CD4~+T淋巴细胞、血清转氨酶及血小板水平对马尔尼菲蓝状菌病患者预后的预测价值

目的运用受试者工作曲线(ROC)评价CD4~+ T淋巴细胞、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及血小板(PLT)对获得性免疫缺陷综合征(AIDS)合并马尔尼菲蓝状菌病(TSM)患者预后的预测价值。方法采用回顾性研究方法,对柳州市人民医院2013年1月—2015年6月收治的AIDS合并TSM患者,依据其预后分为好转组和恶化组,采用ROC评估CD4~+ T淋巴细胞、ALT、AST以及PLT对其预后的预测价值。结果共收治96例AIDS合并TSM初始治疗患者,其中好转组54例,恶化组42例。血清ALT水平好转组患者低于恶化组26. 5 (7. 0,148. 0) U/L VS 47. 5 (11. 0,116. 0) U/L]。血清AST水平好转组患者低于恶化组49. 0(10. 0,198. 0) U/L VS 188. 0(33. 0,435. 0) U/L]。血浆PLT水平好转组患者高于恶化组133. 0(13. 0,303. 0)×10~9/L VS 33. 5 (7. 0,113. 0)×10~9/L],CD4~+ T淋巴细胞水平好转组患者高于恶化组为24. 0 (5. 0,112. 0)个/μL VS 14. 5(2. 0,78. 0)个/μL],差异均具有统计学意义(均P 0. 05)。ROC曲线分析显示:当AST≥2×ULN联合PLT≤62×10~9/L时,用于预测TSM患者预后的曲线下面积(AUC)为0. 917(95%CI:0. 835～0. 998),P 0. 05,敏感度、特异度、阳性预测值、阴性预测值分别为90. 0%、93. 3%、93. 1%和90. 3%。结论 AST以及PLT可作为预测AIDS合并TSM患者预后的重要指标,当AST≥2×ULN且PLT≤62×10~9/L时,需警惕TSM患者近期预后不良。

Predictive value of CD4+ T lymphocyte, serum aminotransferase, and platelet in the prognosis of patients with Talaromycosis marneffeii

ObjectiveTo apply the receiver operating characteristic(ROC) curve to evaluate the predictive value of CD4+ T lymphocyte, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet (PLT) in the prognosis of patients with acquired immunodeficiency syndrome(AIDS) and Talaromycosis marneffei (TSM）.MethodsA retrospective study was conducted on patients with AIDS associated TSM in Liuzhou General Hospital from January 2013 to June 2015, patients were divided into improved group and deteriorated group according to prognosis, value of CD4+ T lymphocyte, ALT, AST and PLT in predicting the prognosis of patients were evaluated by ROC curve.ResultsA total of 96 cases of AIDS combined with TSM were initially treated, including 54 cases in improved group and 42 in deteriorated group. Serum ALT level in improved group was lower than that in deteriorated group (26.5［7.0, 148.0］ U/L VS 47.5［11.0, 116.0］ U/L). Serum AST level in improved group was lower than that in deteriorated group (49.0［10.0, 198.0］U/L VS 188.0［33.0, 435.0］ U/L). Plasma PLT level in improved group was higher than that in deteriorated group (133.0［13.0, 303.0］ ×109/L VS 33.5［7.0, 113.0］ ×109/L), CD4+ T lymphocyte level in improved group was higher than that in deteriorated group (24.0［5.0, 112.0］/μL VS 14.5［2.0,78.0］/μL), difference were all significant ( all P<0.05). ROC curve analysis showed that when AST≥2×ULN combined with PLT≤62×109/L, the area under curve (AUC) to predict the prognosis of TSM patients was 0.917 (95% CI: 0.835-0.998, P<0.05), sensitivity, specificity, positive predictive value, and negative predictive value were 90.0%, 93.3%, 93.1%, and 90.3%, respectively.ConclusionAST and PLT can be used as important prognostic indicators for prognosis of patients with AIDS and TSM, when AST≥2×ULN and PLT≤62×109/L, possibility of poor prognosis in TSM patients needs to be paid attention.