Absolute lymphocyte count as a surrogate marker for CD4+ cell count in monitoring of antiretroviral therapy,Northwest Ethiopia: retrospective evaluation

Objective

To determine the use of total lymphocyte count as a surrogate marker for CD4+ cell count among HIV infected patients at the University of Gondar Hospital.

Methods

A retrospective cross sectional study was conducted at the University of Gondar Hospital antiretroviral therapy laboratory from December 2011 to May 2012. Data on CD4+ cell count, total lymphocyte count, sex, and age were collected from 2964 HIV infected patients and analyzed using SPSS version 16 computer software.

Results

Total lymphocyte count was significantly correlated with CD4+ cell count (P<0.001; r²=0.434). The sensitivity, specificity, positive predictive value, negative predictive value of total lymphocyte count<1 200 cells/mm³ to predict CD4+ cell count <200 cells/mm³ was 57.8%, 86.4%%, 34.1%, 86.39%, respectively. A total lymphocyte count<1 000cells/mm³ was found to have suboptimal sensitivity (69.0%), and specificity (85.0%) for predicting a CD4+ cell count <200 cells/mm³.

Conclusions

Total lymphocyte count and CD4+ cell count was positively correlated. Hence, lymphocyte count less than or equal to 1 000/mm³ can be used as a cutoff value in place where there is no CD4+ cell counting machine.     

HIV感染者外周血淋巴细胞总数与CD4+T淋巴细胞计数相关性研究

目的 分析HIV感染者外周血淋巴细胞总数(total lymphocyte count,TLC)与CD4+T淋巴细胞计数相关性,探讨将外周TLC作为监测HIV感染者病情变化指标的可行性.方法 回顾性分析我院54例HIV感染者TLC与CD4+T淋巴细胞计数相关性,判断CD4+T淋巴细胞计数分别＜100× 106/L、＜2...     

Comparison of prognostic impact of absolute lymphocyte count,absolute monocyte count,absolute lymphocyte count/absolute monocyte count prognostic score and ratio in patients with diffuse large B cell lymphoma

BackgroundThe combination of absolute lymphocyte count (ALC) and absolute monocyte count (AMC) at diagnosis has prognostic relevance in patients with diffuse large B cell lymphoma (DLBCL).AimsThe present study was designed to investigate the prognostic significance of ALC and AMC and to determine whether ALC/AMC ratio or ALC/AMC prognostic score is better predictor of outcome in DLBCL.MethodsWe retrospectively analyzed the prognostic significance of ALC and AMC, ALC/AMC ratio and ALC/AMC prognostic score at diagnosis in 222 DLBCL patients treated with R-CHOP.ResultsROC analysis showed that optimal cut-off values of AMC and ALC/AMC ratio with the best sensitivity and specificity were 0.59 × 10⁹/L and 2.8, respectively. Cut-off of ALC was determined according to the literature data (1 × 10⁹/L). Low ALC, high AMC, low ALC/AMC ratio and high ALC/AMC prognostic score were in significant association with lower rate of therapy response and survival. In contrast, these parameters were not in significant correlation with relapse rate. The patients with low ALC, “high” AMC, low ALC/AMC ratio and high ALC/AMC prognostic score at diagnosis had significantly shorter EFS and OS. In multivariate analysis all tested parameters (ALC, AMC, ALC/AMC prognostic score and ALC/AMC ratio) are independent risk factors along with “bulky” disease and IPI.ConclusionAll tested parameters (ALC, AMC, ALC/AMC score and ALC/AMC ratio) may be useful prognostic factors in DLBCL patients. ALC/AMC score has a slight advantage as it allows the classification of patients into three prognostic groups. Further studies are needed to determine which of these parameters has the highest predictive value.     

