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目的探讨人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者(HIV/AIDS)外周血总淋巴细胞数(TLC)和CD4+T细胞计数的相关性,明确将TLC作为HIV/AIDS疾病进展监测指标的可行性。方法分析2000年1月至2006年5月在北京协和医院艾滋病诊疗中心诊治的未经抗病毒治疗的317例HIV/AIDS患者TLC和CD4+T细胞计数之间的相关性,判断TLC代替CD4+T计数<100×106/L,<200×106/L和<350×106/L的准确度和最佳临界值,计算各临界值的敏感度、特异度、阳性预测值和阴性预测值。结果317例HIV/AIDS患者外周血TLC和CD4+T细胞计数[中位数(25%分位数,75%分位数),单位为×106/L]分别为1300(1754,932)和242(384,86),二者呈显著正相关性(r=0.722,P<0.01)。以TLC预测CD4+T细胞计数<100×106/L,<200×106/L和<350×106/L具有较高准确度,其ROC曲线下面积分别达到0.866、0.853和0.863(P均<0.01)。随着TLC临界值取值的降低,敏感度逐渐减低,特异度则逐渐增大。结论该研究结果为应用TLC作为监测HIV/AIDS初诊、初治患者疾病进展和确定抗病毒治疗时机的替代指标提供了试验依据。
Objective To investigate the correlation between total lymphocyte count (TLC) and CD4 + T cell count in peripheral blood of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (HIV / AIDS) TLC as a marker of HIV / AIDS disease progression monitoring. Methods The correlation between TLC and CD4 + T cell counts in 317 HIV / AIDS patients without anti-virus treatment diagnosed and treated in Peking Union Medical College AIDS Center from January 2000 to May 2006 was analyzed. The results showed that TLC instead of CD4 + The sensitivity, specificity, positive predictive value and negative predictive value of each critical value were calculated according to the accuracy and the best critical value of T count <100 × 106 / L, <200 × 106 / L and <350 × 106 / L. Results The peripheral blood TLC and CD4 + T cell counts of 317 patients with HIV / AIDS [median (25% quantile, 75% quantile) × 106 / L] were 1300 (1754,932) and 242 (384,86), there was a significant positive correlation between them (r = 0.722, P <0.01). The CD4 + T cell counts of <100 × 106 / L, <200 × 106 / L and <350 × 106 / L were predicted by TLC with high accuracy and the areas under the ROC curve were 0.866, 0.853 and 0.863, 0.01). TLC with lower threshold value, and gradually reduce the sensitivity and specificity increase gradually. Conclusion The results of this study provide the experimental basis for the application of TLC as a surrogate marker for monitoring the initial diagnosis of HIV / AIDS, the progression of disease in newly diagnosed patients and the timing of antiviral therapy.