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2010年最引人注目的病人：艾滋病被治愈 |
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2010年12月29日07:51 来源：《中国青年报》
 蒂莫西·雷·布朗(Timothy Ray Brown)一定是2010年最引人注目的病人。 有关他的一切都神秘极了，很少有人知道他头发的颜色，家里养着什么宠物，或是喜欢哪个电影明星。尽管如此，全世界的媒体都在争相报道这个居住在德国柏林的42岁白人男子。他曾经被艾滋病纠缠了整整10年。12月8日，一个由德国三所大学医学部研究人员组成的七人小组在著名科学杂志《血液》上发表在线论文称，“我们的研究结果证明这个病人的艾滋病被治愈了”。 自从1981年艾滋病毒被发现后，在这个“世纪杀手”多达6000万人的追杀名单中，布朗也许是第一个也是目前唯一一个被治愈的人。这名德国病人的痊愈被视为“令人震撼的突破性进展”。 治疗白血病时治愈了艾滋病 奇迹发生在一栋砖红色的建筑里，那是位于德国首都的夏洛特医院，也是欧洲规模最大的大学医院。 布朗是这家医院的老病号了。自从10年前被诊断出患有艾滋病后，他就一直在这里接受药物治疗。病毒没有击垮这个中年男人的身体，而是一直在他体内平静地潜伏着。 在清华大学艾滋病综合研究中心教授张林琦看来，这正是艾滋病毒可怕的地方。如果将细胞看成一座金库，这种病毒就像是一个劫匪。这个在显微镜下看来就像是个“小刺球”的病毒，会破解“金库”大门的“安全密码”，冲进细胞内部。然后，它会将自己的印记整合进细胞最内部的染色体，变成细胞的一部分。 如今，人们对这个抢劫者带来的危险已经不再陌生，它会攻击人体免疫系统中最重要的T4淋巴组织。一旦免疫组织崩溃，人的抵抗能力变低，就极有可能因感染死亡。 抢劫者可能在病人体内潜伏10年以上。因此，当人们将药物“警察”派入被感染的病人体内时，也往往难以追捕到这些悄悄隐藏的坏蛋。 布朗就一直生活在这群劫匪的阴影之下。同时，另外一种可怕的疾病又悄悄地缠上了他。几年前，这个倒霉的男人确诊患有白血病。在两种“绝症”的夹击之下，看起来，他几乎失去了生存下去的可能。 不过，夏洛特医院临床医生主任埃克哈德·蒂尔(Eckhard T hiel)并没有放弃，这个主攻血液学和肿瘤学的医生决定进行一个大胆的尝试。在上个世纪90年代中期，美国的一些科学家曾经发现，有一些人天生不会受到艾滋病毒的感染。蒂尔和他的同事们开始思考，如果在与布朗骨髓配型的捐献者中找到一个“天生不受艾滋病毒感染者”，“在用骨髓移植治疗白血病后，是不是病人体内的艾滋病毒也会跟着一起消失呢”？ 事实上，在普通人的细胞“金库”外，大多设置了两个“安全密码”，一个被称作CD4，另外一个则被称作CCR5。但对艾滋病毒来说，这两组密码破解起来非常容易，所谓的安保措施形同虚设。 但在那些天生对艾滋病毒“免疫”的幸运儿细胞上，由于基因突变，CCR5基因编码区域第185号氨基酸后发生了32碱基缺失。这种被称为CCR5△32的缺陷型基因就相当于为金库加密，劫匪无论使出怎样的招数，都无法溜到金库之中。 布朗十分幸运，在60名适合布朗进行骨髓移植的捐献者中，研究小组为他找到了一位具有CCR5△32型基因的人。2007年2月，当布朗接受移植手术后，捐献者的骨髓开始在他的体内运作，新的血细胞开始产生。
如同医生们曾经预想过的那样，新生成的细胞具有CCR5△32缺陷型基因。在3年多的追踪调查后，医生们确信一个奇迹发生了，“艾滋病毒在这个病人的体内完全消失了”。 在这个大家甚至不敢大声提到“治愈”二字的领域里，这绝对是个振聋发聩的发现 就在一年以前，为这个病例撰写的论文发表在世界医学界享有盛名的《新英格兰医学杂志》。那时，这个来自德国的研究小组很谨慎地表示“通过骨髓移植长期控制了艾滋病毒”。张林琦记得，这个病例令整个科学领域“震惊极了”。 在那篇论文发表之前，这种可怕的病毒一直被称作“史后世纪的瘟疫”。艾滋病毒被誉为全世界“头号传染病杀手”，每年有200万人因此死亡。 世界卫生组织也在自己的官方网站撰文称，如果坚持治疗，“艾滋病毒感染者可以保持良好状态，保持劳动能力，延长生命时间，即使在低收入国家的艾滋病毒感染者也可以做到。”不过，WHO同样斩钉截铁地说：“艾滋病毒感染不能被治愈。” 因此，当布朗体内再也找不到艾滋病毒的行踪时，路透社在报道中写道，在这个“大家甚至不敢大声提到‘治愈’二字的领域里，这绝对是个振聋发聩的发现”。 尽管这是一种“无法治愈”的疾病，但对它的研究并没有因此搁浅。目前，抗病毒治疗可以延长病人寿命30年到50年，比完全治愈的预期寿命只提前10年。 上个世纪90年代，华裔科学家何大一提出了著名的“鸡尾酒疗法”，即同时使用几种药物，每一种药物针对艾滋病毒繁殖周期中的不同环节，从而达到抑制或杀灭艾滋病毒的目的。 今年11月，一篇由美国加州大学旧金山分校的研究小组发表在《新英格兰医学杂志》上的论文称，抗逆转录病毒药物可能在一定程度上降低艾滋病的感染风险和传播速度，“它第一次证明了定期服用药物可部分减少艾滋病在男同性恋和双性恋男性高危人群中的传播速度”。 曾经在美国担任何大一助手的张林琦发现，虽然药物可以抑制新的细胞被感染，但已经被感染的细胞却还能在体内存活很长时间。这些病毒悄悄地潜伏着，致使药物甚至根本没法发觉。这成为“根治艾滋病的最大障碍”。 他把艾滋病毒比作“微观世界中的超人”，尽管直径只有短短的100纳米，却是一个“令人敬畏的对手”。 几年前，这个已经和艾滋病毒打了19年交道的“海归”教授决定开始研制艾滋病疫苗。如今，在实验室的动物实验里，疫苗已经产生了“非常好的观测结果”。
今年7月，美国国家过敏症和传染病研究所专家在《科学》期刊上发表研究成果，称发现了两种能够“绑定”并打击90%%以上艾滋病病毒变异毒株的抗体。 不过，这并不意味着疫苗即将投入生产。张林琦说：“虽然方向清楚，但路有多远，谁也不知道。” 当布朗被治愈的消息传出后，那些曾经认为“这是一个没法根治疾病”的科学家都感到非常兴奋。这证明了医学界之前的猜想，“如果利用基因手段将细胞表面的CCR532碱基敲掉，那么感染者体内的艾滋病毒就可能被彻底清除。” 一些欧美的科学家已经准备鼓励CCR5△32型人群捐献骨髓，并在全世界的艾滋病毒感染者中寻找适合的配型。他们兴奋地告诉绝望的病人，“别担心，艾滋病是可以治愈的”。 复制布朗的幸运并不容易 不过，想要复制布朗的幸运并不是件容易的事。在张林琦看来，这个德国病人被治愈的过程，简直就像“被闪电连续击中好几次的小概率事件”。一个被艾滋病毒感染的白血病患者，一个对艾滋病毒“免疫”的骨髓配型，一个能付得起巨额医疗费的钱包，这些要素缺一不可。 至少，一个中国病人很难完成这一点，因为黄种人中少有具有CCR5△32型基因的人。而在100个欧洲人中，也只有一个人具有这种保护能力极强的突变基因。 美国艾滋病病毒医学协会前会长扎格认为，“如果将这种方法变成标准疗法，存在着很大风险。” 目前，干细胞或骨髓移植常用于癌症治疗，但没有人知道健康人如果接受这种手术需要承担多大的危险。它涉及利用强力药物和放射物摧毁人体原有的免疫系统，然后输入捐献者的骨髓，以重造一个新的免疫系统，而这种疗法及其引发的并发症很有可能提高死亡率。 “这个方法并不实际，而且很可能把人杀死。”美国马里兰大学人类病毒学院的加洛博士说。26年前，正是这个科学家与他的工作伙伴一起发现了艾滋病毒。“我不想在这个有趣的事情上泼冷水，不过，你知道，这充其量也就是件趣事而已。而且，直到这个人死了，进行详细的检查，才能完全确定病毒彻底消失了。” 对于张林琦来说，“科学的不可预测性太大了，一些事情开始时看上去只是好玩而已，但最后很可能带来里程碑式的进展。” 他曾经的同事帕克斯顿就是一个好例子。那个病毒学家同时也是一个同性恋。上个世纪90年代中期，出于好奇，他对自己周围一些同性恋朋友的血液进行检测。结果令人大吃一惊，一部分人很容易被艾滋病毒感染，而另一部分则根本不会被感染。