HIV/AIDS患者中CD4细胞计数与总淋巴细胞计数间相关性研究

目的评价总淋巴细胞计数与CD4细胞计数间的相关性.方法回顾性分析了226例艾滋病病毒(HIV)阳性患者共330对同一天获得的CD4细胞计数与总淋巴细胞计数间的相关性,阳性预测值(PPV)、敏感性、特异性分别在不同的总淋巴细胞计数范围对应于CD4细胞计数<200个/mm3和CD4细胞计数<350个/mm3时获得.结果 330对CD4细胞计数与总淋巴细胞计数之间存在相关性(r=0.528,P<0.01),总淋巴细胞计数<1 400个/mm3对应于CD4细胞计数<200个/mm3有70.11%的阳性预测值,72.61%的敏感性,88.46%的特异性,总淋巴细胞计数<1 900个/mm3对应于CD4细胞计数<350个/mm3有80.97%的阳性预测值,70.92%的敏感性,74.54%的特异性.结论总淋巴细胞计数可以作为评价患者患机会性感染的危险程度及何时开始药物治疗的一种低消费的监测手段.阳性预测值(PPV)、敏感性、特异性分别在总淋巴细胞计数<1 400个/mm3对应于CD4细胞计数<200个/mm3和总淋巴细胞计数<1 900个/mm3对应于CD4细胞计数<350个/mm3时表现最为明显.     

Absolute lymphocyte count predicts overall survival in follicular lymphomas

The peripheral blood absolute lymphocyte count (ALC) recovery after autologous stem cell transplantation has been shown to be an independent prognostic factor for survival for different haematologic malignancies. The role of ALC at diagnosis for follicular (grades 1 and 2) lymphomas (FL) on survival is not well described. The primary objective of this study was to assess the role of ALC on overall survival (OS) in FL patients. Of 1104 FL patients, 228 patients were originally diagnosed, followed, and had all treatment at the Mayo Clinic from 1984 and 1999, were evaluated. The median follow-up was 89 months (range: 8.35-248). ALC as a continuous variable was identified as a predictor for OS [Hazard ratio (HR) = 0.74, P < 0.04]. ALC >/= 1.0 x 10(9)/l (n = 164) predicted a longer OS versus ALC < 1.0 x 10(9)/l (n = 64; 175 vs. 73 months respectively, P < 0.0001). When compared with the Follicular Lymphoma International Prognostic Index (FLIPI), ALC was an independent prognostic factor for OS by multivariate analysis (HR = 0.677, P < 0.0001). These data suggest a critical role of FL patients' immune status at diagnosis on survival.     

Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer

AIM： To investigate the long-term effect of the number of resected lymph nodes （LNs） on the prognosis of patients with node-negative gastric cancer. METHODS： Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate. RESULTS： The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival （P 〈 0.05）. A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥ 15 for pT1-2, ≥ 20 for pT3-4, and ≥ 15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate （P 〈 0.01）. The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs （P 〉 0.05）.CONCLUSION： For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the postoperative complication rate.     

New prognostic model for patients with advanced gastric cancer: Fluoropyrimidine/platinum doublet for first-line chemotherapy

BACKGROUNDNew prognostic factors have been reported in patients with metastatic or recurrent gastric cancer (MRGC), necessitating modifications to the previous prognostic model.AIMTo develop a new model, MRGC patients who received fluoropyrimidines/ platinum doublet chemotherapy between 2008 and 2015 were analyzed.METHODSA total of 1883 patients was divided into a training set (n = 937) and an independent validation set (n = 946).RESULTSMultivariate analysis showed that the following six factors were associated with poor overall survival (OS) in the training set: Eastern Cooperative Oncology Group performance score ≥ 2 and bone metastasis (2 points each), peritoneal metastasis, high alkaline phosphatase level, low albumin level, and high neutrophil-lymphocyte ratio (1 point each). A prognostic model was developed by stratifying patients into good (0-1 point), moderate (2-3 points), and poor (≥ 4 points) risk groups. In the validation set, the median OS of the three risk groups was 15.8, 10.1, and 5.7 mo, respectively, and those differences were significant (P < 0.001).CONCLUSIONWe identified six factors readily measured in clinical practice that are predictive of poor prognosis in patients with MRGC. The new model is simpler than the old and more easily predicts OS.     

