Roles of IP-10，SAA，hs-CRP，PCT and CD4+ T cell count determinations in HIV/AIDS patients with opportunistic infection

doi:10.3969/j.issn.1673-8640.2023.08.004

Abstract

Abstract:

Objective To investigate the changes and clinical roles of plasma interferon-gamma induced protein 10（IP-10），serum amyloid A（SAA），procalcitonin（PCT） and high-sensitivity C-reactive protein（hs-CRP）in patients with human immunodeficiency virus（HIV） infection and acquired immunodeficiency syndrome（AIDS）（referred to as HIV/AIDS） complicated with opportunistic infection（OI）. Methods A total of 187 HIV/AIDS patients were enrolled and classified into OI group（63 cases） and non-OI group（124 cases） according to whether they were combined with OI. According to prognosis，the patients with OI were classified into good prognosis group（45 cases） and poor prognosis group（18 cases）. The levels of IP-10，SAA，hs-CRP and PCT and CD4⁺ T cell count were determined in all the patients before and after 4 weeks of treatment. Logistic regression analysis was used to analyze the risk factors of HIV/AIDS patients with OI. Spearman rank correlation was used to analyze the correlation between the indicators. Results Before treatment，the levels of SAA，PCT，hs-CRP and IP-10 in good prognosis group and poor prognosis group were higher than those in non-OI group（P<0.05），and the level of IP-10 in poor prognosis group was higher than that in good prognosis group（P<0.05）. After 4 weeks of treatment，the levels of SAA，PCT，hs-CRP and IP-10 in good prognosis group and non-OI group were lower than those before treatment（P<0.05），while there was no statistical significance before and after treatment in poor prognosis group（P>0.05）. Multivariate Logistic regression analysis showed that the decrease of CD4⁺ T cell count and the increase of SAA，PCT，hs-CRP and IP-10 were risk factors for OI in HIV/AIDS patients [odds ratios（OR） were 0.028，15.606，25.499，9.147 and 10.303，95% confidence intervals（CI） were 0.006-0.128，3.224-75.532，1.544-421.002，1.705-49.071 and 2.582-41.118，P<0.05 ]. Spearman rank correlation analysis showed that IP-10，SAA，hs-CRP and PCT were negatively correlated with CD4⁺ T cell count（r=-0.297，-0.390，-0.348 and -0.264，P<0.05）. Conclusions CD4⁺ T cell count，SAA，PCT，hs-CRP and IP-10 are related to HIV/AIDS combined with OI，and they may be used as the indicators for prognosis.

Key words: Interferon-gamma induced protein 10, Acute phase reaction protein, Human immunodeficiency virus, Acquired immunodeficiency syndrome, Opportunistic infection

CLC Number:

R446.1

ZHAO Jing, LI Yongqin, LI Yan, FAN Weiguang, YANG Xuegang. Roles of IP-10，SAA，hs-CRP，PCT and CD4⁺ T cell count determinations in HIV/AIDS patients with opportunistic infection[J]. Laboratory Medicine, 2023, 38(8): 725-729.

Figures/Tables 5

References 19

[1]	杨萱. 2009—2013年河南省艾滋病机会性感染回顾性研究[D]. 郑州: 郑州大学, 2014.
[2]	Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy,1996-2006:collaborative analysis of 13 HIV cohort studies[J]. Clin Infect Dis, 2010, 50(10):1387-1396. DOI URL
[3]	中华医学会感染病学分会艾滋病丙肝学组, 中国疾病预防与控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中华临床感染病杂志, 2021, 14(5):321-343.
[4]	LUO B, SUN J, CAI R, et al. Spectrum of opportunistic infections and risk factors for in-hospital mortality of admitted AIDS patients in Shanghai[J]. Medicine(Baltimore), 2016, 95(21):e3802.
[5]	MOORE R D, CHAISSON R E. Natural history of opportunistic disease in an HIV-infected urban clinical cohort[J]. Ann Intern Med, 1996, 124(7):633-642. DOI PMID
[6]	曹汴川, 黄喆, 肖科, 等. 获得性免疫缺陷综合征患者合并机会性感染的淋巴细胞亚群和HIV-1病毒载量的特点分析[J]. 中国感染与化疗杂志, 2020, 20(5):481-486. DOI
[7]	BOULWARE D R, HULLSIEK K H, PURONEN C E, et al. Higher levels of CRP,D-dimer,IL-6,and hyaluronic acid before initiation of antiretroviral therapy(ART) are associated with increased risk of AIDS or death[J]. J Infect Dis, 2011, 203(11):1637-1646. DOI URL
[8]	王政, 杨海峰, 刘菲, 等. 艾滋病病毒-1型感染艾滋病患者载毒数量的作用及与常见机会感染发生的关系[J]. 中国临床医生杂志, 2017, 45(10):60-62.
[9]	LIOVAT A S, REY-CUILLÉ M A, LÉCUROUX C, et al. Acute plasma biomarkers of T cell activation set-point levels and of disease progression in HIV-1 infection[J]. PLoS One, 2012, 7(10):e46143. DOI URL
[10]	SLAATS J, TEN OEVER J, VAN DE VEERDONK F L, et al. IL-1β/IL-6/CRP and IL-18/ferritin:distinct inflammatory programs in infections[J]. PLoS Pathog, 2016, 12(12):e1005973. DOI URL
[11]	SACK G H Jr. Serum amyloid A-a review[J]. Mol Med, 2018, 24(1):46. DOI
[12]	朱星成, 段勇, 黄革联, 等. PCT、hs-CRP、SAA对细菌与病毒感染的鉴别作用[J]. 国际检验医学杂志, 2014,(22):3048-3050.
[13]	吴勇, 许文芳, 赵姣萍, 等. 血清淀粉样蛋白在艾滋病患者机会性感染中的诊断价值[J]. 中国卫生检验杂志, 2018, 28(5):542-544.
[14]	梁飞立, 何艳英, 余丰, 等. C-反应蛋白在HIV/AIDS的表达及其相关性研究[J]. 中华医院感染学杂志, 2014, 24(2):271-273.
[15]	ANTONELLI A, FERRARI S M, GIUGGIOLI D, et al. Chemokine(C-X-C motif) ligand(CXCL)10 in autoimmune diseases[J]. Autoimmun Rev, 2014, 13(3):272-280. DOI URL
[16]	MEDOFF B D, SAUTY A, TAGER A M, et al. IFN-gamma-inducible protein 10(CXCL10) contributes to airway hyperreactivity and airway inflammation in a mouse model of asthma[J]. J Immunol, 2002, 168(10):5278-5286. DOI URL
[17]	QIU X, XIONG T, SU X, et al. Accumulate evidence for IP-10 in diagnosing pulmonary tuberculosis[J]. BMC Infect Dis, 2019, 19(1):924. DOI PMID
[18]	PASTOR L, CASELLAS A, CARRILLO J, et al. IP-10 levels as an accurate screening tool to detect acute HIV infection in resource-limited settings[J]. Sci Rep, 2017, 7(1):8104. DOI PMID
[19]	WANG Z, WU T, MA M, et al. Elevated interferon-γ-induced protein 10 and its receptor CXCR3 impair NK cell function during HIV infection[J]. J Leukoc Biol, 2017, 102(1):163-170.

