人类免疫缺陷病毒感染患者CD4细胞计数与生存的对数关系。

Logarithmic relationship of the CD4 count to survival in patients with human immunodeficiency virus infection.

作者信息

Nightingale S D, Jockusch J D, Haslund I, Cal S X, Peterson D M, Loss S D

机构信息

Division of General Internal Medicine, University of Texas Southwestern Medical School, Dallas.

出版信息

Arch Intern Med. 1993 Jun 14;153(11):1313-8.

PMID:8099477

Abstract

BACKGROUND

Survival, and the incidence of events that define the acquired immunodeficiency syndrome (AIDS), are known to be inversely related to the CD4 count in patients with human immunodeficiency virus infection. We wished to quantify this relationship more precisely, particularly for patients with CD4 counts of less than 50/mm3.

METHODS

Prospective surveillance for survival and for all AIDS-defining events was performed on all 2682 patients with human immunodeficiency virus infection who had at least one CD4 count performed at a large urban public hospital during a 3-year period. Product-limit survival and incidence of AIDS-defining events were calculated as a function of baseline CD4 count.

RESULTS

The 1-year product-limit survival was 17% +/- 6% for patients after a baseline CD4 count of 1 to 4/mm3; 44% +/- 6% after a count of 5 to 9/mm3; 48% +/- 5% after a count of 10 to 19/mm3; 51% +/- 4% after a count of 20 to 39/mm3; 62% +/- 5% after a count of 40 to 59/mm3; 71% +/- 4% after a count of 60 to 99/mm3; 79% +/- 3% after a count of 100 to 199/mm3; and 92% +/- 2% after a count of 200 to 499/mm3. One-year survival and baseline CD4 count were related by the following formula: percent 1-year survival = 10 + 32(log10 CD4 count) (R2 = .97; P < .001). The 1-year incidence of a first AIDS-defining event and baseline CD4 count were related by the following formula: percent developing AIDS in 1 year = 104-36(log10 CD4 count) (R2 = .89; P < .001). Similar relationships were calculated between the logarithm of the baseline CD4 count and the 1-year incidence of most AIDS-defining events. These relationships were linear over the CD4 range of 1 to 499/mm3 and over follow-up periods of 6 months to 2 years.

CONCLUSIONS

The relationship of the CD4 count to survival, and to the incidence of AIDS-defining events, is logarithmic. This relationship helps explain the substantial differences in 1-year survival associated with baseline CD4 counts in the range below 50/mm3.

摘要

背景

已知人类免疫缺陷病毒感染患者的生存情况以及定义获得性免疫缺陷综合征（AIDS）的事件发生率与CD4细胞计数呈负相关。我们希望更精确地量化这种关系，尤其是对于CD4细胞计数低于50/mm³的患者。

方法

对一家大型城市公立医院在3年期间至少进行过一次CD4细胞计数的2682例人类免疫缺陷病毒感染患者进行生存情况及所有AIDS定义事件的前瞻性监测。计算乘积限生存及AIDS定义事件的发生率作为基线CD4细胞计数的函数。

结果

基线CD4细胞计数为1至4/mm³的患者1年乘积限生存率为17%±6%；计数为5至9/mm³后为44%±6%；计数为10至19/mm³后为48%±5%；计数为20至39/mm³后为51%±4%；计数为40至59/mm³后为62%±5%；计数为60至99/mm³后为71%±4%；计数为100至199/mm³后为79%±3%；计数为200至499/mm³后为92%±2%。1年生存率与基线CD4细胞计数的关系由以下公式表示：1年生存率百分比 = 10 + 32(log₁₀CD4细胞计数)（R² = 0.97；P < 0.001）。首次AIDS定义事件的1年发生率与基线CD4细胞计数的关系由以下公式表示：1年内发生AIDS的百分比 = 104 - 36(log₁₀CD4细胞计数)（R² = 0.89；P < 0.001）。在基线CD4细胞计数的对数与大多数AIDS定义事件的1年发生率之间也计算出了类似的关系。这些关系在CD4细胞计数范围为1至499/mm³以及随访期为6个月至2年的情况下呈线性。