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目的研究人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者CD8+T细胞激活分子CD38、人类白细胞Ⅱ类抗原(HLA-DR)与血浆HIV载量的相关性,分析用CD8+CD38+、CD8+HLA-DR+的比例替代HIV载量的可行性。方法采集1998—2006年期间在北京协和医院初诊的HIV感染者或AIDS患者236例和56名同期健康献血员的抗凝静脉血,用流式细胞术分析CD8+T细胞分别表达CD38和HLA-DR的比例,用分支DNA技术(bDNA)检测血浆病毒载量(VL)。用受试者工作特征曲线(ROC)分别预测VL>1×103拷贝/mL、>1×104拷贝/mL和>1×105拷贝/mL时CD8+CD38+、CD8+HLA-DR+比例的临界值范围。结果236例患者的CD4+T细胞计数138(16,262)×106/L,显著低于对照组(P<0.01);CD8+T细胞计数618(353,879),显著高于对照组(P<0.05);CD8+CD38+、CD8+HLA-DR+的比例分别为85.4%(72.5%,92.2%)和40.3%(17.5%,59.7%),显著高于对照组(P<0.01),与HIV载量的相关性分别为0.429(P<0.01)和0.282(P<0.01)。用CD8+CD38+>80.4%预测VL>1×103拷贝/mL的敏感度和特异度为80.6%和75.0%;用CD8+HLA-DR+预测VL>1×105拷贝/mL的敏感度和特异度为78.7%和81.4%。结论对HIV感染或AIDS初诊的患者可以尝试用CD38和HLA-DR激活亚群来预测血浆HIV载量,这种替代检测方法具有一定的可行性。
Objective To investigate the correlation between CD8 +, HLA-DR and plasma HIV load in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) , To analyze the feasibility of replacing the HIV load with the proportion of CD8 + CD38 +, CD8 + HLA-DR +. Methods Collecting anticoagulated venous blood of 236 HIV-infected and AIDS-infected patients newly diagnosed at Peking Union Medical College Hospital from 1998 to 2006 and 56 healthy blood donors from the same period. The expression of CD38 and HLA- DR ratio, the plasma viral load (VL) was detected using the branched DNA technique (bDNA). The receiver operating characteristic curve (ROC) was used to predict the cutoffs of CD8 + CD38 +, CD8 + HLA-DR + ratios at VL> 1 × 103 copies / mL,> 1 × 104 copies / mL, and> 1 × 105 copies / range. Results The 236 patients had significantly higher CD4 + T cell counts (138,26 × 106 / L) than those in the control group (P <0.01) and 618 (353,879), which were significantly higher than those in the control group (P <0.05) ; The proportions of CD8 + CD38 + and CD8 + HLA-DR + were 85.4% (72.5%, 92.2%) and 40.3% (17.5%, 59.7% The correlations were 0.429 (P <0.01) and 0.282 (P <0.01), respectively. The sensitivity and specificity of predicting VL> 1 × 103 copies / mL with CD8 + CD38 +> 80.4% were 80.6% and 75.0%; the sensitivity and specificity of predicting VL> 1 × 105 copies / mL with CD8 + HLA-DR + 78.7% and 81.4%. Conclusion Patients with HIV infection or newly diagnosed AIDS can try to predict the HIV load by using CD38 and HLA-DR activating subpopulations. This alternative method is feasible.