CD+8 T细胞激活分子CD38、HLA-DR与HIV-1载量的相关性研究

目的研究HIV/AIDS患者CD8^＋ T细胞表达激活分子CD38、HLA-DR水平与血浆病毒载量（VL）的相关性,以及用CD8CD38、CD8HLA-DR比例替代VL检测的可行性.方法用流式细胞术分析103例接受12个月高效抗逆转录病毒治疗（HAART）患者的CD＋8 T细胞表达CD38和HLA-DR水平;用分支DNA扩增技术检测血浆VL.用敏感性、特异性、准确性等参数分析能有效预测VL＜50拷贝/ml、VL＜500拷贝/ml、VL＞1000拷贝/ml和VL＞10 000拷贝/ml时CD8CD38和CD8HLA-DR的检测范围.结果103例艾滋病患者CD38、HLA-DR和VL在12个月治疗中均呈下降趋势;CD38和VL在HAART治疗前及治疗第1、3、6、9、12个月6个检测点的总相关系数为0.483（P＜0.001）、HLA-DR和VL的总相关系数为0.477（P＜0.001）.用CD8CD38和CD8HLA-DR的水平预测VL值有显著诊断价值：当CD38＜68.5%和＜72.5%时预测VL＜50拷贝/ml和＜500拷贝/ml有较高的灵敏度和特异性;当HLA-DR在＞39.5%和＞46.5%时预测VL＞1000拷贝/ml和＞10 000拷贝/ml有较高的灵敏度和特异性.结论在条件匮乏的艾滋病高发区,可以用CD8CD38和CD8HLA-DR激活亚群的结果来预测血浆VL,作为监测HIV疾病进展和评价抗病毒疗效的参考.

The correlation of HIV-1 viral load to expression of CD8+ T lymphocyte activators CD38 and HLA-DR

Objective To investigate the correlation of CD_(38) and HLA-DR abnormal activating expression on CD+_8T with plasma viral load (VL) and evaluate the possibility of the economical CD_ 38 and HLA-DR test to substitute VL assay in HIV/AIDS patients. Methods A multi-point correlation study of the percentage of CD_ 38 and HLA-DR on CD+_8T by flow cytometry with plasma VL by bDNA was performed in 103 HIV/AIDS patients during a 12-month highly active anti-retroviral therapy (HAART). The cutoff values of CD_ 38 and HLA-DR were evaluated with ROC area, sensitivity and specificity for predictive VL<50 copies/ml, <500 copies/ml, >1000 copies/ml and >10 000 copies/ml respectively. Results The level of CD_ 38 and HLA-DR on CD+_8T in 103 patients decreased gradually with the reduction of VL during a 12-month HAART. The correlation of CD_ 38 and HLA-DR with VL in the year of HAART was 0.424,0.376,0.335,0.326,0.297,0.285 and 0.377,0.318,0.333,0.312,0.361, 0.358 with significant P value. Moreover, the overall correlation of CD_ 38 and HLA-DR with VL were 0.483 (P<0.001) and 0.477 (P<0.001). Depending on optimal ROC, sensitivity and specificity for the substitute method, the cutoffs percentage of CD_ 38 were <68.5% and <72.5% for predictive VL<50 copies/ml and <500 copies/ml as well as >39.5% and >46.5% of HLA-DR cutoff to predict VL>1000 copies/ml and >10 000 copies/ml. Conclusion The detection of CD_(38) and HLA-DR percentage expression on CD+_8T can be available for prediction about HIV VL assay as a substitute method to survey the disease progression and HAART outcome in some resource-limited areas of China.