艾滋病患者淋巴细胞数和CD_4^+ T细胞计数的相关性研究

Study on the correlation between total lymphocyte counts and CD_4^+ T cell counts in HIV/AIDS

目的研究感染人免疫缺陷病毒(HIV)的艾滋病(AIDS)患者总淋巴细胞数(TLC)和CD4+阳性T淋巴细胞数量(CD4+T)的相关性,探讨TIE作为CD4+T替代方案在监测HIV疾病进展和高效抗逆转录病毒治疗(HAART)疗效中发挥的作用。方法分析121例患者在治疗前和HAART中TLC和CD4+T的相关性,并动态观察治疗1、6、12个月患者TLC增加值(△TLC)和CD4+T增加值(△CD4+T)的相关性。通过ROC面积、敏感度、特异度、阳性预测值和阴性预测值分析,寻找能有效预测CD4+T>200个／μl、>350个／μl的TLC的范围;预测△CD4+T>50个／μl、>100个／μl、>150个／μl时△TLC的范围。结果121例艾滋病患者TLC和CD4+T在治疗前相关系数r为0．723,P<0．01;在HAART后1、3、6、9和12个月时也保持一定的相关性,平均相关系数r为0．624±0．094。△TLC和△CD4+T在HAART过程中具有更高的相关性,平均相关系数r为0．760±0．086。在HAART前用TLC <1300个／μl和<1500个／μl预测CD4+T<200个／μl和<350个／μl具有显著的预测价值。HAART后1个月预测△CD4+T>50个／μl的△TLC最佳临界值为>190个／μl,6个月时预测△CD4+T>100个／μl的△TLC最佳临界值为>360个／μl,12个月时预测ACD4+T>150个／μl的△TLC最佳临界值为>690个／μl。结论在条件匮乏的艾滋病高发区,可以采用TLC和△TLC预测CD4+T和△CD4+T,监测HIV疾病进展和评价HAART疗效。

Objective To analyze the correlation between total lymphocyte count （TLC） and CD4^＋T lymphocyte count and evaluate the effect of TLC on HIV progression monitoring and clinical HAART as economical substitute for CD4^＋ T count in HIV/AIDS patients. Methods A work studying the correlation of TLC with CD4^＋ T count at pre-HAART and 12 months follow-up HAART was performed in 121 follow-up cases. The dynamical correlation between TLC increment （△TLC） and CD4^＋T increment （△CD4^＋T） was observed in follow-up 121 cases during 12 months. TLC cutoff and △TLC cutoff were accessed according to ROC area, sensitivity, specificity, positive predictive value and negative predictive value for CD4^＋ T 〉 200/ μl, 〉 350/μl and △CD4^＋T 〉 50/μl, 〉 100/μl , 〉 150/μl respectively. Results The significant correlation （r value） between TLC and CD4^＋T count before HAART was 0. 723 （P 〈0. 01 ） as similar as correlation during 12 months follow-up HAART in which the mean r value was 0. 621 ± 0. 080. The remarkable dynamical correlations between △TLC and △CD4^＋ T were found comparing to that between TLC and CD2 T count within 12-month HAART which average r value was 0. 760 ± 0. 086. It was significant value in prediction CD4^＋ T count 〈 200/μl and 〈 350/μl with TLC cut-off 〈 1300/μl and 〈 1500/μl before HAART. Moreover, as more significant markers in HAART, the cut-offs of △TLC to predict optimal △CD4^＋ T were 〉 190/μl for 〉 50/μl at M1, 〉 360/μl for 〉 100/μl at M6, 〉 690/μl for 〉 150/μl at M12 respectively. Conclusion TLC assay, especially △TLC for prediction of △CD4^＋ T can be available as a substitute method to estimate HIV disease progression and clinical HAART in some resource-constrained area of China.