HIV/AIDS患者外周血CD4+ T细胞计数和淋巴细胞计数相关性的多中心研究

摘要

目的 对淋巴细胞计数预测CD4+ T细胞计数的准确性进行评价,为临床应用提供支持.方法 在全国23个分中心共筛查2 013例未接受抗病毒治疗的HIV/AIDS患者,经流式细胞术检测CD4+ T细胞计数,分析血常规当中的淋巴细胞计数和CD4+ T细胞计数之间的相关性,绘制ROC曲线判断淋巴细胞计数预测CD4+T细胞计数的准确性,并计算其敏感度、特异度、阳性预测值和阴性预测值.结果 2 013例HIV/AIDS患者的淋巴细胞计数和CD4+ T细胞计数分别为(1 600±670)×106/L和(244±148)×106/L,两者呈现显著正相关性(r=0.482,P＜0.000 1),以淋巴细胞计数预测CD4T细胞计数＜100×106/L、＜200×106/L和＜350×106/L的AUCROC分别为0.790(95％ CI0.761 ～0.818,P＜0.000 1),0.733(95％ CI0.710 ～0.755,P ＜0.000 1)和0.732 (95％ CI0.706 ～0.758,P ＜0.000 1).结论 在HIV/AIDS患者的临床诊治中,用淋巴细胞计数预测CD4+ T细胞计数有其实用价值,可以考虑在不具备CD4+ T细胞计数直接检测时作为替代指标用于监测疾病进展,也可以在获得CD4+ T细胞计数结果之前用来初步快速判断患者病情.%Objective To evaluate the accuracy of lymphocyte count as a surrogate for CD4+T cell count in treatment-na(i)ve HIV-infected adults.Methods A total of 2 013 HIV-infected patients were screened at 23 sites in China.CD4+ T cell counts were measured by flow cytometry.Correlation between CD4+ T cell count and peripheral lymphocyte count were analyzed by spearman coefficient.AUCRoc were used to evaluate the performance of lymphocyte count as a surrogate for CD4+ T cell count.Results The lymphocyte count and CD4+T cell count of these 2 013 patients were (1 600±670) × 106/L and (244 ± 148) × 106/L respectively.CDa+ T cell count were positively correlated with lymphocyte count(r =0.482,P ＜0.000 1).AUCROC of lymphocyte count as a surrogate for CD4+ T cell counts of ＜ 100 × 106/L,＜200 × 106/L and ＜ 350 × 106/L were 0.790 (95％ CI 0.761-0.818,P ＜ 0.000 1),0.733 (95％ CI 0.710-0.755,P ＜ 0.000 1) and 0.732 (95％ CI 0.706-0.758,P ＜ 0.000 1) respectively.Conclusion Lymphocyte count could be considerad as a potential surrogate marker for CD4+ T cell count in HIV/AIDS patients not having access to T cell subset test by flowcytometry.