Correlation of CD4+ T cell count with total lymphocyte count, haemoglobin and erythrocyte sedimentation rate levels in human immunodeficiency virus type-1 disease

Background: Studies in human immunodeficiency virus (HIV) infected adults have demonstrated association of total lymphocyte count (TLC) <1200/mm³ and subseqnent disease progression or mortality. The association of other surrogate makers such as haemoglobin (Hb), and erythrocyte sedimentation rate (ESR) with CD4 count and disease progression has also been suggested. This study was carried out to determine the relationship of CD4-positive T lymphocyte counts with TLC, Hb and ESR in HIV-infected individuals.Methods: The study population comprised of 215 antiretroviral treatment naive HIV-1 infected adults. The CD4 positive T cell counts, TLC, Hb and ESR of study participants were measured. Spearman's rank order correlation and Receiver Operating Characteristic were used for statistical analyses.Result: The sensitivity, specificity, positive and negative likelihood ratios for cut-off value of TLC <1200/mm³ for predicting CD4 counts <200 cells/mm³ and <350 cells/mm³ were 9.4%, 100%, not measurable and 1.1, and 6.1 %, 98.8 %, 5.13 and 0.95, respectively. The association of Hb (<10, 11, 12 g/dl and <10, 12, 14 g/dl for CD4 counts <200 cells/mm³ and <350 cells/mm³, respectively), and ESR (<10, 20 and 30 mm fall after 1 hour) with these two CD4 counts cut-off values were suboptimal.Conclusion: This study reveals the poor association of TLC, Hb, and ESR with CD4 counts in HIV infected adults, thus highlighting the need to review the utility of these surrogate markers, for predicting CD4 counts in people living with HIV/AIDS.     

Value of the use of absolute lymphocyte as surrogate for CD4 count in resource poor situations

Background:

The initiation of antiretroviral (ARV) drugs and monitoring of human immunodeficiency virus (HIV) treatment in developing nations such as sub-Sahara Africa is based on the clinical stage and level of CD4 count. Clinical stages can easily be determined using the World Health Organisation (WHO) criteria, this is not so with CD4 count where the right equipment and expertise are not easily available. This lead to various studies being carried out in search of surrogates for CD4 count with use of total lymphocyte count (TLC) being suggested by some studies.

Objective:

In situation where determination of CD4 cell count is not available or feasible, lymphocyte count is believed to be one alternative method for immunological classification of Acquired Immunodeficiency Syndrome (AIDS). Such assumption may not be true of every population. The objective is, therefore, to examine the correlation between the absolute lymphocyte count and the CD4+ lymphocyte count in HIV positive patients.

Materials and Methods:

One hundred and sixty-five consecutive HIV positive patients were recruited for the study before the commencement of ARV drugs over a period of 13 months. The haemotological parameters such as the CD4 count was done by flow cytometry using Partec cyflow counter machine made in Germany, with strict adherence to the manufacturer''s standard operating procedure. TLC were also determined using Sysmex haematology blood analyser, following the manufacturer''s standard operating procedure. Patients were then grouped into CD4 and Total lymphocyte (TLC) categories. These were then compared to determine if there is any correlation as shown in previous studies. Statistical analysis of data was done using Statistical Package for Social Sciences (SPSS) and statistical significance of data was based on P value of less than 0.05. There was significant positive correlation (P value 0.000) between TLC and CD4 count.

Results:

Majority of the patients with TLC less than 1000/mm^[3] had CD4 count <200 cells/μl. Using TLC <1000/mm^[3] threshold, there was high sensitivity of 81.8% but low specificity and positive predictive value of 47.5% and 19.4%, respectively, for CD4 count <200 cells/μl. Further assessment using TLC of <1,200/mm^[3] for the currently accepted CD4 count cut-off of <350 cells/μl for initiation of antiretroviral drugs, the sensitivity, specificity, positive predictive value were found to be 76.5%, 26.7%, 21.3%, respectively.

Conclusions:

Considering the low specificity and positive predictive value, it was concluded that the use of TLC of as a surrogate for CD4 count is unreliable. However, where there is no alternative, it could be used with caution bearing in mind its limitations.     