科学家们在帕克斯顿的实验基础上找到了CCR5△32。而正是十几年前那个出于好奇才进行的实验，救了德国病人布朗一命。 “科学发展不可能一步到位，距离治愈艾滋病可能还有很长的路，但现在至少跨出了第一步。”张林琦说。对于这位长期从事艾滋病病毒研究的教授来说，这位奇特的德国病人至少证明了一点，如果能在体内敲掉CCR5的32碱基，就有根治艾滋病的可能。 “在基础科学研究中，计划永远赶不上变化快，没有人能说得准，究竟是在什么时刻，在哪个实验室里，这项研究就会取得成功。”他认真地说。 (赵涵漠) The most striking of 2010 patients: AIDS be cured At 07:51 on December 29, 2010 Source: "China Youth Daily" December 7, Huaihua, China's first AIDS Care Center - Care Center of Hongjiang District. Care Center Laohong (a pseudonym) in with the baby to play. Timothy West Brown (Timothy Ray Brown) must be the most compelling of 2010 patients. Everything about him was very mysterious, very few people know his hair color, home reared any pets, or like what a movie star. Nevertheless, the world's media are rushing to report on the living in Berlin, Germany, 42-year-old white man. He has been entangled for a whole 10 years of AIDS. December 8, a German study of three Department of Medicine, University of the composition of the seven-member scientific journal in the famous "blood," published online papers said, "Our results show that this patient has been cured of AIDS." Since 1981, HIV was discovered, in this "century killer" as many as 6,000 people to kill list, Brown is perhaps the first and the only one who has been cured. The German patient's recovery was regarded as "a stunning breakthrough." Treatment of leukemia cure AIDS Miracles take place in a red brick building, it is the capital of the Charlotte hospital in Germany and Europe's largest university hospital. Brown is old and sick, this hospital has. Since 10 years ago was diagnosed with AIDS, he has been receiving medical treatment here. Virus does not defeat the middle-aged man's body, but has been quietly lurking in his body. AIDS Research Center at Tsinghua University, Professor Zhang Linqi it, this place is terrible HIV. If the cell as a vault, the virus is like a robber. This seems like under the microscope is a "small thorn ball" of the virus, it will break the "vault" door "security code", rushed into the cell interior. Then, it will mark their integration into the chromosomes within the cell the most, become a part of cells. Today, the people, bringing the risk of robbery is no longer strange, it will attack the body's immune system is the most important T4 lymphoid tissue. Once the collapse of the immune tissue, the human resistance to change is low, most likely to die due to infection. Robbery may lurk in a patient over 10 years. Therefore, when people drug "police" sent into the body of infected patients, they are often difficult to hunt down bad guys in these quietly hidden. Brown has been living in the shadow of these robbers. Meanwhile, the other a terrible disease and wrap him quietly. A few years ago, the hapless man diagnosed with leukemia. In both "incurable disease" under the attack, it seems, he almost lost the possibility of survival. However, hospital clinicians, director Charlotte Eckhard Mohamad (Eckhard T hiel) did not give up, the main medical hematology and oncology decision to conduct a bold attempt. In the mid-90s last century, some U.S. scientists have found that some people are born to HIV infection will not be. Steele and his colleagues began to think, if equipped with the Brown-type donor bone marrow to find a "born free from HIV," "in the treatment of leukemia with bone marrow transplantation, the patient is HIV in the body will disappear along with it? " In fact, in ordinary people's cell "treasury", most of the set of two "secure password", one was called CD4, another were called CCR5. But for HIV, it is very easy password cracking groups, the so-called security measures useless. But in those born to HIV "immune" cells of the lucky ones, due to gene mutation, CCR5 gene coding region after amino acid No. 185 of 32 base deletion. This is known as CCR5 △ 32 of the defective gene is equivalent encryption for