CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)检测在结核病合并HIV患者中的变化及临床意义

Changes and clinical significance of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)detection in tuberculosis pa⁃tients with HIV

目的分析CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)检测在结核病合并人类免疫缺陷病毒(HIV)患者中的变化及临床意义。方法收集郑州市第六人民医院2017年12月至2020年12月收治的559例结核病患者的临床资料,根据患者是否合并HIV感染分为合并组(结核病合并HIV,n=48)与未合并组(未合并HIV,n=511),根据不同HIV病毒载量对合并组进行分组:Ⅰ组<10^(3)copies/mL;Ⅱ组40~10^(3) copies/mL;Ⅲ组>10^(3) copies/mL。比较两组及不同HIV病毒载量患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平变化情况;Pearson法分析上述因子与HIV病毒载量的相关性。绘制受试者工作特征曲线(ROC),分析CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)对结核病合并HIV的诊断价值。结果合并组CD4^(+)、CD4^(+)/CD8^(+)水平明显低于未合并组,CD8^(+)水平显著高于未合并组,差异均有统计学意义(P<0.05)。CD4^(+)、CD4^(+)/CD8^(+)水平:Ⅰ组>Ⅱ组>Ⅲ组;CD8^(+):Ⅰ组<Ⅱ组<Ⅲ组,差异均有统计学意义(P<0.05)。相关性分析结果示,CD4^(+)、CD4^(+)/CD8^(+)与HIV病毒载量呈显著负相关(P<0.05),CD8^(+)与HIV病毒载量呈正相关关系(P<0.05)。ROC曲线结果显示,CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)联合检测诊断结核病合并HIV的曲线下面积(AUC)为0.815,明显高于单独诊断(P<0.05)。结论CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)在结核病合并HIV呈异常表达,且与HIV病毒载量具有一定相关性,通过检测患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平有利于结核病合并HIV感染早期诊断。

Objective To analyze the Changes and clinical significance of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)detection in tuberculosis patients with human immunodeficiency virus(HIV).Methods The clinical data of 559 tuberculosis patients admitted to Zhengzhou Sixth People􀆳s Hospital from December 2017 to December 2020 were collected.According to whether the patients are combined with HIV infection,they are divided into the combined group(tuberculosis combined with HIV,n=48)and the non⁃combined group(non⁃merged HIV,n=511),The level changes of CD4^(+),CD8^(+),CD4^(+)/CD8^(+) in the two groups and those patients with different HIV viral loads were compared;Pearson’s method was used to analyze the correlation between above factors and HIV viral load.The receiver operating characteristic curve(ROC)was drew to analyze the diagnostic value of CD4^(+),CD8^(+),CD4^(+)/CD8^(+) to tuberculosis with HIV.Results The CD4^(+)and CD4^(+)/CD8^(+) levels in the combined group were significantly lower than those in the non⁃combined group,and the CD8^(+) level was significantly higher than that in the non⁃combined group,and the differences were statistically significant(P<0.05).CD4^(+),CD4^(+)/CD8^(+) levels:groupⅠ>groupⅡ>groupⅢ;CD8^(+) level:groupⅠ<groupⅡ<groupⅢ,the difference was statistically significant(P<0.05).The results of correlation analysis showed that CD4^(+),CD4^(+)/CD8^(+) and HIV viral load were significantly negatively correlated(P<0.05),and CD8^(+) and HIV viral load were positively correlated(P<0.05).The ROC curve results showed that the area under curve(AUC)of the combined detection of CD4^(+),CD8^(+),CD4^(+)/CD8^(+) in the diagnosis of tuberculosis with HIV was 0.815,which was significantly higher than that of the single diagnosis(P<0.05).Conclusion CD4^(+),CD8^(+),CD4^(+)/CD8^(+) are abnormally expressed in tuberculosis complicated with HIV,and have a certain correlation with HIV viral load.Detection of the patient's CD4^(+),CD8^(+),CD4^(+)/CD8^(+) levels is beneficial to the early diagnosis of tuberculosis complicated with HIV infection.