认识免疫重建炎症综合征ppt课件.pptVIP

认识免疫重建炎症综合征; A 35-year-old male with an 8-year history of AIDS presented with a 3-day history of recurrent frontal headaches, subjective fever and alter edmental status. He had a history of non-adherence to medications, but he had resumed antiretroviral drugs for about 10 weeks. Four weeks prior to presentation to our hospital, he had been diagnosed with cryptococcal meningitis (CM) in an outside hospital and had received a 7 day course of intravenous amphotericin B (lipid complex preparation). This was discontinued due to progressive acute kidney injury and he was subsequently placed on high dose (800 mg) oral fluconazole (FLU) daily.;Case Report;;HIV infection is characterized by a gradual reduction in the counts of CD4+ lymphocytes;命名; 分枝杆菌引起的淋巴结病、结核病的异常表现 进展性多灶性脑白质病的恶化 耶氏肺孢子菌肺炎 弓形虫病的复发 巨细胞病毒性视网膜炎 病毒性肝炎…… 有些则可能表现为自身免疫性疾病;IRIS的危害;艾滋病患者在接受ART后6个月内IRIS的发病率： 欧美发达国家为10％ ～15％。 资源有限的发展中国家为20％ ～25％。 绝大多数发生于治疗的前3个月 。 ;体液免疫相关的辅助性T细胞在介导机体与外源性抗原的免疫反应中起重要作用。 同源性配体激发Th0细胞(初始CD4+T细胞)在不同细胞因子的作用下进行分化。 Th1细胞能分泌γ干扰素(interferon γ，IFN-γ)，引起前炎症反应。 Th2细胞能分泌抗炎和免疫抑制性细胞因子[如interleukin 10，IL-10)。 Th3细胞能分泌转化生长因子β (transforming growth factorβ ，TGF-β )。 Th2细胞能抑制Th1细胞的转化及其细胞功能。 一个正常功能的免疫系统是基于Th1和Th2功能的平衡。;Schematic diagram demonstrating the proposed pathogenesis of PR/IRIS in relation to time, mycobacterial load, and the immune response. The lower panel shows pathogenesis in the non-PR/IRIS context, wherein mycobacterial burden and the immune response/inflammation are closely coupled temporally, and where inflammation (and clinical features) resolves in tandem with mycobacterial burden when treatment is initiated. The upper panel shows pathogenesis in the context of PR/IRIS, wherein the baseline immunocompromised phenotype means there is excessive mycobacterial outgrowth in a poorly inflamed environment. When treatment is initiated that reverses immunocompromise, an excessively exuberant inflammatory response develops (PR/IRIS) with symptoms temporally distinct from those arising as part of