Guenter P, Muurahainen N, Simons G, Kosok A, Cohan G R, Rudenstein R, Turner J L
Department of Surgery, Graduate Hospital, Philadelphia, PA 19146.
J Acquir Immune Defic Syndr (1988). 1993 Oct;6(10):1130-8.
This investigation retrospectively studied relationships between survival in human immunodeficiency virus-seropositive outpatients receiving recent therapies (n = 77) and two markers of nutritional status, serum albumin and percent of usual body weight. Subjects were observed for an average of 186 +/- 8 days; 19% died within the study period. Kaplan-Meier curves and Cox regressions showed that older subjects who had lower CD4 counts, lower albumin levels, or had lost more weight demonstrated poorer survival. Albumin levels and weight loss were related to CD4 counts. The relative risk of death for subjects with low albumin levels (< 3.5 g/dl) was 3.6 times greater (p < 0.021, with 95% confidence limits [95%CL] of 1.2-10.9) than that for subjects with normal albumin levels (> or = 3.5 g/dl), even after controlling for age and CD4 counts. Similarly, after controlling for CD4 counts and age, subjects whose baseline body weights were < 90% of their usual weight had a greater relative death risk (8.3 times greater, p < 0.002, 95% CL 2.3-34.1) than those who had lost less. Survivors and nonsurvivors who had similar CD4 counts differed significantly in albumin levels (p < 0.05). Thus, nutritional status influences survival independent of CD4 counts.
本研究回顾性分析了近期接受治疗的77例人类免疫缺陷病毒血清反应阳性门诊患者的生存情况与两个营养状况指标（血清白蛋白和平时体重百分比）之间的关系。对受试者平均观察了186±8天；19%的受试者在研究期间死亡。Kaplan-Meier曲线和Cox回归分析显示，年龄较大、CD4细胞计数较低、白蛋白水平较低或体重减轻较多的受试者生存情况较差。白蛋白水平和体重减轻与CD4细胞计数有关。白蛋白水平低（<3.5 g/dl）的受试者的死亡相对风险比白蛋白水平正常（≥3.5 g/dl）的受试者高3.6倍（p<0.021，95%置信区间[95%CL]为1.2 - 10.9），即使在对年龄和CD4细胞计数进行校正之后。同样，在对CD4细胞计数和年龄进行校正后，基线体重<平时体重90%的受试者的相对死亡风险比体重减轻较少的受试者高（高8.3倍，p<0.002，95%CL为2.3 - 34.1）。CD4细胞计数相似的存活者和非存活者在白蛋白水平上有显著差异（p<0.05）。因此，营养状况独立于CD4细胞计数影响生存。
