Shapiro N I, Karras D J, Leech S H, Heilpern K L
Division of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
Ann Emerg Med. 1998 Sep;32(3 Pt 1):323-8. doi: 10.1016/s0196-0644(98)70008-3.
To determine whether the absolute lymphocyte count (ALC) (white blood count x lymphocyte percentage) can be used to predict a low CD4 count.
We conducted a retrospective data analysis of consecutive CD4 count analyses performed between January 1, 1995, through December 1, 1995, at an urban university teaching hospital. Results of consecutive CD4 counts and simultaneously measured ALCs were analyzed from samples obtained in inpatient, clinic, and emergency department settings. The ability of ALC to predict a CD4 count less than 200 cells/mm3 was analyzed by calculating sensitivities, specificities, predictive values, and likelihood ratios for a range of ALC values.
Among the 807 samples, 322 results (40%) had a CD4 count less than 200 cells/mm3. The ALC and CD4 count were correlated (r=.69, P<.0001). An ALC less than 1,000 cells/mm3 predicted CD4 counts less than 200 cells/mm3 with a sensitivity of .67 (95% confidence interval .62 to .72), specificity of .96 (.94 to .98), positive predictive value of .91 (.87 to .95), and a negative predictive value of .81 (.78 to .84). An ALC less than 2,000 cells/mm3 predicted CD4 counts less than 200 cells/mm3 with a sensitivity of .97 (.95 to .99), specificity of .41 (.37 to .45), positive predictive value of .52 (.48 to .56), and negative predictive value of .95 (.92 to .98).
A reliable relationship exists between ALC and CD4 count. In a similar population, an ALC less than 1,000 cells/mm3 is predictive of a CD4 count less than 200 cells/mm3, and an ALC greater than or equal to 2,000 cells/mm3 is predictive of a CD4 count greater than or equal to 200 cells/mm3. Physicians may find these criteria useful in identifying patients with increased risk of opportunistic infection.
确定绝对淋巴细胞计数（ALC）（白细胞计数×淋巴细胞百分比）是否可用于预测低CD4计数。
我们对1995年1月1日至1995年12月1日在一所城市大学教学医院进行的连续CD4计数分析进行了回顾性数据分析。对从住院部、门诊部和急诊科采集的样本的连续CD4计数结果和同时测量的ALC进行了分析。通过计算一系列ALC值的敏感性、特异性、预测值和似然比，分析了ALC预测CD4计数低于200个细胞/mm³的能力。
在807个样本中，322个结果（40%）的CD4计数低于200个细胞/mm³。ALC与CD4计数相关（r = 0.69，P < 0.0001）。ALC低于1000个细胞/mm³预测CD4计数低于200个细胞/mm³，敏感性为0.67（95%置信区间0.62至0.72），特异性为0.96（0.94至0.98），阳性预测值为0.91（0.87至0.95），阴性预测值为0.81（0.78至0.84）。ALC低于2000个细胞/mm³预测CD4计数低于200个细胞/mm³，敏感性为0.97（0.95至0.99），特异性为0.41（0.37至0.45），阳性预测值为0.52（0.48至0.56），阴性预测值为0.95（0.92至0.98）。
ALC与CD4计数之间存在可靠的关系。在类似人群中，ALC低于1000个细胞/mm³可预测CD4计数低于200个细胞/mm³，而ALC大于或等于2000个细胞/mm³可预测CD4计数大于或等于200个细胞/mm³。医生可能会发现这些标准有助于识别机会性感染风险增加的患者。
