Masur H, Ognibene F P, Yarchoan R, Shelhamer J H, Baird B F, Travis W, Suffredini A F, Deyton L, Kovacs J A, Falloon J
National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland.
Ann Intern Med. 1989 Aug 1;111(3):223-31. doi: 10.7326/0003-4819-111-3-223.
To determine if circulating CD4+ lymphocyte counts are predictive of specific infectious or neoplastic processes causing pulmonary dysfunction.
Retrospective, consecutive sample study.
Referral-based clinic and wards.
We studied 100 patients infected with human immunodeficiency virus (HIV) who had had 119 episodes of pulmonary dysfunction within 60 days after CD4 lymphocyte determinations.
Circulating CD4 counts were less than 0.200 X 10(9) cells/L (200 cells/mm3) before 46 of 49 episodes of pneumocystis pneumonia, 8 of 8 episodes of cytomegalovirus pneumonia, and 7 of 7 episodes and 19 of 21 episodes of infection with Cryptococcus neoformans and Mycobacterium avium-intracellulare, respectively. In contrast, circulating CD4 counts before episodes of nonspecific interstitial pneumonia were quite variable: Of 41 episodes, 11 occurred when CD4 counts were greater than 0.200 X 10(9) cells/L. The percent of circulating lymphocytes that were CD4+ had a predictive value equal to that of CD4 counts. Serum p24 antigen levels had no predictive value.
Pneumocystis pneumonia, cytomegalovirus pneumonia, and pulmonary infection caused by C. neoformans or M. avium-intracellulare are unlikely to occur in HIV-infected patients who have had a CD4 count above 0.200 to 0.250 X 10(9) cells/L (200 to 250 cells/mm3) or a CD4 percent above 20% to 25% in the 60 days before pulmonary evaluation. Patients infected with HIV who have a CD4 count below 0.200 X 10(9) cells/L (or less than 20% CD4 cells) are especially likely to benefit from antipneumocystis prophylaxis.
确定循环CD4 +淋巴细胞计数是否可预测导致肺功能障碍的特定感染或肿瘤性疾病。
回顾性连续样本研究。
基于转诊的诊所和病房。
我们研究了100例感染人类免疫缺陷病毒（HIV）的患者，这些患者在CD4淋巴细胞测定后的60天内发生了119次肺功能障碍发作。
在49例肺孢子菌肺炎发作中的46例、8例巨细胞病毒肺炎发作中的8例、7例新型隐球菌感染发作中的7例以及21例鸟分枝杆菌胞内感染发作中的19例之前，循环CD4计数均低于0.200×10⁹细胞/L（200个细胞/mm³）。相比之下，非特异性间质性肺炎发作前的循环CD4计数变化很大：在41例发作中，有11例发生时CD4计数大于0.200×10⁹细胞/L。循环中CD4 +淋巴细胞的百分比具有与CD4计数相同的预测价值。血清p24抗原水平无预测价值。
在肺部评估前60天内，CD4计数高于0.200至0.250×10⁹细胞/L（200至250个细胞/mm³）或CD4百分比高于20％至25％的HIV感染患者不太可能发生肺孢子菌肺炎、巨细胞病毒肺炎或由新型隐球菌或鸟分枝杆菌胞内感染引起的肺部感染。CD4计数低于0.200×10⁹细胞/L（或CD4细胞少于20％）的HIV感染患者尤其可能从抗肺孢子菌预防中受益。
