人类免疫缺陷病毒感染者及艾滋病患者CD8^+CD38^+ CD8^+HLA-DR+比例与HIV载量的相关性研究  

The correlation of HIV viral load to percentage of CD38,HLA-DR expresson on CD8^+T lymphocyte in HIV/AIDS patients

作　　者：韩扬[1] 邱志峰[1] 李太生[1] 谢静[1] 左玲燕[1] 李雁凌[1] 匡季秋[1] 王爱霞[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院感染科,北京100730

出　　处：《中国实用内科杂志》2007年第11期847-850,共4页Chinese Journal of Practical Internal Medicine

基　　金：卫生部艾滋病防治应用性研究(2003-05);首都医学发展科研基金(2003-1006);卫生部部属医疗机构临床重点学科项目

摘　　要：目的研究人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者CD8+T细胞激活分子CD38、人类白细胞Ⅱ类抗原(HLA-DR)与血浆HIV载量的相关性,分析用CD8+CD38+、CD8+HLA-DR+的比例替代HIV载量的可行性。方法采集1998—2006年期间在北京协和医院初诊的HIV感染者或AIDS患者236例和56名同期健康献血员的抗凝静脉血,用流式细胞术分析CD8+T细胞分别表达CD38和HLA-DR的比例,用分支DNA技术(bDNA)检测血浆病毒载量(VL)。用受试者工作特征曲线(ROC)分别预测VL>1×103拷贝/mL、>1×104拷贝/mL和>1×105拷贝/mL时CD8+CD38+、CD8+HLA-DR+比例的临界值范围。结果236例患者的CD4+T细胞计数138(16,262)×106/L,显著低于对照组(P<0.01);CD8+T细胞计数618(353,879),显著高于对照组(P<0.05);CD8+CD38+、CD8+HLA-DR+的比例分别为85.4%(72.5%,92.2%)和40.3%(17.5%,59.7%),显著高于对照组(P<0.01),与HIV载量的相关性分别为0.429(P<0.01)和0.282(P<0.01)。用CD8+CD38+>80.4%预测VL>1×103拷贝/mL的敏感度和特异度为80.6%和75.0%;用CD8+HLA-DR+预测VL>1×105拷贝/mL的敏感度和特异度为78.7%和81.4%。结论对HIV感染或AIDS初诊的患者可以尝试用CD38和HLA-DR激活亚群来预测血浆HIV载量,这种替代检测方法具有一定的可行性。Objective To investigate the correlation of CD38, HLA-DR abnormal activating expression on CD8^＋ T with plasma viral load（VL） and evaluate the possibility of the economical CD38, HLA-DR test to substitute VL assay in HIV/ AIDS patients. Methods Clinical data and anti-coagulated venous blood samples were collected from 236 ARV naive HIV/AIDS patients during 1998--2006 in Peking Union Medical College Hospital. The percentages of CD38, HLA-DR on CD8^＋ T were determined by flow cytometry and plasma HIV copies were detected with bDNA analyzer. All subjects were analyzed the correlation of CD38/HLA-DR with viral load. The cutoff percentages of CD38 and HLA-DR were evaluated with ROC area,including sensitivity and specificity for predictive VL 〉 1 × 10^3 copies/mL, 〉 1 × 10^4 copies/mL and 〉 1 × 10^5 copies/mL respectively. Results The median CD4^＋ T count 138 （ 16,262） × 10^6/L in 236 cases,which was significantly lower than CD4^＋ T of healthy donors （ P 〈 0. 01 ） while CD8^＋ T counts was 618 （ 353,879 ） and CD8^＋ CD38 ^＋ , CD8 ^＋ HLA-DR ＋ percentage was 85. 4% （72. 5 % ,92. 2% ）and 40. 3% （17. 5 % ,59. 7% ）, which were respectively higher than healthy control（P 〈 0. 05, P 〈 0. 01 and P 〈 0. 01 ）. Viral load was 4. 84（4.46,5.47 ） lg copies/mL. Moreover,plasma VL was positively related with CD38 and HLA-DR expression（r = 0. 429, P 〈 0. 01 and r = 0. 282, P 〈 0.01 ） on CD8 ^＋ T. With optimal ROC analysis to control sensitivity and specificity for substitute method, the cutoff percentage of CD8^＋ CD38^＋ was 〉 80. 4% in predictive VL 〉 1 × 10^3 copies/mL with 80. 6% sensitivity and 75.0% specificity whereas CD8^＋ HLA-DR ^＋ percentage was 36. 7% in predictive VL 〉 1 × 10^5copies/mL with 78. 7% sensitivity and 81.4%. Conclusion The detection of CD38 and HLA-DR percentage expression on CD8^＋ T before HAART may be available for prediction about plasma HIV load assay as substitute method to survey the disease progression.

关 键 词：人类免疫缺陷病毒 CD38 人类白细胞Ⅱ类抗原 病毒载量 

分 类 号：R5[医药卫生—内科学]