the vault, the robbers no matter what the tricks resorted to, can not sneak into treasury. Brown is very lucky for Mr Brown in the 60 bone marrow transplant donors, the research team as he has found a gene with a CCR5 △ 32 people. February 2007, when Brown received after transplantation, bone marrow donors in his body began the operation to start generating new blood cells. As doctors, as had been expected, the newly generated cells with CCR5 △ 32 defective genes. In the 3 years after follow-up survey, doctors were sure that a miracle happened, "HIV in the patient's body disappeared completely." We could not even loud in the reference to "cure" the word of the field, this is definitely a enlightening discovery Just over a year ago, paper written for the cases published in the prestigious medical profession in the world, "New England Journal of Medicine." At that time, the research team from Germany is very careful to say that "long-term control of bone marrow transplantation by the HIV virus." Zhang Linqi remember this case the whole field of science "was astonished." In that paper before publication, this terrible virus has been called "the history of the plague after the century." HIV known as the world's "number one infectious killer," 200 million people have died each year. World Health Organization is also the official website of the author himself said that if adherence to treatment, "HIV can be kept in good condition, maintaining the ability to work to extend the life time, even in low-income countries living with HIV can do." However, WHO also categorically said: "HIV can not be cured." Thus, when Brown could not find the body when the whereabouts of HIV, Reuters writes in the report, in this "out loud that we could not even 'cure' word of the field, this is definitely a enlightening discovery" . Although this is a kind of "incurable" disease, but its study has not run aground. Currently, antiviral treatment can prolong life 30 years to 50 years, life expectancy than a complete cure only 10 years earlier. 90s of last century, Chinese scientists made the famous Ho "cocktail therapy", which also use several drugs, each drug against HIV in different aspects of reproductive cycle, and thus inhibit or kill HIV purposes. This year in November, a University of California, San Francisco by the research team published in the "New England Journal of Medicine" on the paper, said anti-retroviral drugs may to a certain extent, reduce HIV risk of infection and propagation velocity, "which for the first a proof can be part of the regular medications to reduce AIDS in gay and bisexual men, the propagation velocity of high-risk groups. " Ho has served as an assistant in the United States Zhang Linqi found that, although drugs can inhibit the infection of new cells, but they have been infected cells in the body can survive a long time. The virus lurks quietly, with the result of drug or simply can not find. This became the "cure AIDS, the biggest obstacle." He HIV as "a microcosm of the Superman", even though only a short period of 100 nm in diameter, it is a "formidable opponent." A few years ago, this has been beaten for 19 years and AIDS dealings of the "returnees" professors decided to develop an AIDS vaccine. Now, in laboratory animal experiments, the vaccine has produced "very good observations." This year in July, the National Institute of Allergy and Infectious Diseases experts in the "science" research results published in the journal, said that the two can "bind" and to combat more than 90%% variation of strains of HIV antibodies. However, this does not mean the vaccine will soon put into