总淋巴细胞计数对河南省6～18岁HIV/AIDS患者CD4+ T计数的预测作用

目的:探讨总淋巴细胞计数(TLC)作为CD4+T淋巴细胞(CD4+T)计数替代标志物对儿童及青少年HIV/AIDS患者细胞免疫功能的预测作用。方法:采用回顾性队列研究方法,分析266例6～18岁HIV/AIDS患者抗病毒治疗(HAART)前后TLC和CD4+T计数的相关性;通过受试者工作特征曲线判断TLC代替CD4+T<350mm-3计数的预测价值和最佳分界值。结果:HAART前、6个月和12个月时,TLC和CD4+T计数均呈正相关关系(rS分别为0.791、0.625和0.680,P<0.001)。HAART前用TLC<2600mm-3预测CD4+T<350mm-3具有较高的价值,灵敏度和特异度分别为83.56%和79.31%;HAART6个月及12个月时,用TLC预测CD4+T<350mm-3的最佳预测阈值均为2400mm-3,灵敏度分别为76.40%和71.03%,特异度分别为72.38%和82.39%。结论:TLC是CD4+T计数较好的替代标志物,可用于监测儿童及青少年HIV/AIDS患者HAART疗效。     

Rate of decline in CD4 count in HIV patients not on antiretroviral therapy

Background

The progressive decline in the CD4 count in HIV patients leads to a more general decline in immune functioning. The study has been carried out to determine the decline in CD4 count in HIV patients.

Methods

The study was conducted in a medical college hospital at Maharashtra. The information on baseline CD4 count was gathered from positive patient records registered in the central disease registry. The baseline CD4 count was the first count of CD4 obtained when the patient is diagnosed as HIV positive and further two subsequent readings. The time from baseline (t1) till the last CD4 count (t2) was divided into the different quartiles and the median decline in CD4 count in each quartile was determined. As the time between the two CD4 count measurements was not uniform the rate of change in CD4 was measured with respect to time as [X (t2) − X (t1)/(t2 − t1)]. Correlation was assessed using correlation coefficient.

Results

As the CD4 counts were following skewed distribution, the normality was achieved by cuberoot transformation. The overall rate of decline in CD4 count was estimated to be 35 cells/μL per year with 95% confidence interval (CI) as (17.01, 85.04). The correlation coefficient between decline in CD4 and the initial CD4 count in the four time quartiles was (r = −0.51; p = 0.001, r = −0.79; p = 0.000, r = −0.48; p = 0.015 and r = −0.80; p = 0.000) respectively. The median decline in the CD4 count in 0–6 months was 3 cells/μL, in (6–11) months was approximately 26 cells/μL, in (11–21.5) months was 30 cells/μL and in more than 21.5 months the median decline was 52 cells/μL.

Conclusions

There was a progressive decline in the CD4 count following HIV infection. An understanding of the influence of decline in CD4 count in HIV patients not on ART is important for clinical management of HIV disease.     

Is total lymphocyte count a predictor for CD4 cell count in initiation antiretroviral therapy in HIV-infected patients?

Background:

Since laboratory assessments of HIV-infected patients by flow cytometric methods are expensive and unavailable in resource-limited countries, total lymphocyte count by haematology cell counter is supposed to be a suitable surrogate marker to initiate and monitor course of the disease in these patients. The aim of this study was to evaluate the utility of total lymphocyte count as a surrogate marker for CD4 count in HIV-infected patients.

Patients and Methods:

In a prospective study 560 HIV-positive individuals evaluated for total and CD4 lymphocyte count. For correlation between CD4 count and total lymphocyte count, haemoglobin and haematocrit we defined cut-off values as 200 cell/μl, 1200 cell/μl, 12 gr/dl and 30%, respectively, and compared CD4 count with each parameter separately. Positive predictive value, negative predictive value, sensitivity and specificity of varying total lymphocyte count cutoffs were computed for CD4 count ≤ 200 cell/μl and ≤ 350 cell/μl.

Results:

Strong degree of correlation was noted between CD4 and total lymphocyte count (r: 0.610, P < 0.001). Mean and standard deviation of total lymphocyte count, haemoglobin and haematocrit in relation to CD4 count were calculated which indicated significant correlation between these variables. Kappa coefficient for agreement was also calculated which showed fair correlation between CD4 200 cell/μl and total lymphocyte count 1200 cell/μl (0.35).

