MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Trop Med Int Health. 2010 Feb;15(2):259-62. doi: 10.1111/j.1365-3156.2009.02448.x.
To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings.
We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut-offs: <200 and <350 cells/microl in ART naive adults.
Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/microl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut-off of <350 cells/microl was used. Inter-observer agreement (k 0.46) was fair/moderate.
While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed.
评估灰/远端条带甲和/或口腔色素沉着作为资源匮乏地区提示严重免疫抑制从而有资格接受抗逆转录病毒治疗（ART）的指标的作用。
我们检测了灰/远端条带甲和/或口腔色素沉着是否可用于鉴定初治成人 CD4 细胞计数<200 和<350 个/微升两个界值的患者。
拍摄并评估了 403 个指甲和口腔。灰/远端条带甲和/或口腔色素沉着与 CD4 细胞计数<200 个/微升（P<0.001）显著相关，敏感性为 66%，特异性为 50%，阴性预测值为 77%。但是，当 CD4 细胞计数<350 个/微升的界值时则没有相关性。观察者间一致性（κ=0.46）为中等/适度。
尽管灰/远端条带甲和/或口腔色素沉着与低 CD4 计数相关，但敏感性和κ评分太低，不能推荐该方法作为指导 ART 启动的工具；将错过大量有资格接受 ART 的个体。