组别	例数	SAA/（mg/L）	hs-CRP/（mg/L）	PCT/（μg/L）	IP-10/（pg/mL）
预后不良组	18
治疗前		62.48（12.65~169.44）^#	30.26（5.65~92.40）^#	0.45（0.17~0.84）^#	888.45（594.73~1 162.89）^#△
治疗4周后		221.52（125.68~300.00）	90.20（16.83~135.03）	0.36（0.10~2.46）	1 025.62（786.54~1 407.88）
预后良好组	45
治疗前		34.50（3.00~127.34）^*#	15.69（1.90~63.36）^*#	0.32（0.17~0.70）^*#	518.34（400.09~761.27）^*#
治疗4周后		20.60（6.75~65.57）	1.30（0.50~5.00）	<0.10	259.69（192.04~390.97）
无OI组	122
治疗前		<3.00^*	1.80（1.33~3.63）^*	0.21（0.10~0.28）^*	161.06（103.71~315.60）^*
治疗4周后		<3.00	0.85（0.60~2.90）	0.10（0.10~0.12）	165.17（83.03~244.75）

组别	例数	SAA/（mg/L）	hs-CRP/（mg/L）	PCT/（μg/L）	IP-10/（pg/mL）
预后不良组	18
治疗前		62.48（12.65~169.44）^#	30.26（5.65~92.40）^#	0.45（0.17~0.84）^#	888.45（594.73~1 162.89）^#△
治疗4周后		221.52（125.68~300.00）	90.20（16.83~135.03）	0.36（0.10~2.46）	1 025.62（786.54~1 407.88）
预后良好组	45
治疗前		34.50（3.00~127.34）^*#	15.69（1.90~63.36）^*#	0.32（0.17~0.70）^*#	518.34（400.09~761.27）^*#
治疗4周后		20.60（6.75~65.57）	1.30（0.50~5.00）	<0.10	259.69（192.04~390.97）
无OI组	122
治疗前		<3.00^*	1.80（1.33~3.63）^*	0.21（0.10~0.28）^*	161.06（103.71~315.60）^*
治疗4周后		<3.00	0.85（0.60~2.90）	0.10（0.10~0.12）	165.17（83.03~244.75）

项目	AUC（95%CI^①）	最佳临界值	敏感性/%	特异性/%	Youden指数
SAA	0.849（0.780~0.918）	6.7 mg/L	76.20	91.90	0.681
hs-CRP	0.793（0.713~0.872）	9.3 mg/L	61.90	93.50	0.554
PCT	0.707（0.619~0.795）	0.41 μg/L	44.40	99.20	0.436
IP-10	0.760（0.685~0.836）	328.61 pg/mL	71.30	81.60	0.529

项目	AUC（95%CI^①）	最佳临界值	敏感性/%	特异性/%	Youden指数
SAA	0.849（0.780~0.918）	6.7 mg/L	76.20	91.90	0.681
hs-CRP	0.793（0.713~0.872）	9.3 mg/L	61.90	93.50	0.554
PCT	0.707（0.619~0.795）	0.41 μg/L	44.40	99.20	0.436
IP-10	0.760（0.685~0.836）	328.61 pg/mL	71.30	81.60	0.529

项目	β值	标准误	Wald值	OR值（95%CI）	P值
CD4⁺ T细胞	-3.589	0.783	20.989	0.028（0.006~0.128）	<0.001
SAA	2.748	0.805	11.663	15.606（3.224~75.532）	0.001
hs-CRP	2.213	0.857	6.670	9.147（1.705~49.071）	0.010
PCT	3.239	1.431	5.125	25.499（1.544~421.002）	0.024
IP-10	2.332	0.706	10.910	10.303（2.582~41.118）	0.001