HIV感染者CD4+T淋巴细胞数与总淋巴细胞计数相关性的Meta分析

目的根据艾滋病病毒(Human immunodeficiency virus,HIV)感染者的总淋巴细胞计数(Total lyopho-cyte count,TLC)预测CD4+T淋巴细胞计数<200个/μL的值进行系统评价。方法检索中英文文献,并根据纳入标准对文献进行筛选。利用Meta-DiSc 1.4和Stata/SE 12.0软件,对纳入的研究结果按不同的TLC临界值分别进行合并灵敏度、特异度、阳性预测值、阴性预测值的计算,绘制不同临界值的综合受试者工作特征曲线,计算曲线下面积并进行比较。结果共筛选文献12篇,按TLC临界值分别为1 200个/μL、1 300个/μL、1 400个/μL及1500个/μL进行Meta分析。以TLC<1 200个/μL预测CD4<200个/μL的合并灵敏度和特异度分别为0.62[95%可信区间(Confidence interval,CI):0.60～0.64]和0.81(95%CI:0.80～0.82)。不同TLC临界值下的综合受试者工作特征曲线下面积不相同,但差异无统计学意义。结论以TLC<1 200个/μL预测CD4<200个/μL时准确性最高,此结果与世界卫生组织的建议一致。     

HIV感染者检测病毒载量和CD4淋巴细胞计数的关系

目的 探讨HIV感染者抗逆转录病毒治疗前血液标本HIV病毒载量(VL)及CD4淋巴细胞计数的关系.方法 采用RT-PCR法和流式细胞分析系统,对重庆地区部分HIV病毒感染者169份血液标本的VL和CD4平行检测结果进行分析.结果 169份标本中VL能被定量的有160份(94.7%),其结果6.0×103~2.80×107拷贝/ml之间,CD4细胞计数3~836个/μl.经相关性分析,CD4细胞值与VL对数值呈负相关(r=-0.43,P<0.01).结论平行检测VL和CD4细胞数可帮助了解疾病进展状况,选择开始治疗的时机.     

Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients' survival benefit from rituximab

Objectives: To evaluate the prognostic value of absolute lymphocyte count (ALC) at diagnosis in patients with diffuse large B‐cell lymphoma (DLBCL). Methods: In a large cohort of patients with DLBCL treated with CHOP (n = 119) or RCHOP (n = 102) in our institution, we evaluated the prognostic value of ALC at diagnosis with regards to treatment response, overall (OS) and progression‐free survival (PFS). Use of rituximab, all International Prognostic Index (IPI) determinants, β2microglobulin level, presence of B symptoms or bulky disease, and ALC were evaluated. Results: Low ALC (<1.0 × 10⁹/L) was associated with advanced stage, performance status ≥2, elevated lactate dehydrogenase, number of extranodal involvement ≥2, B symptoms, elevated β2microglobulin and higher IPI risk group. Low ALC was associated with lower CR rate by univariate analysis (odds ratio = 3.29, P = 0.024) but not by multivariate analysis. By univariate analysis using Cox proportional hazard model, low ALC was associated with shorter OS [hazard ratio (HR) = 2.89, P < 0.001] and PFS (HR = 2.91, P < 0.001). Multivariate analysis revealed that low ALC was associated with shorter OS (HR = 2.51, P = 0.003) and PFS (HR = 2.72, P < 0.001), independent of above‐mentioned parameters. Subclass analyses revealed that the use of rituximab improves OS in patients with low ALC (HR = 0.42, P = 0.05) but not in those with high ALC (HR = 0.83, P = 0.71). This observation was most obvious in patients with higher IPI score. Conclusion: Low ALC is a poor prognostic marker in patients with DLBCL and suggests patients’ survival benefit from rituximab.     

