Sabin C A, Phillips A N, Lee C A, Elford J, Timms A, Bofill M, Janossy G
Department of Public Health and Primary Care, Royal Free Hospital School of Medicine, London.
Br J Haematol. 1994 Feb;86(2):366-71. doi: 10.1111/j.1365-2141.1994.tb04741.x.
Whilst the prognostic value of serum beta-2 microglobulin (s-beta 2m) is well documented, the lack of a simple strategy for its use means that it is rarely ever measured in clinical practice. The prognosis associated with s-beta 2m at two different points in HIV infection, as defined by the CD4 count, was studied in a cohort of 111 men with haemophilia registered at the Royal Free Hospital School of Medicine, London. At CD4 counts of 0.5 and 0.2 x 10(9)/l, a raised s-beta 2m level was significantly associated with an increased risk of developing AIDS (P = 0.002 and 0.022 respectively, adjusted for the patient's age). Kaplan-Meier progression rates to AIDS by 4.5 years after a CD4 count of 0.5 x 10(9)/l were 57% (95% CI 32-82%) in those with s-beta 2m levels of 3 mg/l or more, but 20% (95% CI 4-36%) in those with s-beta 2m levels of less than 3 mg/l. By 3.5 years after a CD4 count of 0.2 x 10(9)/l, Kaplan-Meier progression rates to AIDS were 75% (95% CI 52-98%) in those with s-beta 2m levels of 3.8 mg/l or more, and 47% (95% CI 29-66%) in those with s-beta 2m levels of less than 3.8 mg/l. In the absence of acute viral infections, a raised s-beta 2m indicates those who will tend to progress to AIDS more rapidly than those with lower s-beta 2m levels and the same CD4 count. S-beta 2m levels in general are likely to be higher in haemophilia patients than in other, non-haemophilic risk groups. Whilst care should be taken, therefore, when applying our chosen cut-off values to non-haemophilic patients, our findings support the introduction of prophylaxis and antiviral therapies at a higher CD4 count in those with raised s-beta 2m levels relative to other patients in the same risk group whilst delaying treatment in those with lower CD4 counts, but relatively normal s-beta 2m levels.
虽然血清β2微球蛋白（s-β2m）的预后价值已有充分文献记载，但由于缺乏简单的应用策略，在临床实践中很少对其进行检测。在伦敦皇家自由医院医学院登记的111名血友病男性队列中，研究了根据CD4计数定义的HIV感染两个不同阶段s-β2m的预后情况。当CD4计数为0.5×10⁹/L和0.2×10⁹/L时，s-β2m水平升高与患艾滋病风险增加显著相关（分别为P = 0.002和0.022，经患者年龄校正）。在CD4计数为0.5×10⁹/L后4.5年，s-β2m水平≥3mg/L者艾滋病的Kaplan-Meier进展率为57%（95%CI 32 - 82%），而s-β2m水平<3mg/L者为20%（95%CI 4 - 36%）。在CD4计数为0.2×10⁹/L后3.5年，s-β2m水平≥3.8mg/L者艾滋病的Kaplan-Meier进展率为75%（95%CI 52 - 98%），而s-β2m水平<3.8mg/L者为47%（95%CI 29 - 66%）。在无急性病毒感染的情况下，s-β2m升高表明与s-β2m水平较低但CD4计数相同者相比，这些患者更易快速进展为艾滋病。一般来说，血友病患者的s-β2m水平可能高于其他非血友病风险人群。因此，在将我们选定的临界值应用于非血友病患者时应谨慎，但我们的研究结果支持，相对于同一风险组中的其他患者，对于s-β2m水平升高者在较高的CD4计数时引入预防和抗病毒治疗，而对于CD4计数较低但s-β2m水平相对正常者则延迟治疗。
