在8~10年后降至200个/立方毫米以下，进入艾滋病前期。
“现在西医面临两难局面，一是CD4免疫细胞持续减少，如不治疗，将像一列疾驰的‘动车’，奔向疾病发作的‘悬崖’；二是感染者在此期间还未表现出患病症状，西医治疗的毒副反应、高昂价格让早期治疗难以实现。特别是考虑到可能导致过早产生耐药性，西医一般不主张在这一时期进行治疗。”李太生说，“中医药如果能在这一时期发挥作用，为这列‘动车’踩下刹车，将可有效延长感染者的正常生活时间，延缓发病。”
王健：关于这个切入点，我们已经开展工作了。国家重大传染病防治重大科技专项中就有一个子课题——“HIV无症状感染期的中医药干预研究”，目前课题正在进行中。
此外， 2004年8月至2009年6月，中医药治疗艾滋病试点项目使17个省（区、市）的8946例艾滋病患者得到治疗。临床总结发现，经过48个月的中医药治疗，无症状期感染者CD4免疫细胞计数下降幅度减慢，中位数降幅为49个/立方毫米，平均每年下降约12个/立方毫米。虽然这只是个粗略的回顾，但起码已经看到了苗头。真正的干预结果要期待上述课题的结题。
切入点二：免疫功能重建失败后
拧开免疫重建“阀门”
当艾滋病感染者进入发病期，现代医学已经研究出了有效的治疗方法。特别是HAART（高效抗逆转录病毒疗法，俗称“鸡尾酒疗法”）诞生后，80%~85%接受该疗法的患者，体内的病毒载量都能下降到较低水平，CD4免疫细胞数量相应回升，患者的免疫功能也就相应重新建立起来。
“对于这些患者来说，艾滋病实际上已经成为一种可控的慢性疾病。”李太生接着说，“但仍有15%~20%的患者，虽然病毒载量降下来了，免疫功能却迟迟重建不起来。”
李太生把这一现象比作木桶接自来水：“水龙头就好像是CD4免疫细胞的增殖能力，木桶是免疫系统。HAART前，艾滋病病毒不断杀死CD4免疫细胞，就好像一方面木桶漏了个洞，一方面水龙头出水也少，患者的免疫功能自然很低。HAART后，病毒被杀死了，木桶补好了，CD4免疫细胞也能源源不断地‘流出来’。但有15%~20%的患者，虽然HAART帮他补好了木桶，但他的水龙头流量仍然很小。”
“处于这种状况的患者CD4免疫细胞数量提升缓慢，免疫功能改善不明显，仍易患各种并发症，生活质量差。”李太生说，“希望中医药能发挥免疫调节的优势、特色，帮助患者重建免疫系统。”
王健：对于免疫功能重建失败后的治疗，中医药之前还没有严格的科研。此前，中医的主要努力不是集中在HAART后所造成的低载量。但近年来，我们已经注意到中医药在这个领域发挥作用的空间。
国家重大传染病防治重大科技专项中也有一个子课题——“HAART后免疫重建的中医药治疗研究”。课题组分别对患者进行中医的辨证施治、给予固定的中药方剂（固定方有些是有一定的实验基础，有的是基于临床经验的总结）等，总体治则是扶正祛邪。肯定的效果或结论需要等待具体结果的出炉。
切入点三：病毒储存库的清除
引诱病毒“出洞”
“目前，应用HAART，对艾滋病病毒的抑制率能达到98%以上。但艾滋病依然不能被治愈。”李太生提到了现代医学在艾滋病治疗方面的一块“硬骨头”，“即使用最强效的HAART，艾滋病病毒依然不能被全部杀灭，仍有极少量病毒‘潜伏’在人体内。只要用药，这些病毒就处于休眠状态，不出来兴风作浪。一旦停药，这些病毒就会激活，跑出来再次制造事端。”
李太生介绍，目前，研究人员只知道人体内有病毒储存库的存在。但储存库是如何形成的，在体内什么地方、哪个系统，仍是一个谜。所以，迄今HAART仍无法达到杀灭全部艾滋病病毒（即治愈艾滋病）的目标，患者需要终生服药。
“中药有没有办法激活储存库中的病毒，把它引出来，然后西医用HAART把它杀灭？”李太生表示，如果能在该领域取得进展，将有可能打响与艾滋病较量的最后总攻。
王健：彻底清除病毒储存库中潜藏的病毒，工作难度很大。因为对病毒储存库的研究并不充分，有太多的未知。但这确实将成为中医的一个工作方向。
中医更注重实践。我们将尝试应用一些在免疫系统激活方面有较好效果的中药，看能不能把艾滋病病毒引出来。
这3个切入点都是西医对我们的期待。除此之外，中医药在改善和减轻患者症状、提高患者生活质量、减少抗病毒药引起的某些毒副作用、提高患者依从性、费用低廉、无严重不良反应等方面也表现出了优势。这方面的工作，我们也将深入做下去。
Release Date :2010-10-21 Source: Health News
At a recent meeting of the International AIDS Conference in medicine from the Western medicine experts in the industry gathered to discuss entry point for AIDS medicine. "From the point of view of AIDS pathogenesis, at least in three aspects, Western still no good solution. Chinese may wish to start from these areas." Beijing Union Medical College Hospital, director of AIDS treatment center, the Ministry of Health AIDS clinical expert, Deputy Group Long Li Taisheng proposals, causing a strong response from the participating experts.
