艾滋病合并肺结核患者治疗前外周血CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值与预后的关系

The Relationship Between CD4^(+)T Lymphocyte Levels,Ratio of CD4^(+)/CD8^(+)in Peripheral Blood Before Treatment and Prognosis of AIDS Patients with Pulmonary Tuberculosis

目的分析艾滋病(AIDS)合并肺结核(pulmonary tuberculosis,PTB)患者治疗前外周血中CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值与预后的关系。方法采用回顾性倾向性评分匹配方法收集长沙市第一医院2018年6月—2020年5月接受治疗且随访1年内生存的37例AIDS合并PTB患者资料,纳入存活组,另以1∶1比例匹配同期接受治疗且随访1年内病死的37例AIDS合并PTB患者资料,纳入病死组;治疗前两组均接受外周血中CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值及相关实验室指标检测,重点分析治疗前外周血中CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值与AIDS合并PTB患者预后的关系。结果病死组CD4^(+)T淋巴细胞计数、CD4^(+)/CD8^(+)比值均低于存活组(P<0.05);两组间其他基线资料、实验室指标比较差异无统计学意义(P>0.05);经Cox回归分析结果显示,CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)比值降低可能是AIDS合并PTB患者治疗后病死的危险因子(HR=1.051、33.382,P均<0.05);绘制受试者工作曲线(receiver operating curve,ROC)发现,治疗前外周血CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值及二者联合预测AIDS合并PTB患者治疗后病死风险的曲线下面积(area under curve,AUC)>0.80,有一定预测价值。结论AIDS合并PTB患者治疗后病死可能与治疗前外周血中CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值降低有关。

Objective To analyze the relationship between the level of CD4^(+)T lymphocytes,ratio of CD4^(+)/CD8^(+)in peripheral blood before treatment and the prognosis of AIDS patients with pulmonary tuberculosis(PTB).Methods A retrospective propensity score matching method was used to collect the data of 37 AIDS patients with PTB whowere treated in the First Hospital of Changsha from June 2018 to May 2020 and survived within 1 year of follow-up.The data of 37 AIDS patients with PTB who received treatment and died within 1 year of follow-up were matched at a ratio of 1:1 and included in the death group.The levels of CD4^(+)T lymphocytes,ratio of CD4^(+)/CD8^(+)in peripheral blood and related laboratory indexes were detected in both groups before treatment,the relationship between the level of CD4^(+)T lymphocytes,ratio of CD4^(+)/CD8^(+)in peripheral blood before treatment and the prognosis of AIDS patients with PTB was mainly analyzed.Results The count of CD4^(+)T lymphocytes,ratio of CD4^(+)/CD8^(+)in the death group were lower than those in the survival group(P<0.05).There was no statistical significant difference in other laboratory indexes between the two groups(P>0.05).By Cox regression analysis,the decrease of CD4^(+)T lymphocyte,ratio of CD4^(+)/CD8^(+)might be the risk factors of death in patients with AIDS and TB after treatment(HR=1.051,33.382,all P<0.05).The receiver operating curve(ROC)was drawn and found that the area under curve(AUC)of level of CD4^(+)T lymphocytes,ratio of CD4^(+)/CD8^(+)in peripheral blood before treatment and their combination in predicting the risk of death in patients with AIDS and TB was>0.80,which had certain predictive value.Conclusion The death in patients with AIDS and TB after treatment may be related to the decrease of CD4^(+)T lymphocyte level,ratio of CD4^(+)/CD8^(+)in peripheral blood before treatment.