production. Zhang Linqi said: "Although the direction clear, but how long the road, who do not know." When Brown was news of a cure, those who think "this is a can not cure diseases," the scientists are very excited. This proves conjecture before the medical profession, "If the use of genetic tools to the cell surface CCR532 base knock, then the HIV-infected individuals can be completely cleared." Some European and American scientists are ready to encourage the type of people CCR5 △ 32 donated bone marrow, and people living with HIV around the world to find the appropriate matching. They excitedly tell desperate patients, "Do not worry, AIDS can be cured." Fortunately, Brown is not easy to replicate However, you want to copy Brown's luck is not an easy task. In Zhang Linqi view, the German patients were cured of the process, almost like "being struck by lightning several times a row of small probability event." HIV infection in a leukemia patient, an HIV virus "immune" to the bone marrow matching, one can afford to pay huge medical bills wallet, these elements are indispensable. At least one Chinese patients difficult to accomplish this because few people have the yellow gene CCR5 △ 32 people. In the 100 Europeans, and only one person has such a strong protection mutation. American Medical Association, former president of the AIDS virus Zag that "if this approach becomes standard therapy, there is a considerable risk." Currently, stem cell or bone marrow transplantation commonly used in cancer treatment, but no one knows if we accept that healthy people need to take much of the risk of surgery. It involves the use of powerful drugs and radiation to destroy the original body's immune system, then enter the donor's bone marrow to re-create a new immune system, and this therapy and its complications is likely to lead to increased mortality. "This method is not practical, and very likely to kill people." University of Maryland School of the human virus, said Dr. Gallo. 26 years ago, it was the work of the scientist and his partners discovered the HIV virus. "I do not want to pour cold water on this interesting matter, but, you know, funny thing is that at best only. And, until the dead, to conduct a detailed inspection to fully determine if the virus completely disappeared." For Zhang Linqi, the "unpredictability of science too, when things began to look only fun, but in the end is likely to bring progress milestone." Paxton his former colleagues is a good example. Virologist who is also a homosexual. The mid-90s of last century, out of curiosity, some of his own gay friends around the blood for testing. Results are shocked, some people are easily infected with HIV, while the other part will not be infected. Scientists based on the experimental Paxton found CCR5 △ 32. And it is only ten years ago out of curiosity, carried out the experiment, the patients Brown saved a life in Germany. "Scientific development can not step away from a cure for AIDS may also have a long way, but now at least taken the first step." Zhang Linqi said. For the long-term research professor in the AIDS virus for at least the peculiar German patients demonstrated that, if CCR5 in vivo knock down the 32 bases, there is the possibility of cure AIDS. "In basic scientific research, the plan never catch up with rapid change, no one can say for, what exactly is in the moment, in which the laboratory, the study will be successful." He said earnestly. (Cho Han-Mo) |
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［ 作者：佚名 转贴自：本站原创 点击数：196 更新时间：2010-12-30 文章录入：nnb ］
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