CD_8^+ T细胞激活分子CD_(38)、HLA-DR与HIV-1载量的相关性研究

The correlation of HIV-1 viral load to expression of CD_8^+ T lymphocyte activators CD_(38) and HLA-DR

目的研究HIV/AIDS患者CD8+T细胞表达激活分子CD38、HLA-DR水平与血浆病毒载量(VL)的相关性,以及用CD8CD38、CD8HLA-DR比例替代VL检测的可行性。方法用流式细胞术分析103例接受12个月高效抗逆转录病毒治疗(HAART)患者的CD8+T细胞表达CD38和HLA-DR水平;用分支DNA扩增技术检测血浆VL。用敏感性、特异性、准确性等参数分析能有效预测VL<50拷贝/ml、VL<500拷贝/ml、VL>1000拷贝/ml和VL>10000拷贝/ml时CD8CD38和CD8HLA-DR的检测范围。结果103例艾滋病患者CD38、HLA-DR和VL在12个月治疗中均呈下降趋势;CD38和VL在HAART治疗前及治疗第1、3、6、9、12个月6个检测点的总相关系数为0.483(P<0.001)、HLA-DR和VL的总相关系数为0.477(P<0.001)。用CD8CD38和CD8HLA-DR的水平预测VL值有显著诊断价值当CD38<68.5%和<72.5%时预测VL<50拷贝/ml和<500拷贝/ml有较高的灵敏度和特异性;当HLA-DR在>39.5%和>46.5%时预测VL>1000拷贝/ml和>10000拷贝/ml有较高的灵敏度和特异性。结论在条件匮乏的艾滋病高发区,可以用CD8CD38和CD8HLA-DR激活亚群的结果来预测血浆VL,作为监测HIV疾病进展和评价抗病毒疗效的参考。

Objective To investigate the correlation of CD38 and HLA-DR abnormal activating expression on CD8^＋T with plasma viral load （VL） and evaluate the possibility of the economical CD38 and HLA-DR test to substitute VL assay in HIV/AIDS patients. Methods A multi-point correlation study of the percentage of CD38 and HLA-DR on CD8^＋ T by flow cytometry with plasma VL by bDNA was performed in 103 H/V/AIDS patients during a 12-month highly active anti-retroviral therapy （HAART）. The cutoff values of CD38 and HLA-DR were evaluated with ROC area, sensitivity and specificity for predictive VL 〈 50 copies/ ml, 〈500 copies/ml, 〉 1000 copies/ml and 〉 10 000 copies/ml respectively. Results The level of CD38 and HLA-DR on CD8^＋ T in 103 patients decreased gradually with the reduction of VL during a 12-month HAART. The correlation of CD38 and HLA-DR with VL in the year of HAART was 0. 424,0. 376,0. 335, 0. 326,0. 297,0. 285 and 0. 377,0. 318,0. 333,0. 312,0. 361, 0. 358 with significant P value. Moreover, the overall correlation of CD38 and HLA-DR with VL were 0. 483 （P 〈0. 001 ） and 0. 477 （P 〈0. 001 ）. Depending on optimal ROC, sensitivity and specificity for the substitute method, the cutoffs percentage of CD38 were 〈 68. 5% and 〈 72. 5% for predictive VL 〈 50 copies/ml and 〈 500 copies/ml as well as 〉39. 5% and 〉 46. 5% of HLA-DR cutoff to predict VL 〉 1000 copies/m] and 〉 10 000 copies/ml. Conclusion The detection of CD38 and HLA-DR percentage expression on CD8^＋ T can be available for prediction about HIV VL assay as a substitute method to survey the disease progression and HAART outcome in some resource-limited areas of China.