Absolute lymphocyte count predicts therapeutic efficacy of rituximab therapy in follicular lymphomas

The immunologic mechanisms of action of rituximab include complement mediated lysis and antibody-dependent cellular cytotoxicity. We hypothesised that a stronger host immune system prior to rituximab therapy for follicular (grades 1and 2) lymphomas (FL) would result in better response rates and longer time to progression (TTP). Thus, we studied the role of absolute lymphocyte count (ALC) prior to rituximab therapy on treatment efficacy and TTP in FL patients. Between 1996 and 2002, 79 FL patients were treated with single agent rituximab during their lymphoma treatment at the Mayo Clinic. The median age of the cohort was 56.6 years (range: 25-98 years). The median TTP was 12.5 months (range: 1-76 months). Superior TTP was observed with an ALC > or =0.89 x 10(9)/l (n = 40) compared with an ALC <0.89 x 10(9)/l (n = 39) at the time of rituximab therapy (median: 36.5 vs. 8.1 months, respectively, P < 0.0009). Higher complete response rates were observed in the ALC > or =0.89 x 10(9)/l (23/40, 58%) compared with the ALC <0.89 x 10(9)/l (5/39, 13%) (P < 0.0001). Multivariate analysis showed ALC to be an independent predictor for TTP. This study supports our hypothesis that a higher ALC predicts longer TTP following rituximab therapy.     

老年胃癌患者手术风险因素分析

目的 总结分析老年胃癌患者的临床特点和手术风险性.方法 回顾性分析2006年1月至2008年12月607例胃癌手术患者的临床资料,其中年龄＞65岁的老年患者267例,将年龄≤65岁患者340例作为对照组.所有患者均由同一组手术人员完成胃癌根治术.分析比较两组患者术前是否合并心肺疾病、病理类型及术后并发症等.结果 老年组术前存在其他系统疾病者明显高于对照组(68.91%比31.63%,P＜0.01).术后两组并发症的发生率相似,老年组为28.19%(75/267),对照组为25.59%(87/340).但在心肺疾病,尤其是肺部感染的发生率老年组高于对照组(17.23%比5.29%,P＜0.01).老年组淋巴结清扫范围与消化道并发症发生率的关系密切,清扫范围越小,发生率越低.结论 老年胃癌患者术后并发症的发生率主要与手术方式相关.对于术前存在手术风险的老年患者,适当减小手术范围能在根治肿瘤的前提下,减少术后并发症和手术风险.     

老年髋部骨折患者术前血清白蛋白及淋巴细胞总数改变对其预后的影响

目的：探讨术前血清白蛋白（ALB）及淋巴细胞总数（TLC）改变对老年髋部骨折预后的影响。方法回顾性地分析2006年7月至2010年12月在解放军总医院行手术治疗老年髋部骨折的640例患者的临床资料。分别于入院时检测ALB和TLC。临床随访指标包括患者住院时间、住院并发症、住院死亡率、术后3个月死亡率、术后12个月死亡率。将所得资料行多因素统计分析,评价ALB和TLC的变化对患者预后的临床意义。结果640例患者中低ALB患者283例（44.2%）,低TLC患者435例（68%）。ALB和TLC均低于正常值者,术后并发症发生率为13.3%,住院死亡率、术后3个月死亡率、术后1年死亡率分别为4.2%、6.7%、16.7%,均明显高于其他各组（P＜0.05）。多因素分析显示ALB及TLC可作为老年髋部骨折患者死亡风险的预测因素。结论老年髋部骨折患者入院时营养不良可预测术后不良临床结局, ALB及TLC可以作为患者营养不良及不良临床结局的预测因素。     

