CD4 COUNTS AS PREDICTORS OF OPPORTUNISTIC PNEUMONIAS IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
CD4 COUNTS AS PREDICTORS OF OPPORTUNISTIC PNEUMONIAS IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
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DOI：
10.7326/0003-4819-111-3-223
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发表时间：
1989-08-01
影响因子：
39.2
通讯作者：
LANE, HC
中科院分区：
文献类型：
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作者：
MASUR, H;OGNIBENE, FP;LANE, HC
研究目的是确定循环CD 4+淋巴细胞计数是否可预测导致肺功能障碍的特定感染或肿瘤过程。研究设计为回顾性连续样本研究。该设置是一个基于诊所和病房。我们研究了10例感染人类免疫缺陷病毒（HIV）的患者，他们在CD 4淋巴细胞测定后60天内发生了119次肺功能不全。循环CD 4计数小于0.200 × 10 - 4。109个细胞/L（200个细胞/mm ~ 3），分别为46例肺孢子虫肺炎、8例巨细胞病毒肺炎、7例新生隐球菌感染和21例鸟胞内分枝杆菌感染。相反，非特异性间质性肺炎发作前的循环CD 4计数变化很大：在41次发作中，11次发生在CD 4计数大于0.200 × 10 - 6时。109个细胞/L。循环中CD 4+淋巴细胞的百分比与CD 4计数的预测值相等。血清p24抗原水平无预测价值。肺孢子虫肺炎、巨细胞病毒肺炎和C. neoformans或M.在CD 4计数高于0.200至0.250 × 10 - 6的HIV感染患者中不太可能发生细胞内病毒感染。109个细胞/L（200 - 250个细胞/mm 3）或在肺部评价前60天内CD 4百分比高于20%-25%。CD 4计数低于0.200 × 10 - 4的HIV感染患者109个细胞/L（或低于20%的CD 4细胞）特别可能受益于抗肺孢子虫预防。
The study objective was to determine if circulating CD4+ lymphocyte counts are predictive of specific infectious or neoplastic processes causing pulmonary dysfunction. The design was a retrospective, consecutive sample study. The setting was a referral-based clinic and ward. We studied 10 patients infected with human immunodeficiency virus (HIV) who had had 119 episodes of pulmonary dysfunction within 60 days after CD4 lymphocyte determinations. Circulating CD4 counts were less than 0.200 .times. 109 cells/L (200 cells/mm3) before 46 episodes of pneumocystis pneumonia, 8 of 8 episodes of cytomegalovirus pneumonia, and 7 of 7 episodes and 19 of 21 episodes of infection with Cryptococcus neoformans and Mycobacterium avium-intracellulare, respectively. In contrast, circulating CD4 counts before episodes of nonspecific interstitial pneumonia were quite variable: Of 41 episodes, 11 occurred when CD4 counts were greater than 0.200 .times. 109 cells/L. The percent of circulating lymphocytes that were CD4+ had a predictive value equal to that of CD4 counts. Serum p24 antigen levels had no predictive value. Pneumocystis pneumonia, cytomegalovirus pneumonia, and pulmonary infection caused by C. neoformans or M. avium-intracellulare are unlikely to occur in HIV-infected patients who have had a CD4 count above 0.200 to 0.250 .times. 109 cells/L (200 to 250 cells/mm3) or a CD4 percent above 20% to 25% in the 60 days before pulmonary evaluation. Patients infected with HIV who have a CD4 count below 0.200 .times. 109 cells/L (or less than 20% CD4 cells) are especially likely to benefit from antipneumoncystis prophylaxis.