人类免疫缺陷病毒感染者及艾滋病患者外周血总淋巴细胞数和CD4^+T细胞计数的相关性研究  

Total lymphocyte count as a surrogate for CD4^+T lymphocyte count in Chinese HIV-1 infected people.

作　　者：谢静[1] 李太生[1] 邱志峰[1] 韩扬[1] 左玲燕[1] 刘正印[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内科,北京100730

出　　处：《中国实用内科杂志》2007年第11期867-869,共3页Chinese Journal of Practical Internal Medicine

基　　金：首都医学发展科研基金项目(2003-1006);卫生部艾滋病防治应用性研究项目(WA2003-05);卫生部部属医疗机构临床重点学科项目

摘　　要：目的探讨人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者(HIV/AIDS)外周血总淋巴细胞数(TLC)和CD4+T细胞计数的相关性,明确将TLC作为HIV/AIDS疾病进展监测指标的可行性。方法分析2000年1月至2006年5月在北京协和医院艾滋病诊疗中心诊治的未经抗病毒治疗的317例HIV/AIDS患者TLC和CD4+T细胞计数之间的相关性,判断TLC代替CD4+T计数<100×106/L,<200×106/L和<350×106/L的准确度和最佳临界值,计算各临界值的敏感度、特异度、阳性预测值和阴性预测值。结果317例HIV/AIDS患者外周血TLC和CD4+T细胞计数[中位数(25%分位数,75%分位数),单位为×106/L]分别为1300(1754,932)和242(384,86),二者呈显著正相关性(r=0.722,P<0.01)。以TLC预测CD4+T细胞计数<100×106/L,<200×106/L和<350×106/L具有较高准确度,其ROC曲线下面积分别达到0.866、0.853和0.863(P均<0.01)。随着TLC临界值取值的降低,敏感度逐渐减低,特异度则逐渐增大。结论该研究结果为应用TLC作为监测HIV/AIDS初诊、初治患者疾病进展和确定抗病毒治疗时机的替代指标提供了试验依据。Objective To analyze the correlation between total lymphocyte count（TLC）and CD4^＋ ＋T cell count in treatment-naive HIV/AIDS patients and to assess the capability of TLC as a surrogate marker for CD4 count in resource-limited settings. Methods Three hundred and seventeen treatment-naive HIV-1 infected people were enrolled in this study. The correlation between CD4^＋ T cell count and TLC was assessed using scatterplots and Spearman correlation coefficient. Potential TLC predictors were assessed for their sensitivity, specificity, positive predictive value and negative predictive value for a CD4 count 〈 100 × 10^6/L, 〈 200 × 10^6/L and a CD4^＋T cell 〈 350 × 10^6/L. Receiver operating characteristic （ROC） curves were used to visualize sensitivity and specificity of various cutoffs of the TLC. Results The median（ upper quartile ,lower quartile） of TLC and CD4^ ＋ T cell count（ x 106/L） was 1 300（ 1 754,932） and 242（ 384,86）, respectively. A significant linear correlation was seen between the CD4^＋ ＋T cell count and TLC（ r = 0. 722,P 〈 0. 01 ）. The areas under the corresponding ROC curves of the TLC to predict an absolute CIM ＋ T cell count of 〈 100 × 10^6/L, 〈200 × 10^6/L and 〈 350 × 10^6/L were 0. 866,0. 853 and 0. 863 （ P 〈 0. 01 ） respectively. When the TLC cutoff value was lowered, specificity increased but sensitivity decreased. Conclusion TLC has a potential role as a surrogate marker for CD4 cell count in resource-limited settings.

关 键 词：获得性免疫缺陷综合征 人类免疫缺陷病毒 CD4^+T细胞计数 

分 类 号：R5[医药卫生—内科学]