School of Biomedical Engineering, Capital Medical University, Beijing, China.
PLoS One. 2013 Jul 18;8(7):e69704. doi: 10.1371/journal.pone.0069704. Print 2013.
To evaluate the correlation of total lymphocyte count (TLC) and CD4 cell count and the suitability of TLC as a surrogate marker for CD4 cell count of HIV-infected patients in China.
Usefulness of TLC as a surrogate marker for a CD4 cell count <350 cells/mm(3) for HIV-positive patients in China was evaluated by 977 pairs of TLC and CD4 cell count from 977 outpatients. The result was then validated by a literature review which was conducted on 9 relevant articles. Further investigation using the 977 pairs of TLC and CD4 cell count data was done to determine a TLC threshold for predicting a CD4 cell count <500 cells/mm(3). Correlation and receiver operating characteristic (ROC) analysis were performed for both CD4 cell counts, and the sensitivity and specificity were computed.
Good correlation was noted between TLC and CD4 count (r = 0.60, 95% CI, 0.56-0.64). TLC obtained a relatively high diagnostic performance (area under ROC curve, 0.80) for predicting a CD4 cell count <350 cells/mm(3), with a sensitivity of 0.65 (95% CI, 0.61-0.68) and a specificity of 0.80 (95% CI, 0.75-0.85) at the TLC threshold of 1570 cells/mm(3). The literature review suggested that for a CD4 cell count <350 cells/mm(3), the optimal TLC threshold was 1500 cells/mm(3), which was similar to the figure presented in this observational study. As for predicting a CD4 cell count <500 cells/mm(3), TLC obtained a high diagnostic performance (area under ROC curve, 0.82) as well with a sensitivity of 0.70 (95% CI, 0.67-0.73) and a specificity of 0.80 (95% CI, 0.73-0.87).
When considering the antiretroviral therapy for HIV-infected Chinese individuals, total lymphocyte count can be considered as an inexpensive and easily available surrogate marker for predicting two clinically important thresholds of CD4 count of 350 cells/mm(3) and 500 cells/mm(3).
评估总淋巴细胞计数（TLC）与 CD4 细胞计数的相关性，以及 TLC 作为中国 HIV 感染者 CD4 细胞计数替代指标的适用性。
通过对 977 例门诊患者的 977 对 TLC 和 CD4 细胞计数，评估 TLC 作为中国 HIV 阳性患者 CD4 细胞计数<350 个/立方毫米的替代指标的有用性。通过对 9 篇相关文献的综述对结果进行验证。进一步利用 977 对 TLC 和 CD4 细胞计数数据进行研究，以确定预测 CD4 细胞计数<500 个/立方毫米的 TLC 阈值。对 CD4 细胞计数进行相关性和接收者操作特征（ROC）分析，并计算灵敏度和特异性。
TLC 与 CD4 计数相关性良好（r=0.60，95%置信区间，0.56-0.64）。TLC 对预测 CD4 细胞计数<350 个/立方毫米具有较高的诊断性能（ROC 曲线下面积为 0.80），TLC 阈值为 1570 个/立方毫米时，灵敏度为 0.65（95%置信区间，0.61-0.68），特异性为 0.80（95%置信区间，0.75-0.85）。文献综述表明，对于 CD4 细胞计数<350 个/立方毫米，最佳 TLC 阈值为 1500 个/立方毫米，与本观察性研究结果相似。对于预测 CD4 细胞计数<500 个/立方毫米，TLC 也具有较高的诊断性能（ROC 曲线下面积为 0.82），灵敏度为 0.70（95%置信区间，0.67-0.73），特异性为 0.80（95%置信区间，0.73-0.87）。
考虑到中国 HIV 感染者的抗逆转录病毒治疗，总淋巴细胞计数可作为预测 CD4 计数两个重要临床阈值（350 个/立方毫米和 500 个/立方毫米）的廉价、易得的替代指标。
