慢性人类免疫缺陷病毒感染者外周血可溶性B细胞激活因子的变化及意义

The changes and significance of the soluble B cell-activating factor in the peripheral blood of patients with chronic human immunodeficiency virus infection

目的阐述外周血可溶性B细胞激活因子（B cell-activating factor of the tumor necrosis factor family, BAFF）在慢性HIV感染者外周血中的变化，探讨可溶性BAFF浓度与HIV感染疾病进展的相关性。方法收集未经抗病毒治疗门诊HIV感染者50例，健康对照者30例，根据CD4＋T淋巴细胞计数将HIV感染者分为CD4＋T淋巴细胞〈200个/μL组、200～350个/μL组、〉350个/μL组，比较3组和健康对照的B细胞计数、BAFF浓度；并将HIV感染者BAFF浓度和CD4＋T淋巴细胞计数、B淋巴细胞计数、HIV病毒载量分别进行相关性分析；运用受试者工作特征（receiver operation characteristic curve，ROC曲线）分析BAFF在HIV疾病分期中的价值。结果CD4＋T淋巴细胞〈200个/μL组、200～350个/μL组、〉350个/μL组和健康对照组B淋巴细胞计数分别为（90.3±43.1）、（114.4±28.8）、（162.1±29.5）和（307.1±97.0）个/μL，4组间差异有统计学意义（F＝47.92，P〈0.05）；4组BAFF浓度分别为（1 737.5±719.7）、（962.8±341.1）、（859.8±270.4）和（440.3±177.2） ng/L，4组间差异有统计学意义（F＝36.72，P〈0.05）；BAFF浓度与B细胞、CD4＋T淋巴细胞计数均呈负相关（r值分别为－0.722、－0.568，均P〈0.05），BAFF浓度与HIV病毒载量呈正相关（r＝0.607，P〈0.05）；ROC曲线下面积为0.881，当BAFF浓度取1 281.5 ng/L时，提示处于艾滋病期的敏感度、特异度分别为74.1%、87.0%。结论慢性HIV感染者可溶性BAFF浓度明显增高，与B细胞数量减少和疾病进展相关。

ObjectiveTo elaborate the changes of the soluble B cell-activating factor of the tumor necrosis factor family （BAFF） in the peripheral blood of chronic human immunodeficiency virus （HIV）-infected patients, and to study the correlation between the soluble BAFF in HIV-infected patients and the progressions of acquired immune deficiency syndrome （AIDS）.MethodsFifty untreated HIV outpatients and 30 healthy controls were recruited. According to the counts of CD4＋ T lymphocytes, HIV-infected patients were divided into three groups, 〈200 cells/μL group, （200-350） cells/μL group and 〉350 cells/μL group. B cell counts and the BAFF levels were compared among the three groups and the healthy controls. The correlation analysis was conducted for the levels of BAFF, the counts of CD4＋ T lymphocytes and B cells, and viral load in HIV-infected patients. The value of BAFF in staging of HIV disease was identified by receiver operating characteristic （ROC） curve.ResultsThe B cell counts were （90.3±43.1） cells/μL in 〈200 cells/μL group, （114.4±28.8） cells/μL in （200-350） cells/μL group, and （162.1±29.5） cells/μL in 〉350 cells/μL group and （307.1±97.0） cells/μL in healthy controls, which was significantly different among the four groups （F=47.92, P〈0.05）. The concentrations of BAFF in the four groups were （1 737.5±719.7）, （962.8±341.1）, （859.8±270.4）, and （456.9±163.7） ng/L, with significant difference among the groups （F=36.72, P〈0.05）. The level of BAFF was negatively correlated with both B cell counts and CD4＋ T lymphocyte counts （r=-0.722 and -0.568, respectively; both P〈0.05）, and positively correlated with viral load （r=0.607, P〈0.05）. The area under the ROC curve was 0.881. If the level of BAFF was 1 281.5 ng/L, the sensitivity and specificity to predict the period of AIDS were 74.1% and 87.0%, respectively.ConclusionThe levels of soluble BAFF in HIV-infected patients are significantly increased and related with the reduction of B cell counts and disease progression.