THE PROGNOSTIC VALUE OF CELLULAR AND SEROLOGIC MARKERS IN INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE-1
THE PROGNOSTIC VALUE OF CELLULAR AND SEROLOGIC MARKERS IN INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE-1
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DOI：
10.1056/nejm199001183220305
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发表时间：
1990-01-18
影响因子：
158.5
通讯作者：
GIORGI, JV
中科院分区：
文献类型：
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作者：
FAHEY, JL;TAYLOR, JMG;GIORGI, JV
我们评估了受人类免疫缺陷病毒1型（HIV-1）感染影响的三种细胞标志物和五种血清学标志物预测临床获得性免疫缺陷综合征（AIDS）进展的能力。细胞标志物为CD 4+细胞数、CD 8 + T细胞数和CD 4 + T细胞/CD 8 + T细胞比值。血清学标志物为新蝶呤（刺激巨噬细胞的产物）、β 2-微球蛋白、可溶性白细胞介素-2受体、伊加和HIV p24抗原的血清水平。我们评估了这些措施的有用性，前瞻性地进展到艾滋病的标志物，超过四年，在一个队列的395名艾滋病毒血清阳性的同性恋男子谁最初没有艾滋病。CD 4 + T细胞（以绝对数量、淋巴细胞百分比或CD 4+与CD 8 + T细胞的比例表示）是艾滋病进展的最佳单一预测因子，但血清新蝶呤和β 2-微球蛋白水平几乎具有同样的预测能力。新蝶呤水平似乎是比β 2-微球蛋白水平略好的预测因子。伊加、白细胞介素-2受体和p24抗原水平的预测价值较低。逐步多变量分析表明，最好的预测因子，按降序排列，是CD 4 + T细胞（淋巴细胞的百分比或CD 4+：CD 8+比值），血清新蝶呤或β 2-微球蛋白水平，伊加水平，白细胞介素-2受体，和p24抗原。最后三个标志物几乎没有额外的预测能力超过前两个。我们的结论是，在研究的八个标志物中，CD 4 + T细胞水平与血清新蝶呤或β 2-微球蛋白水平相结合最准确地预测了艾滋病的进展。这两种血清标志物中至少有一种反映免疫活化，应沿着在疾病分类方案和治疗反应评价中与CD 4 + T细胞测量一起使用。
We evaluated three cellular and five serologic markers that are affected by infection with the human immunodeficiency virus type 1 (HIV-1) for their ability to predict the progression to clinical acquired immunodeficiency syndrome (AIDS). The cellular markers were the number of CD4+ cells, the number of CD8+ T cells, and the ratio of CD4+ T cells to CD8+ T cells. The serologic markers were the serum levels of neopterin (a product of stimulated macrophages), beta2-microglobulin, soluble interleukin-2 receptors, IgA, and HIV p24 antigen. We evaluated the usefulness of these measures as markers of the progression to AIDS prospectively, over four years, in a cohort of 395 HIV-seropositive homosexual men who were initially free of AIDS. CD4+ T cells (expressed as an absolute number, a percentage of lymphocytes, or a ratio of CD4+ to CD8+ T cells) were the best single predictor of the progression to AIDS, but the serum neopterin and beta2-microglobulin levels each had nearly as much predictive power. The neopterin level appeared to be a slightly better predictor than the beta2-microglobulin level. The levels of IgA, interleukin-2 receptors, and p24 antigen had less predictive value. A stepwise multivariate analysis indicated that the best predictors, in descending order, were CD4+ T cells (the percentage of lymphocytes or the CD4+: CD8+ ratio), the serum level of neopterin or beta2-microglobulin, the level of IgA, that of interleukin-2 receptors, and that of p24 antigen. The last three markers had little additional predictive power beyond that of the first two. We conclude that of the eight markers studied, progression to AIDS was predicted most accurately by the level of CD4+ T cells combination with the serum level of either neopterin or beta2-microglobulin. At least one of these two serum markers, which reflect immune activation, should be used along with measurement of CD4+ T cells in disease-classification schemes and in the evaluation of responses to therapy.