J Acquir Immune Defic Syndr. 2003 Aug 15;33(5):635-41. doi: 10.1097/00126334-200308150-00013.
This study investigated whether age-related patterns of immunologic markers in 1488 uninfected (9789 measurements) and 186 infected (3414 measurements) children differed by gender and race. CD4+, CD8+, and absolute lymphocytes by HIV infection status, gender, and race were assessed using linear mixed-effects natural cubic spline models, allowing for prematurity and maternal CD4+ cell count. In uninfected children, levels of all 3 markers peaked twice in the first few months of life, declining to adult levels by around 8 years of age; uninfected boys and uninfected black children had significantly reduced CD4+ and absolute lymphocyte counts; the gender difference was especially pronounced in black children. Infected children had substantially lower levels and distinctly different patterns; with, e.g., by age 6 months CD4+ cell counts nearly 1200 per mm3 lower than in uninfected infants. Levels also significantly differed by gender and race for infected children, although for gender in the opposite direction. The gender and race differences in CD4+ levels were not explained by a general lymphocytosis nor were they confounded by treatment. These substantial differences in immunologic markers may reflect underlying genetic influence on the cellular immune system and may have implications for clinical decisions about therapeutic management.
本研究调查了1488名未感染儿童（9789次测量）和186名感染儿童（3414次测量）中与年龄相关的免疫标志物模式是否因性别和种族而异。使用线性混合效应自然立方样条模型评估了按HIV感染状态、性别和种族划分的CD4+、CD8+和绝对淋巴细胞数量，并考虑了早产情况和母亲的CD4+细胞计数。在未感染儿童中，所有这3种标志物的水平在生命的最初几个月达到两次峰值，到8岁左右降至成人水平；未感染的男孩和未感染的黑人儿童的CD4+和绝对淋巴细胞计数显著降低；这种性别差异在黑人儿童中尤为明显。感染儿童的水平明显较低且模式明显不同；例如，到6个月大时，感染儿童的CD4+细胞计数比未感染婴儿低近1200个/mm³。感染儿童的水平在性别和种族方面也存在显著差异，尽管性别差异的方向相反。CD4+水平的性别和种族差异既不能用全身性淋巴细胞增多来解释，也不受治疗的干扰。免疫标志物的这些显著差异可能反映了对细胞免疫系统的潜在遗传影响，可能对治疗管理的临床决策产生影响。
