人类免疫缺陷病毒/艾滋病抗病毒治疗患者的基线CD4+T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响

Effect of baseline CD4+T lymphocyte counts on immune function reconsti-tution after antiviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome patients

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中文摘要：目的探讨人类免疫缺陷病毒/艾滋病(HIV/AIDS)患者的基线CD4+T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响,为判断抗病毒治疗的效果提供依据.方法选取2019-2022年赣州市755例抗病毒治疗24周以上的HIV/AIDS患者的临床资料,采集外周血进行CD4+T淋巴细胞计数和病毒载量检测.根据抗病毒治疗24周后的CD4+T淋巴细胞计数将患者分为免疫重建良好组(≥200个/μl)和免疫重建不良组(＜200个/μl).多因素分析采用二分类logistic回归,采用受试者工作特征(ROC)曲线评估模型的预测价值.结果 755例患者中,614例(81.3％)免疫重建良好,141例(18.7％)免疫重建不良.病毒学指标显示有617例(81.7％)病毒学抑制成功,138例(18.3％)病毒学抑制失败.免疫重建不良组中基线CD4+T淋巴细胞计数＞500个/μl占比低于免疫重建良好组,差异有统计学意义(P＜0.05).单因素分析结果显示,免疫重建与性别、年龄、治疗时间和基线CD4+T淋巴细胞计数有关,差异有统计学意义(P＜0.05).logistic回归模型进行多因素分析结果显示,性别女(β=-0.642,OR=0.526,95％CI:0.288～0.962)、治疗时间 1～2 年(β=-0.538,OR=0.584,95％CI:0.383～0.890)、基线 CD4+T 淋巴细胞计数 200～500 个/μl(β=-2.761,OR=0.063,95％CI:0.035～0.116)及基线 CD4+T 淋巴细胞计数＞500 个/μ l(β=-3.206,OR=0.041,95％CI:0.010～0.169)是免疫重建不良的独立保护因素(P＜0.05).年龄＞50 岁(β=1.554,OR=4.730,95％CI:1.028～21.751)是免疫重建不良的独立危险因素(P＜0.05).基于基线CD4+T淋巴细胞计数的模型对免疫重建不良预测的ROC曲线下面积为0.834(P＜0.05).结论性别、年龄、抗病毒治疗时间和基线CD4+T淋巴细胞计数是HIV/AIDS患者免疫功能重建的独立影响因素.

外文摘要：Objective To investigate the effect of baseline CD4+T lymphocyte counts on immune function reconstitution after antiviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients,and to provide evidence for judging the efficacy of antiviral therapy.Methods The clinical data of 755 HIV/AIDS patients with more than 24 weeks of antiviral treatment in Ganzhou City from 2019 to 2022 were selected,and CD4+T lymphocyte counts and viral load were detected in peripheral blood.According to the CD4+T lymphocyte counts after 24 weeks of antiviral treatment,the patients were divided into good immunoreconstructive group(≥ 200/μ l)and poor immunoreconstructive group(＜200/μl).In multivariate analysis,binary logistic regression was used and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model.Results Among 755 patients,614(81.3％)had good immune reconstitution and 141(18.7％)had poor immune reconstitution.Virological indicators showed successful virological inhibition in 617 cases(81.7％)and failure in 138 cases(18.3％).The proportion of baseline CD4T lymphocyte count＞500/μl in poor immune reconstitution group was lower than that in good immune reconstitution group,and the difference was statistically significant(P＜0.05).Univariate analysis showed that immune reconstitution was associated with gender,age,treatment time and baseline CD4+T lymphocyte counts,and the differences were statistically significant(P＜0.05).Multivariate analysis by logistic regression model showed that the gender of female(β=-0.642,O R=0.526.95％CI:0.288-0.962),treatment time 1-2 years(β=-0.538,OR=0.584,95％CI:0.383-0.890),baseline C D4T lymphocyte count 200-500/μl(β=-2.761,OR=0.063,95％CI:0.035-0.116)and baseline CD4+T lymphocyte count＞500/μl(β=-3.206,OR=0.041,95％CI:0.010-0.169)were independent protective factors for poor immune reconstitution(P＜0.05).Age＞50 years old(β=1.554,OR=4.730,95％CI:1.028-21.751)was an independent risk factor for poor immune reconstruction(P＜0.05).Baseline CD4+T lymphocyte count models predicted poor immune reconstitution with an area under the ROC curve of 0.834(P＜0.05).Conclusion Gender,age,duration of antiviral therapy and baseline CD4T lymphocyte count are independent factors for immune reconstitution in HIV/AIDS patients.

外文关键词：

Human immunodeficiency virus/acquired immunodeficiency syndrome patientCD4 T lymphocyte countBaselineImmune reconstitutionViral load

作者：

苏俊枝、高倩、刘俊杰、吴雨宸

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作者单位：

江西省赣州市疾病预防控制中心检验科,江西赣州 341000

关键词：

人类免疫缺陷病毒/艾滋病患者 CD4+T淋巴细胞计数基线免疫重建病毒载量

基金：

江西省卫生健康委科技计划项目江西省卫生健康委科技计划项目江西省赣州市科技计划项目

项目编号：

202312004202410836GZ2023ZSF341

出版年：

2024

中国当代医药

中国保健协会当代创新（北京）医药科学研究院

中国当代医药

影响因子：1.215

ISSN：1674-4721

年,卷(期)：2024.31(24)

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