Opiates and immune function. Consequences on infectious diseases with special reference to AIDS.
Opiates and immune function. Consequences on infectious diseases with special reference to AIDS.
复制标题
阿片类药物和免疫功能。
DOI：
--
复制
发表时间：
1992
期刊：
影响因子：
--
通讯作者：
B. Rouveix
中科院分区：
文献类型：
--
作者：
B. Rouveix
越来越多的体外和体内证据表明，外源性阿片类药物对免疫系统的细胞有各种影响。其结果是，药理浓度的阿片类药物抑制了细胞介导的免疫，表现为B淋巴细胞产生T依赖抗体的抑制，T淋巴细胞功能的改变，如增殖、迟发型超敏反应、移植物抗宿主反应和细胞毒性NK细胞活性的降低。巨噬细胞/单核细胞氧化爆发和吞噬功能也受到损害，这种作用可能是由各种阿片受体类型介导的，因为它们被阿片拮抗剂纳洛酮阻断或逆转。其他可能的相互作用机制仍有待阐明：外源性阿片类药物可作用于中枢神经系统的神经元，从而激活神经内分泌系统，从而导致血清糖皮质激素水平升高。中枢神经系统和淋巴组织之间的另一个潜在联系是交感神经系统，通过交感神经系统，阿片类药物诱导的激活可能导致去甲肾上腺素能抑制免疫系统。这些对免疫系统的抑制作用的临床后果体现在静脉注射阿片成瘾者感染发生率的显着增加。艾滋病的出现和静脉注射吸毒者被确认为一个严重的危险群体，推动了人们对这一领域的兴趣。通过各种实验模型在体外和体内获得的数据表明，吗啡增加了对细菌和病毒感染的敏感性，后者的影响可能与阿片类药物对伽玛-干扰素水平的抑制有关。给药剂量和给药时间对结果有很大影响：体内慢性阿片类药物治疗似乎诱导了一种免疫耐受状态，对病毒感染具有正常的抵抗力，而短期或单次给药则有不利影响。在前一种情况下，其他因素，如吗啡诱导的CD4+细胞数量增加，可能倾向于增强艾滋病毒感染者的传染性。
There is an increasingly body of evidence, obtained both in vitro and in vivo, showing that exogenous opioids have a variety of effects on cells of the immune system. The consequence is that opiates at pharmacological concentrations suppress cell-mediated immunity, as reflected by depressed T-dependent antibody production by B lymphocytes, altered T lymphocyte functions such as proliferation, delayed-type hypersensitivity, graft-versus-host responses and decreased cytotoxic NK cell activity. The macrophage/monocyte oxidative burst and phagocytosis are also impaired, effects probably mediated by various opioid receptor types as they are blocked or reversed by naloxone, an opioid antagonist. Other possible mechanisms of interaction remain to be elucidated: exogenous opioids can act on neurons of the central nervous system, thereby activating the neuroendocrine system with a subsequent increase in serum glucocorticoid levels. Another potential link between the central nervous system and lymphoid tissue is the sympathetic nervous system, via which opioid-induced activation could result in noradrenergic inhibition of the immune system. The clinical consequences of these suppressive effects on the immune system are seen in the striking increase in the incidence of infections in intravenous opioid addicts. The advent of AIDS and the identification of intravenous drug abusers as a critical risk group have propelled interest in this area. Data obtained both in vitro and in vivo with various experimental models shows that morphine increases susceptibility to bacterial and viral infections, the latter effect possibly being related to a depressive effect of opioids on gamma-interferon levels. The dosage and time of administration strongly influence the results: it appears that chronic opioid treatment in vivo induces a state of immune tolerance, with normal resistance to viral infections, whereas short or single administration has a detrimental effect. In the former context, other factors such as a morphine-induced increase in CD4+ cell numbers may tend to enhance the infectivity of HIV-infected subjects.