人类免疫缺陷病毒/艾滋病抗病毒治疗患者的基线CD4^(+)T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响  

Effect of baseline CD4^(+)T lymphocyte counts on immune function reconstitution after antiviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome patients

作　　者：苏俊枝 高倩 刘俊杰 吴雨宸 SU Junzhi;GAO Qian;LIU Junjie;WU Yuchen(Clinical Laboratory,Ganzhou Centre for Disease Control and Prevention,Jiangxi Province,Ganzhou 341000,China)

机构地区：[1]江西省赣州市疾病预防控制中心检验科,江西赣州341000

出　　处：《中国当代医药》2024年第24期14-18,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202312004、202410836);江西省赣州市科技计划项目(GZ2023ZSF341)。

摘　　要：目的探讨人类免疫缺陷病毒/艾滋病(HIV/AIDS)患者的基线CD4^(+)T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响,为判断抗病毒治疗的效果提供依据。方法选取2019—2022年赣州市755例抗病毒治疗24周以上的HIV/AIDS患者的临床资料,采集外周血进行CD4^(+)T淋巴细胞计数和病毒载量检测。根据抗病毒治疗24周后的CD4^(+)T淋巴细胞计数将患者分为免疫重建良好组(≥200个/μl)和免疫重建不良组(<200个/μl)。多因素分析采用二分类logistic回归,采用受试者工作特征(ROC)曲线评估模型的预测价值。结果755例患者中,614例(81.3%)免疫重建良好,141例(18.7%)免疫重建不良。病毒学指标显示有617例(81.7%)病毒学抑制成功,138例(18.3%)病毒学抑制失败。免疫重建不良组中基线CD4^(+)T淋巴细胞计数>500个/μl占比低于免疫重建良好组,差异有统计学意义(P<0.05)。单因素分析结果显示,免疫重建与性别、年龄、治疗时间和基线CD4^(+)T淋巴细胞计数有关,差异有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,性别女(β=-0.642,OR=0.526,95%CI:0.288~0.962)、治疗时间1~2年(β=-0.538,OR=0.584,95%CI:0.383~0.890)、基线CD4^(+)T淋巴细胞计数200~500个/μl(β=-2.761,OR=0.063,95%CI:0.035~0.116)及基线CD4^(+)T淋巴细胞计数>500个/μl(β=-3.206,OR=0.041,95%CI:0.010~0.169)是免疫重建不良的独立保护因素(P<0.05)。年龄>50岁(β=1.554,OR=4.730,95%CI:1.028~21.751)是免疫重建不良的独立危险因素(P<0.05)。基于基线CD4^(+)T淋巴细胞计数的模型对免疫重建不良预测的ROC曲线下面积为0.834(P<0.05)。结论性别、年龄、抗病毒治疗时间和基线CD4^(+)T淋巴细胞计数是HIV/AIDS患者免疫功能重建的独立影响因素。Objective To investigate the effect of baseline CD4^(+)T lymphocyte counts on immune function reconstitution after antiviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients,and to provide evidence for judging the efficacy of antiviral therapy.Methods The clinical data of 755 HIV/AIDS patients with more than 24 weeks of antiviral treatment in Ganzhou City from 2019 to 2022 were selected,and CD4^(+)T lymphocyte counts and viral load were detected in peripheral blood.According to the CD4^(+)T lymphocyte counts after 24 weeks of antiviral treatment,the patients were divided into good immunoreconstructive group(≥200/μl)and poor immunoreconstructive group(<200/μl).In multivariate analysis,binary logistic regression was used and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model.Results Among 755 patients,614(81.3%)had good immune reconstitution and 141(18.7%)had poor immune reconstitution.Virological indicators showed successful virological inhibition in 617 cases(81.7%)and failure in 138 cases(18.3%).The proportion of baseline CD4^(+)T lymphocyte count>500/μl in poor immune reconstitution group was lower than that in good immune reconstitution group,and the difference was statistically significant(P<0.05).Univariate analysis showed that immune reconstitution was associated with gender,age,treatment time and baseline CD4^(+)T lymphocyte counts,and the differences were statistically significant(P<0.05).Multivariate analysis by logistic regression model showed that the gender of female(β=-0.642,OR=0.526,95%CI:0.288-0.962),treatment time 1-2 years(β=-0.538,OR=0.584,95%CI:0.383-0.890),baseline CD4^(+)T lymphocyte count 200-500/μl(β=-2.761,OR=0.063,95%CI:0.035-0.116)and baseline CD4^(+)T lymphocyte count>500/μl(β=-3.206,OR=0.041,95%CI:0.010-0.169)were independent protective factors for poor immune reconstitution(P<0.05).Age>50 years old(β=1.554,OR=4.730,95%CI:1.028-21.751)was an independent risk factor for poor immune re

关 键 词：人类免疫缺陷病毒/艾滋病患者 CD4^(+)T淋巴细胞计数 基线 免疫重建 病毒载量 

分 类 号：R512.91[医药卫生—内科学]