免疫缺陷与经治疗的 HIV 感染患者队列中严重临床终点的风险。
Immunodeficiency and the risk of serious clinical endpoints in a well studied cohort of treated HIV-infected patients.
机构信息
National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Cliffbrook Campus, Coogee, Sydney, New South Wales, Australia.
出版信息
AIDS. 2010 Jul 31;24(12):1877-86. doi: 10.1097/QAD.0b013e32833b1b26.
OBJECTIVE
To investigate the relative predictive value of CD4(+) metrics for serious clinical endpoints.
DESIGN
Observational.
METHODS
Patients (3012; 20 317 person-years) from control arms of ESPRIT and SILCAAT were followed prospectively. We used Cox regression to identify CD4(+) metrics (latest, baseline and nadir CD4(+) cell count, latest CD4(+)%, time spent with CD4(+) count below certain thresholds and CD4(+) slopes) independently predictive of all-cause mortality, non-AIDS deaths, non-AIDS (cardiovascular, hepatic, renal and non-AIDS malignancy) and AIDS events. Akaike information criteria (AIC) were calculated for each model. Significant metrics (P < 0.05) were then additionally adjusted for latest CD4(+) cell count.
RESULTS
Non-AIDS deaths occurred at a higher rate than AIDS deaths [rate ratio: 6.48, 95% confidence interval (CI) 5.1-8.1], and non-AIDS events likewise (rate ratio: 1.72, 95% CI 1.65-1.79). Latest CD4(+) cell count was strongly predictive of lower risk of death (hazard ratio per log2 rise: 0.48, 95% CI 0.43-0.54), with lowest AIC of all metrics. CD4(+) slope over seven visits, after additional adjustment for latest CD4(+) cell count, was the only metric to be an independent predictor for all-cause (hazard ratio for slope <-10 cells/microl per month vs. 0 +/- 10: 3.04, 95% CI 1.98-4.67) and non-AIDS deaths (hazard ratio for slope <-10 cells/microl per month vs. 0 +/- 10: 2.62, 95% CI 1.62-4.22). Latest CD4(+) cell count (per log(2) rise) was the best predictor across all four endpoints and predicted hepatic (hazard ratio 0.46, 95% CI 0.33-0.63) and renal events (hazard ratio 0.39, 95% CI 0.21-0.70), but not cardiovascular events (hazard ratio 1.05, 95% CI 0.77-1.43) or non-AIDS cancers (hazard ratio 0.78, 95% CI 0.59-1.03).
CONCLUSION
Latest CD4(+) cell count is the best predictor of serious endpoints. CD4(+) slope independently predicts all-cause and non-AIDS deaths.
目的
研究 CD4(+) 指标对严重临床终点的相对预测价值。
设计
观察性研究。
方法
对 ESPRIT 和 SILCAAT 研究的对照组中的 3012 例患者（20317 人年）进行前瞻性随访。我们使用 Cox 回归来确定 CD4(+) 指标（最新、基线和最低 CD4(+) 细胞计数、最新 CD4(+)%、CD4(+) 计数低于特定阈值和 CD4(+) 斜率的时间）是否可独立预测全因死亡率、非艾滋病死亡、非艾滋病（心血管、肝脏、肾脏和非艾滋病恶性肿瘤）和艾滋病事件。计算了每个模型的赤池信息量准则（AIC）。然后，对具有统计学意义的指标（P<0.05），进一步进行最新 CD4(+) 细胞计数的调整。
结果
非艾滋病死亡的发生率高于艾滋病死亡[比率比：6.48，95%置信区间（CI）5.1-8.1]，非艾滋病事件的发生率也更高[比率比：1.72，95%CI 1.65-1.79]。最新 CD4(+) 细胞计数可强烈预测死亡率降低的风险（每增加一个对数 2 升高的危险比：0.48，95%CI 0.43-0.54），所有指标中 AIC 最低。在进一步调整最新 CD4(+) 细胞计数后，七个访视期间的 CD4(+) 斜率是全因（斜率<-10 个细胞/微升/月与 0 +/- 10：3.04，95%CI 1.98-4.67）和非艾滋病死亡（斜率<-10 个细胞/微升/月与 0 +/- 10：2.62，95%CI 1.62-4.22）的唯一独立预测因素。最新 CD4(+) 细胞计数（每对数 2 升高）是所有四个终点的最佳预测指标，预测肝脏（危险比 0.46，95%CI 0.33-0.63）和肾脏事件（危险比 0.39，95%CI 0.21-0.70），但不预测心血管事件（危险比 1.05，95%CI 0.77-1.43）或非艾滋病癌症（危险比 0.78，95%CI 0.59-1.03）。
结论
最新 CD4(+) 细胞计数是严重终点的最佳预测指标。CD4(+) 斜率可独立预测全因和非艾滋病死亡。
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