HIV／AIDS患者血常规检测结果与CD4^＋T淋巴细胞计数之间的相关性研究

The correlation between CD4^＋ T, cell count and the routine blood tests in HIV/AIDS patients

目的通过对HIV感染者和AIDS患者血常规总淋巴细胞数（TLC）、Hb、PLT、WBC与CD4^＋T淋巴细胞计数相关性的研究，探讨用血常规多项指标检测联合预测HIV／AIDS患者CD4^＋T淋巴细胞计数的可行性。方法778例HIV／AIDS患者共采集1038份血样，血常规中四项指标：TLC、Hb、WBC、PLT与CD4^＋T淋巴细胞计数相关分析采用Spearman秩和相关。绘制受试者工作特征（ROC）曲线以判断各项指标预测CD4^＋T淋巴细胞计数的真实度及其最佳临界值，计算各临界值的敏感度、特异度、阳性预测值和阴性预测值。采用联合试验评价多指标联合预测CD4^＋T淋巴细胞计数〈200个／μl的可行性。结果TLC、Hb、WBC、PLT与CD4^＋T淋巴细胞计数之间均存在正相关，相关系数分别为r=0．64，P=0．000；r=0．36，P=0．000；r=0．24，P=0．000；r=0．09，P=0．000。TLC、Hb预测CD4^＋T淋巴细胞计数的ROC曲线下面积分别在0．82—0．84、0．66～0．70之间。单独使用TLC预测CD4^＋T淋巴细胞计数〈50、200、350个／μl的最佳临界值分别为TLC〈1100×10^6／L、1200×10^6／L、1400×10^6／L。TLC〈1200×10^6／L与Hb〈120g／L联合预测CD4^＋T淋巴细胞计数〈200个／μl的敏感度为45．3％，特异度为82．8％。结论本研究结果显示TLC〈1200×10^6／L与Hb〈120g／L联合预测CD4^＋T淋巴细胞计数〈200个／μl的临床使用价值不高。

Objective To determine the feasibility of human routine blood tests as a surrogate for CD4^＋ T cell count through studying the correlation of CD4^＋ T cell count with total lymphocyte count （TLC）, hemoglobin （Hb）,blood platelet （PLT）,and white cell count （WBC） in HIV/AIDS patients. Methods 1 038 parson-time blood tests among 778 HIV/AIDS patients were performed and Spearman correlation analysis was used. Predictive power and the cut-off for potential predictors of CD4^＋ T cell count were assessed through receiver operating characteristic （ROC） curves. Combination test was used to assess the capability of multiple indexes to serve as surrogate markers for CD4^＋ T cell count. Results Significant correlations with CD4^＋ T cell count were observed for TLC, Hb, PLT and WBC. The Spearman correlation coefficients were r = 0.64, P=0.000; r =0.36,P=0.000; r =0.24, P =0.000; r =0.09, P =0.000,respectively. No correlation between TLC and CD4^＋ T cell count was found when TLC was more than 2 000×10^6/L（r =0. 12, P = 0. 15）. The areas under ROC curve of TLC and Hb for predicting CD4^＋ T cell count were between 0. 82 to 0. 84, and 0. 66 to 0. 70, respectively. When CD4^＋ T cell count were less than 50,200,350 cells/pal respectively, the optional cut-off value was TLC 〈 1 100×10^6/L, 1 200×10^6/L and 1 400×10^6/L When the study combined TLC 〈 1 200×10^6/L and Hb 〈 120 g/L for prediction of CD4^＋ T cell count 〈 200/μl, the sensitivity was 45.3% and specificity was 82. 8%. Conclusion There is no significant application value for fon of TLC 〈 1 200×10^6/L and Hb 〈 120 g/L as a surrogate for prediction of CD4^＋ T cell count 〈200/μl.