HIV 감염 환자에서 질병 경과 평가를 위한 혈액학적 지표들의 유용성
The Usefulness of Hematological Parameters for Assessing Disease Progression in Patients with HIV Infection
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배경: 인간면역결핍바이러스(HIV) 감염 환자들에서 CD4+ T 세포수와 바이러스 핵산량은 임상 경과를 반영하는 주요 검사이지만 검사 수행 자원을 필요로 한다. 본 저자들은 자동혈구분석기로 측정되는 혈액학적 지표가 HIV 감염 환자에서 CD4+ T 세포수와 바이러스 핵산량을 반영하는 인자로서 유용한지 평가하고자 하였다. 방법: 말초 혈액 검체를 치료를 받지 않은 HIV 신환 감염자 14명, ART 치료중인 HIV 감염환자 105명, 비감염대조자 103명으로부터 수집하였다. 혈액학적 지표는 자동혈구분석기인 ADVIA 2120i (Sie-mens Healthcare Diagnostics, USA)로 측정하였다. HIV 감염 환자에서는 CD4+ T 세포수와 바이러스 핵산량을 검사하였다. 결과: HIV 신환 감염군과 치료 중인 감염군에서 large unstained cells의 백분율(%LUCs)은 각각 2.5±1.6%, 1.9±0.7%로 비감염대조군의 1.6±0.5%에 비해 높았으며 낮은 CD4+ T 세포수(<200/ L) 혹은 높은 바이러스 핵산량(≥200 copies/mL)을 나타내는 HIV 감염군에서 %LUCs는 2.4±1.0, 2.4±0.8로 다른 감염군에 비해 높았다. 림프구수는 비감염 대조군(2.0±0.6×109/L)과 신환 감염군(1.5±0.6×109/L)간에 유의한 차이를 보였으며 500/ L 이상의 CD4+ T 세포수를 가진 HIV 감염군(2.5±0.6×109/L)과 다른 감염군 간에도 차이를 나타냈다. 호중구수는 높은 바이러스 핵산량의 감염군(3.0±1.4×109/L)과 낮은 바이러스 핵산량의 감염군(3.7±1.3×109/L) 간에 차이를 나타냈다. CD4+ T 세포수는 림프구수(r=0.642, P< 0.0001) 및 %LUCs (r=-0.287, P=0.002)와 상관성을 보였다. 결론: %LUCs, 림프구수 및 호중구수는 HIV 감염 환자에서 면역결핍과 질병 경과를 추적 관찰하는 데 이용되는 CD4+ T 세포수와 바이러스 핵산량을 반영하는 인자로서의 가능성을 가진다.
Abstract
Background: In patients with HIV, CD4+ T cell count and viral load are the main laboratory tests performed to assess clinical management. However, they require extensive resources. In this study, we aimed to determine whether hematological parameters measured using a hematology analyzer are useful as surrogate markers of CD4+ T cell count and viral load in HIV-infected patients. Methods: Peripheral blood samples were obtained from 14 HIV-naïve, 105 HIV-treated, and 103 uninfected individuals. Hematological parameters were measured using the ADVIA 2120i hematology analyzer (Siemens Healthcare Diagnostics, USA). Results: In HIV-naïve and -treated patients, the percentage of large unstained cells (%LUCs) was 2.5±1.6% and 1.9±0.7%, respectively, compared to 1.6±0.5% in HIV-uninfected controls. The %LUCs was higher in HIV patients with low CD4+ T cell count below 200/μL (2.4±1.0%) or high viral load ≥200 copies/mL (2.4±0.8%) than in other infected groups. Significant differences in lymphocyte count were observed between the HIV-naïve (1.5±0.6×109/L) and uninfected (2.0±0.6×109/L) groups as well as between HIV patients with CD4+ T cells ≥500/μL (2.5±0.6×109/L) and other infected groups. Neutrophil count varied between high viral load (3.0±1.4×109/L) and low viral load (3.7±1.3×109/L) groups. The CD4+ T cell count correlated with lymphocyte count (r=0.642, P<0.0001) and %LUCs (r=-0.287, P=0.002). Conclusions: %LUCs, lymphocyte count, and neutrophil count are probable surrogate markers of CD4+ T cells and viral load.
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