Feeney C, Bryzman S, Kong L, Brazil H, Deutsch R, Fritz L C
Department of Internal Medicine, Highland General Hospital, Oakland, CA 94602-1018, USA.
Crit Care Med. 1995 Oct;23(10):1680-5. doi: 10.1097/00003246-199510000-00012.
To determine the range of T-lymphocyte subsets (CD4, CD8, and CD4/CD8 ratios) in acutely ill, hospitalized patients and to determine whether these concentrations correlate with illness severity, survival rate, or immunodepression.
Cross-sectional study, comparing Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and the calculated, disease-specific, predicted mortality rate with T-lymphocyte subsets.
Urban county hospital intensive care unit (ICU), serving as the designated trauma center.
One hundred two consecutively admitted ICU patients (72 medical and 30 surgical).
None.
Patient clinical data, APACHE II scores, and their associated predicted mortality rate were recorded. Blinded human immunodeficiency virus (HIV) and lymphocyte testing was performed on samples from all patients on ICU admission. Despite only three (2.9%) of 102 patients testing positive for HIV antibodies, 41% (42/102) of patients had CD4 concentrations of < 400 cells/microL, and 29% (29/102) had CD4 concentrations of < 300 cells/microL. Mean CD8 concentrations were even lower, compared with normal laboratory values, resulting in a slight increase in CD4/CD8 ratios, although 16% (16/102) of patients had a CD4/CD8 ratio of < 1. CD4 counts were linearly related to total lymphocyte concentrations (Pearson correlation coefficient = 0.948), but no relationship was found between total lymphocyte or lymphocyte subset counts and APACHE II score, predicted mortality rate, or survival rate.
Acute illness alone, in the absence of HIV infection, can be associated with profound decreases of T-lymphocyte populations. This problem is unpredictable and does not correlate with severity of illness, predicted mortality rate, or actual mortality rate. No conclusions regarding HIV serostatus or survival can be made based on single measurements of T-cell concentrations in acutely ill hospitalized patients.
确定急性病住院患者的T淋巴细胞亚群（CD4、CD8及CD4/CD8比值）范围，并确定这些浓度是否与疾病严重程度、生存率或免疫抑制相关。
横断面研究，比较急性生理与慢性健康状况评分系统II（APACHE II）评分以及计算得出的疾病特异性预测死亡率与T淋巴细胞亚群。
城市县医院重症监护病房（ICU），为指定的创伤中心。
102例连续入住ICU的患者（72例内科患者和30例外科患者）。
无。
记录患者临床数据、APACHE II评分及其相关的预测死亡率。对所有患者入住ICU时的样本进行人类免疫缺陷病毒（HIV）和淋巴细胞检测，检测人员对结果不知情。尽管102例患者中只有3例（2.9%）HIV抗体检测呈阳性，但41%（42/102）的患者CD4浓度<400个细胞/微升，29%（29/102）的患者CD4浓度<300个细胞/微升。与正常实验室值相比，平均CD8浓度更低，导致CD4/CD8比值略有升高，不过16%（16/102）的患者CD4/CD8比值<1。CD4计数与总淋巴细胞浓度呈线性相关（Pearson相关系数=0.948），但未发现总淋巴细胞或淋巴细胞亚群计数与APACHE II评分、预测死亡率或生存率之间存在关联。
在无HIV感染的情况下，单纯急性病可能与T淋巴细胞数量的显著减少有关。这个问题不可预测，且与疾病严重程度、预测死亡率或实际死亡率无关。基于急性病住院患者的单次T细胞浓度测量，无法得出关于HIV血清学状态或生存率的结论。
