β2-微球蛋白、HIV-1 p24抗体及酸解离HIV-1 p24抗原水平：乌干达孕妇中HIV-1垂直传播的预测标志物

Beta 2-microglobulin, HIV-1 p24 antibody and acid-dissociated HIV-1 p24 antigen levels: predictive markers for vertical transmission of HIV-1 in pregnant Ugandan women.

作者信息

Jackson J B, Kataaha P, Hom D L, Mmiro F, Guay L, Ndugwa C, Marum L, Piwowar E, Brewer K, Toedter G

机构信息

Department of Pathology, Case Western Reserve University, Cleveland, OH 44106.

出版信息

AIDS. 1993 Nov;7(11):1475-9.

PMID:8280414

Abstract

OBJECTIVES

To evaluate the clinical utility of plasma beta 2-microglobulin (beta 2M) levels, acid-dissociated HIV-1 p24 antigen, and HIV-1 p24-antibody titers in predicting HIV-1 vertical transmission in 227 HIV-1-infected Ugandan pregnant women.

DESIGN

Plasma beta 2M levels, acid-dissociated HIV-1 p24-antigen positivity, and HIV-1 p24-antibody titers were determined using commercial enzyme immunoassays (EIA) in a Ugandan cohort of 52 HIV-1-seropositive transmitting mothers, 175 HIV-1-seropositive non-transmitting mothers, and 52 seronegative mothers within 6 weeks prior to delivery.

RESULTS

Transmitter mothers had significantly higher plasma concentrations of beta 2M (1.80 +/- 1.13 mg/l) than non-transmitter seropositive mothers (1.32 +/- 0.81 mg/l; P = 0.0013). Similarly, a significantly higher proportion of transmitter mothers had detectable p24 antigen than non-transmitter mothers [six out of 51 (11.8%) versus six out of 173 (3.5%); P = 0.03]. Compared with the vertical transmission rate of 23% in the seropositive group, the positive predictive values of a beta 2M level > 1.5 mg/l or detectable HIV-1 p24 antigen for vertical transmission were 34 and 50%, respectively. Five of six (83.3%) seropositive mothers with both a beta 2M level > 1.5 mg/l and detectable p24 antigenemia transmitted HIV-1 infection to their infants compared with 25 of 124 (20.2%) seropositive mothers with values below the cut-off values for both tests (P = 0.00249). However, beta 2M was not found to be a significant independent predictor of vertical transmission when analyzed in a multivariate model with p24 antigenemia. There was no significant difference in HIV-1 p24-antibody titers in transmitter mothers versus non-transmitter mothers (P = 0.299).

CONCLUSION

beta 2M levels and acid-dissociated HIV-1 p24-antigen assays may be used to predict which HIV-1-infected pregnant women are at greatest risk for vertical transmission. However, only the p24-antigen test was independently predictive of vertical transmission and its clinical utility is limited.

摘要

目的

评估血浆β2微球蛋白（β2M）水平、酸解离HIV-1 p24抗原及HIV-1 p24抗体滴度在预测227例感染HIV-1的乌干达孕妇发生HIV-1垂直传播中的临床效用。

设计

采用商业酶免疫测定法（EIA），对乌干达一组队列中的52例HIV-1血清学阳性的传播型母亲、175例HIV-1血清学阳性的非传播型母亲以及52例血清学阴性母亲在分娩前6周内测定血浆β2M水平、酸解离HIV-1 p24抗原阳性率及HIV-1 p24抗体滴度。

结果

传播型母亲的血浆β2M浓度（1.80±1.13mg/L）显著高于非传播型血清学阳性母亲（1.32±0.81mg/L；P = 0.0013）。同样，传播型母亲中可检测到p24抗原的比例显著高于非传播型母亲[51例中有6例（11.8%），而173例中有6例（3.5%）；P = 0.03]。与血清学阳性组23%的垂直传播率相比，β2M水平>1.5mg/L或可检测到HIV-1 p24抗原对垂直传播的阳性预测值分别为34%和50%。6例β2M水平>1.5mg/L且有p24抗原血症的血清学阳性母亲中有5例（83.3%）将HIV-1感染传播给了婴儿，而124例两项检测值均低于临界值的血清学阳性母亲中有25例（20.2%）（P = 0.00249）。然而，在与p24抗原血症的多变量模型分析中，未发现β2M是垂直传播的显著独立预测因子。传播型母亲与非传播型母亲的HIV-1 p24抗体滴度无显著差异（P = 0.299）。