Conclusion:

This study reveals that despite low sensitivity and specificity of total lymphocyte count as a surrogate marker for CD4, total lymphocyte count is of great importance and benefit in resource-limited settings.     

Assessment of the efficacy of total lymphocyte counts as predictors of AIDS defining infections in HIV-1 infected people

Background: The CD4 count is a dominant prognostic and predictive factor in HIV infection. This study assessed the utility of the total lymphocyte count (TLC) in place of the CD4 count to predict the development of AIDS defining opportunistic infections (ADOI). Methods: The Chelsea and Westminster cohort was used to identify those people with a first episode of an ADOI. Corresponding CD4 and TLCs were recorded before diagnosis or at the time of first prescribing prophylaxis; patients without an AIDS defining opportunistic infection were defined as being at "risk" and receiver operating characteristic (ROC) curves were used to display the results of sensitivity and the false positive error rate of total lymphocyte and CD4 count groups. Results: A significant linear correlation was seen between the log₁₀ CD4 count and log₁₀ TLC (Pearson''s correlation coefficient = 0.70, p<0.001). The finer cut off value for TLC where false positive error rate is minimum and sensitivity maximum was 1500–2000 cells/mm³. Patients with TLC 1000–1500 cells/mm³ were estimated to be at 40% increased risk of developing an ADOI. The cut off value for CD4 counts measured 200 cells/mm³ above which the risk developing an ADOI decreased. Patients with a CD4 count of 150–200 cells/mm³ were at a 34% increased risk of developing an ADOI. The area under the ROC curve for TLC was 10% lower than that for CD4 count. Conclusions: The TLC is minimally less reliable than the CD4 count as a predictor of ADOIs. In the absence of expensive equipment for CD4 measurement, the TLC is a useful test.     

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

Background:

The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.

Materials and Methods:

All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant.

Results:

A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm³, 913 cells/mm³ and 629 cells/mm³ for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06).

Conclusion:

HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.     

Prevalence of Thrombocytopenia among Chinese Adult Antiretroviral-na?ve HIV-positive Patients

Background:

The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.

Methods:

We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.

Results:

A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30–39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200–349 cells/mm³ (3.3%) and >350 cells/mm³ (2.8%) compared with patients with CD4+ counts of 50–199 cells/mm³ (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥50 years, HCV-Ab positivity and having a CD4+ cell count of 50–199 cells/mm³ were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.

Conclusions:

Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.     

Increased early activation of CD56dimCD16dim/- natural killer cells in immunological non-responders correlates with CD4+ T-cell recovery

BackgroundNatural killer (NK) cells play a critical role in suppressing human immunodeficiency virus-1 (HIV-1) infection, but knowledge on whether and how NK cells affect immune reconstitution in HIV-1-infected individuals who receive antiretroviral therapy (ART) is limited.MethodsWe performed a case-control study with 35 healthy individuals and 66 HIV-1-infected patients including 32 immunological non-responders (INRs) with poor CD4⁺ T-cell recovery (<500 cells/μL after 4 years of ART) and 34 immunological responders (IRs) with improved CD4⁺ T-cell recovery (>500 cells/μL after 4 years of ART). NK cell phenotype, receptor repertoire, and early activation in INRs and IRs were investigated by flow cytometry.ResultsA significantly higher proportion of CD56^dimCD16^dim/- NK cells was observed in INRs than IRs before ART and after 4 years of ART. The number of CD56^dimCD16^dim/- NK cells was inversely correlated with CD4⁺ T-cell counts in INRs before ART (r = –0.344, P = 0.050). The more CD69-expressing NK cells there were, the lower the CD4⁺ T-cell counts and ΔCD4, and these correlations were observed in INRs after ART (r = –0.416, P = 0.019; r = –0.509, P = 0.003, respectively). Additionally, CD69-expressing CD56^dimCD16^dim/- NK cells were more abundant in INRs than those in IRs (P = 0.018) after ART, both of which had an inverse association trend towards significance with CD4⁺ T-cell counts. The expression of the activating receptors NKG2C, NKG2D, and NKp46 on CD56^dimCD16^dim/- NK cell subsets were higher in IRs than that in INRs after 4 years of ART (all P < 0.01). Strong inverse correlations were observed between CD69 expression and NKG2C, NKG2A^-NKG2C⁺, NKG2D, and NKp46 expression on CD56^dimCD16^dim/- NK cells in INRs after ART (NKG2C: r = –0.491, P = 0.004; NKG2A^-NKG2C⁺: r = –0.434, P = 0.013; NKG2D: r = –0.405, P = 0.021; NKp46: r = –0.457, P = 0.008, respectively).ConclusionsINRs had a larger number of CD56^dimCD16^dim/- NK cells characterized by higher activation levels than did IRs after ART. The increase in the CD56^dimCD16^dim/- NK cell subset may play an adverse role in immune reconstitution. Further functional studies of CD56^dimCD16^dim/- NK cells in INRs are urgently needed to inform targeted interventions to optimize immune recovery.     

