The CD4 Lymphocyte Count is a Better Predictor of Overall Infection Than the Total Lymphocyte Count in ANCA-Associated Vasculitis Under a Corticosteroid and Cyclophosphamide Regimen: A Retrospective Cohort.
The CD4 Lymphocyte Count is a Better Predictor of Overall Infection Than the Total Lymphocyte Count in ANCA-Associated Vasculitis Under a Corticosteroid and Cyclophosphamide Regimen: A Retrospective Cohort.
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DOI：
10.1097/md.0000000000000843
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发表时间：
2015-05
期刊：
影响因子：
1.6
通讯作者：
Chen M
中科院分区：
文献类型：
--
作者：
Shi YY;Li ZY;Zhao MH;Chen M
补充数字内容可在文本中获得抗神经炎细胞质自身抗体相关性血管炎（AAV）患者在免疫抑制治疗期间感染的患病率很高，总淋巴细胞计数（TLC）已被证明是感染的独立预测因子。本研究探讨了TLC及其亚群，特别是CD 4计数在单个中国队列中预测AAV感染的价值。从1997年12月至2013年10月，我科共回顾性招募了124例AAV患者。比较了多变量考克斯模型与在三个典型时间点（即基线时、免疫抑制剂剂量降低开始时和感染或删失前末次访视时）测量的CD 4计数或TLC，或将测量值作为随时间变化的协变量，以选择最具预测性的感染时间点。计算并比较在最具预测性时间点测量的TLC（AUC（t）TLC）和CD 4计数（AUC（t）CD 4计数）的时间依赖性受试者工作特征曲线下面积（AUC（t））。在平均11.5（范围0.5-142）个月的随访期间，124例患者中有55例（44.3%）发生了微生物学证实的感染。总体感染的独立预测因子为初始肌酐清除率（P = 0.02和0.04）、肺间质纤维化（P = 0.04和0.05）、肺结节或空洞（P = 0.002和0.002）、CD 4计数（P <0.001）或TLC（P = 0.05）。 在不同时间点拟合的考克斯模型的比较证实了末次访视是总体感染的最具预测性的访视。通过AUC测量的末次访视的CD 4计数或TLC的预测值显示，在免疫抑制治疗的前2年，AUC（t）CD 4计数（62.8-70.2%）几乎总是高于AUC（t）TLC（55.2-58.1%）（P = 0.01-0.2）。 在不同病原体中，非细菌感染的CD 4计数和TLC均表现良好（AUC（t）69.2-82.7%），两者之间差异无显著性（P> 0.1）。 TLC和CD 4计数都是腺相关病毒患者总体感染和非细菌感染的独立危险因素。CD 4计数对总体感染的预测价值高于TLC，特别是在免疫抑制治疗的前2年。
Supplemental Digital Content is available in the text Patients with antineutrophil cytoplasmic autoantibody associated vasculitis (AAV) have a high prevalence of infection during immunosuppressive therapy, and the total lymphocyte count (TLC) has been demonstrated to be an independent predictor of infection. The current study investigated the value of the TLC and its subsets, particularly the CD4 count, for predicting infections of AAV in a single Chinese cohort. A total of 124 AAV patients were retrospectively recruited in our department from December 1997 to October 2013. Multivariate Cox models with the CD4 count or TLC measured at three typical time points, that is, at baseline, at the beginning of immunosuppressant dose reduction, and at the last visit before infection or censoring, or with the measurements included as time-varying covariates, were compared to select the most predictive time point for infection. A time-dependent area under the receiver operating characteristic curve (AUC(t)) for the TLC (AUC(t)TLC) and the CD4 count (AUC(t)CD4count) measured at the most predictive time point were calculated and compared. During an average follow-up of 11.5 (range 0.5–142) months, 55 of the 124 patients (44.3%) experienced a microbiologically confirmed infection. Independent predictors of overall infection were initial creatinine clearance (P = 0.02 and 0.04), pulmonary interstitial fibrosis (P = .04 and .05), pulmonary nodule or cavity (P = 0.002 and .002), CD4 count (P < 0.001) or TLC (P = 0.05) from the last visit. The comparison of Cox models fitted at different time points confirmed the last visit to be the most predictive one for overall infection. The predictive value of the CD4 count or TLC from the last visit measured by AUC showed that the AUC(t)CD4count (62.8–70.2%) was almost always higher than AUC(t)TLC (55.2–58.1%) during the first 2 years of immunosuppressive therapy (P = 0.01–0.2). In terms of different pathogens, both the CD4 count and TLC performed well for non-bacterial infection (AUC(t) 69.2–82.7%), and the difference between them was not significant (P > 0.1). The TLC and CD4 count were both independent risk factors of overall infection and non-bacterial infection in AAV patients. The CD4 count had a higher predictive value than the TLC for overall infections, particularly during the first 2 years of immunosuppressive therapy.