China Academy of Traditional Chinese Medicine AIDS Research Center Deputy Director, Ministry of Science and Chinese medicine treatment of AIDS Research Group Leader Wang Jian, said in an interview, "Our work can not be 'big and' need to identify along a clear idea of entry point to play a role in a targeted manner. Western strong place, we do not touch or a touch less, try to do some 'timely' work. "
A starting point: the treatment of early stage of infection
For the progression of "step on the brake"
According to Li Taisheng introduced, people infected with AIDS virus, the main pathological process is impaired immune system, T lymphocytes, especially CD4 immune cells were damaged, resulting in a variety of opportunistic infections and tumors. Therefore, the division of AIDS, four times (acute infection, asymptomatic HIV infection, HIV and AIDS pre-period) is mainly based on the number of CD4 immune cells.
Healthy people is about 800 CD4 immune cells / cubic mm. In acute infection, the rapid rise in HIV viral load, CD4 corresponding decline in the number of immune cells. But most of the infected CD4 immune cells without treatment can be recovered to normal or near normal levels.
And then went to asymptomatic infection, CD4 immune cells continued to slowly decrease. In untreated cases, symptoms of immune CD4 cells per cubic millimeter per year decreased by 50 ~ 60. Most infections in the 8 to 10 years down to 200 / cubic millimeter below into the pre-AIDS.
"Western medicine is now facing a dilemma, one CD4 immune cells continued to decrease, if not treated, will gallop like a 'motor car', toward the disease onset of the 'cliff'; Second, during infection has not been demonstrated in patients symptoms, Western medicine treatment toxicity, high price for early treatment difficult to achieve. particularly given the resistance may lead to premature, generally not in favor of Western medicine for treatment during this period. "Li Taisheng said," if Chinese medicine play a role in this period, for this column 'Train' hit the brakes, will be able to effectively extend the normal life time of infection, delay the onset. "
Wang Jian: On this starting point, we have to work out. Major national science and technology projects in infectious diseases there is a major sub-topics - "HIV asymptomatic infection intervention research in Chinese medicine", the current issue in progress.
In addition, from August 2004 to June 2009, Chinese medicine treatment of AIDS pilot project to 17 provinces (autonomous regions and municipalities), 8,946 cases of AIDS patients receive treatment. Clinical Summary found that after 48 months of medical treatment, asymptomatic infected CD4 immune cell count decline slowed, with a median decline of 49 / cubic millimeter, with an average annual rate of about 12 / cubic millimeter. While this is a rough review, but at least have seen the signs. Interfere with the results of the real issues to look forward to the knot problem.
Starting point two: after the failure of immune reconstitution
Unscrew the immune reconstitution "valve"
When the incidence of AIDS into the period, modern medicine has developed an effective method of treatment. Especially the HAART (highly active antiretroviral therapy, commonly known as "cocktail therapy") after the birth, 80% to 85% of patients receiving the therapy, the body's viral load can be reduced to low levels, CD4 immune cells in the corresponding pick-up the patient's immune function will be re established.
"For these patients, AIDS has virtually become a chronic manageable disease." Li Taisheng continued, "but there are still 15% to 20% of patients, although the viral load down, and immune function has as yet re not up. "
Li Taisheng bucket compared to the phenomenon of running water: "Water tap is like the proliferation of CD4 immune cells, the immune system barrel. HAART before HIV kills CD4 immune cells constantly, as if on the one hand barrel leak hole, while the tap water is also less, the patient's natural immune function is low. HAART, the virus is killed, make a good barrel, CD4 immune cells can also stream to 'flow out'. However, 15% 20% of patients, although HAART to help him make a good barrel, but his tap flow remains small. "
"The patients in this situation the number of CD4 immune cells increase slowly improved immune function was not obvious, is still susceptible to a variety of complications, poor quality of life." Li Taisheng said, "I hope that the immune regulation of Chinese medicine can play the advantages, features, help reconstruction of the immune system of patients. "
Wang Jian: For failure of immune reconstitution after treatment, traditional Chinese medicine is also not strictly scientific research before. Previously, the main efforts of Chinese medicine is not concentrated in the post-HAART caused by the low load. But in recent years, we've noticed in the field of medicine play a role in this space.
Major national science and technology projects of major infectious diseases also has a sub-project - "HAART immune reconstitution after treatment in Chinese medicine research." Traditional Chinese Medicine Research Group, respectively Differential Treatment of patients given a fixed Chinese herbal formula (there is a certain fixed side some of the experimental basis, some based on clinical and experience), etc., the overall rule is rousing. Positive effects need to wait for concrete results or conclusions of baked.
Three entry points: the removal of the virus repository
Induce virus "hole"
"At present, the application of HAART, the inhibition rate of HIV could reach 98%. But still can not be cured of AIDS." Li Taisheng that modern medicine in HIV treatment in a "tough one", "that is the most effective use of HAART, HIV is still not all been killed, there is still a very small amount of the virus 'latent' in the body. as long as the medication, the virus is dormant, not out of trouble. Once the withdrawal, the viruses will be activated once again come out to create disturbances . "
Li Taisheng, at present, researchers only know the human body the presence of a virus repository. However, how the formation of the repository, where in the body, which system is still a mystery. So far unable to kill all of HAART HIV (the cure for AIDS) targets, patients need lifelong medication.
"Chinese medicine has no way to activate the virus repository, it leads to, and then WESTERN with HAART kill it?" Li Taisheng said that if progress in this area, there will be started the last offensive battle with AIDS.
Wang Jian: complete removal of the virus latent repository of virus, the work is very difficult. Repository for research on the virus is not sufficient, there are too many unknowns. But it really will be a working direction of medicine.
Chinese pay more attention to practice. We will try to apply some of the activation of the immune system has good effect of Chinese medicine, see if I can lead out of the AIDS virus.
The three entry points are the expectations of our Western medicine. In addition, Chinese medicine to improve and reduce symptoms, improve patient quality of life due to certain antiviral drugs to reduce side effects, improve patient compliance, low-cost, no serious adverse reactions, it is also shown advantages. This work, we will further do so.
|