Clinical outcomes and immune reconstitution in 103 advanced AIDS patients undergoing 12-month highly active antiretroviral therapy

Background Highly active antiretroviral therapy (HAART) produces profound suppression of HIV replication, substantial increase in CD4(+) T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients.Methods One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4(+) count: &lt;100 cells/&micro;l or ≥100 cells/&micro;l. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART.Results One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2±0.7) lg copies/ml, the CD4(+) count increased to (168±51) cells/&micro;l [among which the naive phenotype (CD45RA(+)CD62L(+)) increased to (49±27) cells/&micro;l and the memory phenotype (CD45RA(－)) increased to (119±55) cells/&micro;l], and the percentage of CD4(+)CD28(+) cells increased. At the same time, there was a significant reduction of CD8(+) T cell activation. In the 69 patients with the baseline CD4(+) count &lt;100 cells/&micro;l, 37 had a VL &lt;50 copies/ml; while in the 34 patients with the baseline CD4(+) count ≥100 cells/&micro;l, 25 had a VL &lt;50 copies/ml, the difference between the two groups was statistically significant. The CD4(+) T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4(+) count and plasma VL. Over 12 months of HAART, 10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects, 8 skin rashes, 10 lipodystrophy and 1 renal calculus.Conclusions Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS patients after HAART. Side effects are common during HAART and require clinical attention.     

乳腺增生症超声血流与T细胞亚群的相关性

目的 探讨乳腺增生症彩色多普勒超声血流表现与外周血T细胞亚群的相关性。方法 检测83例乳腺增生症患者的超声图像,观察病变区的彩色多普勒血流显像（color doppler flow imaging,CDFI）,测量其最高血流速度Vmax和阻力指数（RI）,应用流式细胞技术检测外周血中T细胞亚群,分别分析超声血流表现与T细胞亚群变化的相关性。结果 乳腺增生症患者有T细胞亚群失调,CD3⁺CD8⁺下降,CD4⁺/CD8⁺上升,CD3⁺CD8⁺与Vmax呈负相关（r=-0.25,P<0.05）;CD3⁺CD8⁺与RI呈负相关（r=-0.547,P<0.01）;CD4⁺/CD8⁺与Vmax呈正相关（r=0.373,P<0.01）;CD4⁺/CD8⁺与RI呈正相关（r=0.464,P<0.01）。结论 对于乳腺增生症患者,超声检测血流,同时检测外周血T细胞亚群的变化,有助于病情的判断。     

淋巴细胞计数对社区获得性肺炎患者细胞免疫功能的判断价值

目的探讨血常规中淋巴细胞计数对社区获得性肺炎患者细胞免疫功能的判断价值。方法留取我院93例社区获得性肺
炎患者（其中53例为非重症,40例为重症）与52例健康体检者的静脉血,行血常规分析及T淋巴细胞绝对计数检测,对比3组受
试者血常规中淋巴细胞计数及T淋巴细胞绝对计数的水平,分析相关性。结果社区获得性肺炎患者血常规中淋巴细胞计数及
T淋巴细胞绝对计数中CD3+、CD4+、CD8+水平均明显低于对照组（P<0.05）,并与血常规中淋巴细胞计数呈显著正相关。建立
CD3+、CD4+、CD8+与淋巴细胞计数（L）间回归方程,对照组CD3+=485.45L+313.48（F=59.68,P<0.01）,CD4+=192.57L+290.11（F=
24.62,P<0.01）,CD8+=275.14L+18.04（F=23.46,P<0.01）;非重症组CD3+=564.15L+25.04（F=96.56,P<0.01）,CD4+=381.91L-37.45（F=
68.60,P<0.01）,CD8+=165.61L+61.83（F=55.47,P<0.01）;重症组CD3+=565.44L+49.09（F=31.87,P<0.01）,CD4+=332.34L-17.37
（F=43.64,P<0.01）,CD8+=223.46L+54.39（F=13.90,P<0.01）。结论社区获得性肺炎患者细胞免疫功能下降,可通过血常规中
淋巴细胞计数粗略估计T淋巴细胞计数水平,节约检验成本。
     

