Susaengrat Wattanchai, Mitchai Manthana, Leerattanapetch Niramol
Medicine Department, Khon Kaen Hospital, Khon Kaen, Ministry of Public Health, Thailand.
J Med Assoc Thai. 2008 Oct;91(10):1514-7.
The purpose of the present study was to evaluate the correlation between total lymphocyte count (TLC) and CD4+ count and TLC cut-off for predicting CD4+ count < 200 cells/mm3.
The 176-naïve HIV-infected patients from the OPD Khon Kaen Hospital, were recruited for CD4+ count by flow cytometer and TLC by automated cell counter. All results were analyzed by STATA statistical software for sensitivity, specificity, PPV and NPV.
From 176 patients, 61 (34.7%) had CD4+ > 200 cells/mm3 and 115 (65.3%) had CD4+ < 200 cells/mm3. The ROC curve between CD4+ count and TLC showed TLC < 1,800 cells/mm3 could predict CD4+ count < 200 cells/mm3 with 78.26% sensitivity, 73.77% specificity, 84.91% PPV, and 64.29% NPV. The sensitivity was further decreased and specificity was increased when TLC was lower than cut-off.
The presented finding indicates that the appropriated TLC for predicting CD4+ count. < 200 cells/mm3 was TLC < 1,800 cells/mm3. TLC can also be used as a surrogate marker for starting ARV therapy in resource limited setting.
本研究旨在评估总淋巴细胞计数（TLC）与CD4 + 计数之间的相关性，以及预测CD4 + 计数<200个细胞/mm³时TLC的临界值。
招募孔敬医院门诊的176例初治HIV感染患者，采用流式细胞仪检测CD4 + 计数，采用自动血细胞计数器检测TLC。所有结果均通过STATA统计软件分析敏感性、特异性、阳性预测值和阴性预测值。
176例患者中，61例（34.7%）的CD4 + >200个细胞/mm³，115例（65.3%）的CD4 + <200个细胞/mm³。CD4 + 计数与TLC之间的ROC曲线显示，TLC<1800个细胞/mm³可预测CD4 + 计数<200个细胞/mm³，敏感性为78.26%，特异性为73.77%，阳性预测值为84.91%，阴性预测值为64.29%。当TLC低于临界值时，敏感性进一步降低而特异性增加。
本研究结果表明，预测CD4 + 计数<200个细胞/mm³的合适TLC为TLC<1800个细胞/mm³。在资源有限的情况下，TLC也可作为开始抗逆转录病毒治疗的替代指标。