阴虚型HBV相关原发性肝癌患者的肿瘤特征及淋巴细胞计数与生化指标的相关性分析

目的探讨阴虚型HBV相关原发性肝癌(PLC)患者的肿瘤特征及淋巴细胞计数与生化指标的相关性。方法收集2013年7月-2015年2月于首都医科大学附属北京地坛医院治疗的PLC患者148例,分为阴虚型PLC组(n=52)和非阴虚型PLC组(n=96)。收集患者的一般资料及实验室指标,包括肿瘤学指标[甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原(CA)19-9],病毒学指标(HBs Ag),肿瘤大体分型(结节型、块状型、巨块型、弥漫型),影像学特征(门静脉主干内径、门静脉癌栓、肝外转移),生化指标[终末期肝病模型(MELD)评分、白细胞(WBC)、红细胞(RBC)、血小板(PLT)、ALT、AST、TBil、GGT、ALP、白蛋白(Alb)、胆碱酯酶(CHE)、凝血酶原时间(PT)、凝血酶原活动度(PTA)]和淋巴细胞计数。符合正态分布的计量资料组间比较采用t检验,相关性分析采用Pearson相关分析;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,相关性分析采用Spearman相关分析。计数资料组间比较采用χ2检验。结果 2组患者的HBs Ag比较差异有统计学意义(χ2=5.658,P=0.017)。与非阴虚型PLC组相比,阴虚型PLC患者的CEA和CA19-9水平升高,2组间比较差异有统计学意义(U值分别为-2.200、-2.194,P值均0.05),MELD评分、TBil、PT升高(t=2.2、U=-2.0、U=-2.0,P值均0.05),PLT和PTA降低(U=-3.1、t=-2.5,P值均0.05),淋巴细胞、T淋巴细胞、CD8+T淋巴细胞、CD4+T淋巴细胞计数均降低(t=-2.7、U=-2.6、t=-2.2、U=-2.9,P值均0.05)。阴虚型PLC患者的CD4+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.360、0.295,P值均0.05);CD8+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.352、0.464,P值均0.05),与MELD评分、TBil、PT呈负相关(r值分别为-0.358、-0.378、-0.520,P值均0.05)。结论阴虚型PLC患者较其他证型肝癌患者肝脏合成功能更差、胆汁淤积更明显、免疫功能更为低下,且患者的CD4+T淋巴细胞计数越低,凝血功能越差;CD8+T淋巴细胞计数越低,凝血功能和肝脏储备功能均差。     

Clinical impact of early absolute lymphocyte count after allogeneic stem cell transplantation

The role of repopulating lymphocytes after allogeneic stem cell transplantation (SCT) includes the prevention of serious infections and attacking residual tumour cells in the early post-transplant phase. Therefore, the current study analysed the role of the absolute lymphocyte count (ALC) on day 21 after SCT in predicting transplant outcomes of 82 patients in terms of the risk of opportunistic infections and recurrence of original disease. The median dose of CD34+, CD3+ and mononuclear cells (MNC) infused was 6.41 x 10(6)/kg, 1.96 x 10(8)/kg and 6.81 x 10(8)/kg respectively. The high ALC group (high ALC on day 21; > or =0.35 x 10(9)/l) was associated with the use of peripheral blood stem cells, matched sibling donors and higher cell doses of MNC, CD3+ and CD4+ cells. The high ALC group also exhibited a better overall survival (56.3% vs. 17.7%) and disease-free survival (50.1% vs. 15.9%) after 3 years and lower incidences of relapse (33.6% vs. 67.1%) and fungal infections (3.0% vs. 19.5%) after 1 year. The incidence of cytomegalovirus antigenaemia was lower in the high ALC group (47.7% vs. 73.7%). Accordingly, identifying the ALC on day 21 would appear to be a useful and simple measurement to predict those patients with a high risk of opportunistic infections and relapse after allogeneic SCT.     

70岁及以上胃癌患者的临床病理特征及预后分析

目的:探讨≥70岁胃癌患者的临床病理特征和影响预后的危险因素。方法:回顾性分析河北医科大学第四医院外三科自2012年1月至2015年1月行根治性手术治疗的2386例胃癌患者,筛选出年龄≥70岁的患者,分析临床特征及影响预后的因素。结果:2386例胃癌患者中年龄≥70岁者342例(14.3%)。两组之间在性别、伴发疾病个...