eNOS/NO途径在单侧输尿管梗阻小鼠肾间质微血管病变中的作用与机制

目的 探讨内皮型一氧化氮合酶(endothelial nitric oxide synthase, eNOS)和一氧化氮(nitric oxide, NO)在单侧输尿管梗阻(unilateral ureteral obstruction, UUO)肾间质纤维化小鼠微血管病变中的作用及机制。方法 64只KM小鼠随机分为两组:假手术组n=32只;单侧输尿管梗阻UUO组n=32只。观察4周,每周检测各组小鼠血BUN、Scr及一氧化氮,流式细胞计数外周血CD133⁺/VEGFR⁺内皮祖细胞(endothelial progenitor cells,EPCs)、Masson染色观察肾组织形态学变化,免疫组化法检测肾间质CD34⁺表达计数微血管密度,实时定量PCR检测肾皮质eNOS、VEGF mRNA表达。结果 UUO组血一氧化氮、内皮祖细胞计数、肾间质微血管密度、eNOS、VEGF mRNA表达水平持续下降,在第2、3、4周与对照组差异有统计学意义。一氧化氮水平与肾间质微血管密度呈正相关(r=0.715,P<0.05);eNOS mRNA表达水平与肾间质微血管密度(r=0.624,P<0.05)、内皮祖细胞计数(r=0.375,P<0.05)、VEGF mRNA(r=0.351,P<0.05)呈正相关。结论 eNOS/NO途径参与了UUO小鼠肾间质微血管的调节,其调节涉及对血管舒张功能影响、介导促血管肾脏因子VEGF mRNA表达及动员内皮祖细胞等机制。     

免疫2号方对高效抗逆转录病毒治疗后艾滋病患者免疫重建的影响：一项随机双盲安慰剂对照临床试验

Objective: To observe the Immune No. 2 (免疫2号方) on the immune reconstitution in patients with human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS) after highly active antiretroviral therapy (HAART). Methods: A randomized, double-blind, placebo-controlled clinical trial was designed. 233 patients failing immune reconstitution after HAART were randomly divided into treatment group (116 cases) and control group (117 cases), respectively using Immune No. 2 plus HAART and placebo combined with HAART for 6 months. CD4, CD45RA, CD45RO cell numbers, as well as the symptoms, signs and integral improvement rates were observed in order to evaluate the immune reconstitution efficiency. Results: after the intervention for 1 month, the effective rate of the treatment group (18.97%, 22/116) was significantly higher than that of the control group (9.40%, 11/117) (P=0.02); 3 months after treatment, the effective rate of the treatment group (27.59%, 32/116) was no difference from that of the control group (22.22%, 26/117) (P=0.31); 6 months after treatment, the effective rate of the treatment group (34.48%, 40/116) was significantly superior to the control group (21.37%, 25/117) (P=0.02). CD4, CD45RA, CD45RO count of the treatment group was significantly higher than that of the control group (P<0.05). The total score of symptoms and signs in the treatment group was significantly lowered compared with the control group (P=0.02), and the improvement of fatigue, muscle and joint pain, pruritus and shortness of breath in the treatment group was better than the control group (P<0.05). Conclusions: Immune No. 2 can effectively improve the numbers of CD4 cells and its subgroups, as well as the main clinical symptoms and signs of patients after HAART, thereby promoting the immune reconstitution.     

<Emphasis Type="Italic">Pneumocystis carinii</Emphasis> pneumonia in a patient on etanercept for psoriatic arthritis

Background  

Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells/mm³. We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.     

BAL fluid cells in newly diagnosed pulmonary sarcoidosis with different clinical activity

Background. Sarcoidosis is associated with an increase in the number of alveolar T cells (CD3⁺ cells) and an increase of the CD3⁺CD4⁺ lymphocyte subset. However, the number of lymphocytes and the CD4/CD8 ratio in bronchoalveolar lavage (BAL) fluid are highly variable in sarcoidosis. Comparative studies have demonstrated that geographic and ethnic factors are linked to the specific characteristics of patients with sarcoidosis.

