Günthard H, Opravil M, Ledergerber B, Olsson K, Vogt M, Fierz W, Lüthy R
Abteilung Infektionskrankheiten, Universitätsspital Zürich.
Dtsch Med Wochenschr. 1993 May 21;118(20):737-45. doi: 10.1055/s-2008-1059385.
The pattern of change over time of CD4-lymphocyte counts was investigated prospectively in 420 patients infected with HIV-1 (106 women, 314 men; mean age 34.9 [21-70] years) to assess its value in prognosticating progression to AIDS. Only those CD4-lymphocyte values were taken into account which had been measured in the asymptomatic stage of the HIV infection and before introduction of antiviral treatment. An average of 4.5 (range 3-10) measurements per person were available. Mean observation time was 2.4 years, the mean annual CD4-lymphocyte decrease was 48 cells/microliters. 121 patients (28.8%) had a fall in CD4-lymphocyte count which in the regression analysis significantly differed from zero. In this group there occurred 19 progressions to AIDS (15.7%), in contrast to only 20 (6.6%) in the 299 patients with a nonsignificant CD4 fall (P < 0.01). Multivariate analysis with the Cox regression indicated that the annual reduction in the CD4 count and the initial CD4 count were the only values of prognostic significance regarding progression to AIDS. There was no evidence that percentage and absolute CD4-lymphocyte counts had a different predictive value. When the initial CD4 count was high (> 900 cells/microliters), there was on average a steeper reduction in CD4-lymphocyte counts than when it was lower. This findings argues against a linear CD4 fall during the total period of observation. The annual CD4 fall, described with linear regression, is a prognostic criterion on its own for early recognition of those patients at a high risk of progression to AIDS while still in the asymptomatic stage of HIV infection.
对420例感染HIV-1的患者（106例女性，314例男性；平均年龄34.9[21 - 70]岁）进行前瞻性研究，观察CD4淋巴细胞计数随时间的变化模式，以评估其对艾滋病进展的预后价值。仅考虑在HIV感染无症状阶段且在开始抗病毒治疗之前测量的CD4淋巴细胞值。每人平均有4.5次（范围3 - 10次）测量数据。平均观察时间为2.4年，CD4淋巴细胞每年平均减少48个细胞/微升。121例患者（28.8%）的CD4淋巴细胞计数下降，在回归分析中显著不同于零。在该组中，有19例进展为艾滋病（15.7%），相比之下，299例CD4计数下降不显著的患者中只有20例（6.6%）进展为艾滋病（P<0.01）。Cox回归多变量分析表明，CD4计数的年度减少量和初始CD4计数是与艾滋病进展相关的仅有的具有预后意义的值。没有证据表明CD4淋巴细胞计数的百分比和绝对值具有不同的预测价值。当初始CD4计数较高（>900个细胞/微升）时，CD4淋巴细胞计数的平均下降幅度比初始计数较低时更大。这一发现与观察期内CD4呈线性下降的观点相悖。用线性回归描述的CD4年度下降本身就是一个预后标准，可用于在HIV感染无症状阶段早期识别那些进展为艾滋病风险较高的患者。