Aim of the study. To investigate peculiarities of BAL fluid (BALF) cell patterns in different clinical activity of pulmonary sarcoidosis at the time of diagnosis.

Material and methods. A total of 308 non-treated patients (138 asymptomatic and 170 with sarcoidosis-related symptoms) and 40 previously empirically steroid-treated patients with newly diagnosed sarcoidosis have been prospectively examined.

Results. Significant BAL fluid lymphocytosis and increased CD4/CD8 ratio were characteristic for all three sarcoidosis patient groups. A total of 12% of asymptomatic patients, 3% of patients with sarcoidosis-related symptoms, and 5% of previously treated symptomatic patients had normal BALF cell counts. Non-treated patients with sarcoidosis-related symptoms had significantly higher lymphocytosis (45±19% versus 39±17%, P<0.01), CD4/CD8 ratio (9.3±5.0 versus 5.7±4.5, P<0.001), and total BALF cell count (411±322 106/mL versus 334±273 106/mL, P<0.05), compared with asymptomatic patients. However, previously treated symptomatic patients had lower lymphocytosis (39±15% versus 45±19%, P=0.058), and total BALF cell count (292±166 106/mL versus 411±322 106/mL, P<0.05) compared with non-treated symptomatic patients. The same trend was noticed for CD4/CD8 ratio (8.3±4.8), although a statistically significant difference was not achieved.

Conclusions. Independently of clinical symptoms at the time of diagnosis sarcoid patients have significantly different BAL fluid cell patterns compared to healthy persons. BAL fluid cell changes are more prominent in corticosteroid non-treated patients with clinically active sarcoidosis. Treatment with systemic corticosteroids may modify typical BALF cellular patterns of sarcoidosis.     

三维双回波稳态进动序列在正常青年人腕管内正中神经的应用研究

目的 探讨正常青年人腕管内正中神经的MRI表现及解剖参数。方法 测量25名健康志愿者正中神经桡骨远端及豆状骨层面截面积（CSA1、CSA2）,计算肿胀率（MNSR）、扁平率（MNFR）、腕横韧带弓形率（FRAR）,将上述数据与年龄、腕围、体质指数（BMI）进行相关性分析,并统计以上所有数据的95%置信区间。结果 25名健康志愿者的CSA1、CSA2分别为（8.34±1.46）和（9.40±1.97）mm²,MNSR、MNFR和FRAR分别为（1.13±0.18）、（2.41±0.73）和（0.06±0.02）;MNFR与腕围、BMI存在正相关（r=0.51、0.46,P<0.05）;CSA1与腕围存在负相关（r=-0.51,P<0.05）。结论 三维回波稳态进动序列显示正中神经更清晰,测量更准确,利于腕管综合征的早期诊断。     

Efficacy of Saam acupuncture treatment on improvement of immune cell numbers in cancer patients: a pilot study

ObjectiveTo collect preliminary data on the effects of Saam acupuncture with regard to the immunity in cancer patients.MethodsTen cancer patients were analyzed for improvements in immunity. Acupuncture was applied at the 5 acupuncture points, Jingqu (LU 8), Zutonggu (BL 66), Yanggu (SI 5), Yangchi (TE 4), and Zhongwan (CV 12) for 2 weeks with 4 sessions. We assessed the effect of Korean Saam acupuncture on the immune system in cancer patients by measuring particular blood cell subsets, including CD3+, CD4+, CD8+, CD19+, and CD56+ cells, as well as total white blood cell count, absolute neutrophil count, and fatigue score. The measurement was performed before and after acupuncture and at a 2-week follow-up.ResultsThere was a statistically significant increase in the number of CD3+ (P=0.023) and CD8+ cells (P<0.001) and T-cell subsets, as well as a decrease in the fatigue severity scale (FSS) score (P= 0.001) after Saam acupuncture using the 5 acupoints.ConclusionAcupuncture may improve the immune system by increasing the counts of a few immune cells and relieve fatigue in cancer patients by decreasing FSS scores. Although this was a non-controlled study, it constitutes preliminary research investigating the potential effects of Saam acupuncture in increasing the counts of several immune cells in cancer patients.