HIV感染/AIDS患者认知障碍影响因素及CD4+T淋巴细胞计数水平的预测价值分析

doi:10.19871/j.cnki.xfcrbzz.2026.04.006

新发传染病电子杂志 ›› 2026, Vol. 11 ›› Issue (4): 36-43.doi: 10.19871/j.cnki.xfcrbzz.2026.04.006

HIV感染/AIDS患者认知障碍影响因素及CD4⁺T淋巴细胞计数水平的预测价值分析

熊磊¹, 张淑颖¹, 李桃¹, 何江林¹, 卢晓希², 万婷¹, 谢利秋¹, 杨佳³, 高月琴¹, 熊维¹, 戈杨⁴, 王印⁵, 傅思琪¹, 张娜¹, 侯可可¹

1.成都市公共卫生临床医疗中心放射科,四川成都 610061;
2.成都市公共卫生临床医疗中心手术室,四川成都 610061;
3.成都市公共卫生临床医疗中心重大传染病管理部,四川成都 610061;
4.成都市公共卫生临床医疗中心功能检查室,四川成都 610061;
5.成都市公共卫生临床医疗中心感染科,四川成都 610061

收稿日期:2026-01-16 出版日期:2026-08-31 发布日期:2026-09-14
通讯作者: 侯可可,Email：15980980@qq.com
基金资助:
1.四川省医学会青年创新项目（Q2024056）; 2.成都市科技局技术创新研发项目（2024-YF05-01215-SN）; 3.成都市医学科研课题项目（2025122、2025561）

Analysis of factors influencing cognitive impairment and the predictive value of CD4⁺ T lymphocyte count in patients with HIV/AIDS

Xiong Lei¹, Zhang Shuying¹, Li Tao¹, He Jianglin¹, Lu Xiaoxi², Wan Ting¹, Xie Liqiu¹, Yang Jia³, Gao Yueqin¹, Xiong Wei¹, Ge Yang⁴, Wang Yin⁵, Fu Siqi¹, Zhang Na¹, Hou Keke¹

1. Department of Radiology, Public Health Clinical Center of Chengdu, Sichuan Chengdu 610061, China;
2. Operating Room, Public Health Clinical Center of Chengdu, Sichuan Chengdu 610061, China;
3. Department of Major Infectious Disease Management, Public Health Clinical Center of Chengdu, Sichuan Chengdu 610061, China;
4. Department of Functional Examination, Public Health Clinical Center of Chengdu, Sichuan Chengdu 610061, China;
5. Department of Infectious Diseases, Public Health Clinical Center of Chengdu, Sichuan Chengdu 610061, China

Received:2026-01-16 Online:2026-08-31 Published:2026-09-14

摘要/Abstract

摘要： 目的探讨HIV感染/AIDS患者中认知障碍的相关影响因素,并评估CD4⁺T淋巴细胞计数对认知障碍的判别效能,为临床早期识别认知障碍高风险人群提供参考。方法采用横断面研究设计,纳入2024年1月1日至2025年11月30日于成都市公共卫生临床医疗中心就诊的HIV感染/AIDS患者共71例,根据认知功能评估结果分为认知正常组（n=43）和认知障碍组（n=28）。通过医院电子病历系统收集患者一般临床资料、社会人口学特征及实验室指标,同时获取脑结构影像学定量参数。采用单因素分析比较两组间差异,并在此基础上结合变量的统计独立性及临床可及性,构建二元Logistic回归模型筛选与认知障碍相关的独立因素。进一步对差异有统计学意义的变量进行受试者工作特征曲线分析（receiver operating characteristic,ROC）,评估其预测效能。结果单因素分析结果显示,认知障碍组患者CD3⁺T淋巴细胞计数、CD4⁺T淋巴细胞计数显著低于认知正常组（t=2.128,P=0.037;t=6.044,P< 0.01）,婚姻/伴侣状态在两组间差异具有统计学意义（χ²=6.303,P=0.012）;颞叶灰质体积在认知障碍组呈降低趋势,未校正的组间比较差异有统计学意义（t=2.114,P=0.038）,但经FDR校正后差异不再显著。二元Logistic回归分析结果显示,CD4⁺T淋巴细胞计数（OR=0.270,95%CI：0.133~0.547,P<0.001）及婚姻/伴侣状态（单身对非单身,OR=5.702,95%CI：1.193~27.251,P=0.029）均与认知障碍显著相关。ROC曲线分析表明,CD4⁺T淋巴细胞计数对认知障碍具有良好的判别效能,曲线下面积为0.886（95%CI：0.812~0.961,P<0.001）,当截断值约为260 cells/μl时,敏感度为93.0%,特异度为67.9%。结论 CD4⁺T淋巴细胞计数水平降低及单身状态是HIV感染/AIDS患者认知障碍的主要影响因素。CD4⁺T淋巴细胞计数对认知障碍具有较好的预测价值,可作为临床早期识别认知障碍高风险患者及开展随访管理的参考指标。

关键词: 人类免疫缺陷病毒, 获得性免疫缺陷综合征, 认知障碍, CD4⁺T淋巴细胞计数, 脑结构磁共振成像, 预测价值

Abstract: Objective To investigate factors associated with cognitive impairment in patients with HIV/AIDS and to evaluate the discriminative performance of CD4⁺ T lymphocyte count for cognitive impairment, thereby providing evidence for the early clinical identification of individuals at high risk of cognitive impairment. Method A cross-sectional study was conducted. A total of 71 patients with HIV/AIDS who attended Chengdu Public Health Clinical Medical Center between January 1, 2024 and November 30, 2025 were enrolled. According to cognitive function assessment results, the patients were divided into a cognitively normal group (n=43) and a cognitive impairment group (n=28). General clinical data, sociodemographic characteristics, and laboratory indicators were collected from the hospital electronic medical record system, and quantitative brain structural imaging parameters were also obtained. Univariate analysis was performed to compare differences between the two groups. Based on the results of univariate analysis, statistical independence of variables, and clinical accessibility, a binary logistic regression model was constructed to identify independent factors associated with cognitive impairment. Receiver operating characteristic (ROC) curve analysis was further performed for significant variables to evaluate their discriminative performance. Result Univariate analysis showed that CD3⁺ T lymphocyte count and CD4⁺ T lymphocyte count were significantly lower in the cognitive impairment group than in the cognitively normal group (t=2.128,P=0.037; t= 6.044, P<0.01, respectively). Marital/partner status differed significantly between the two groups (χ²=6.303,P=0.012). Temporal lobe gray matter volume tended to be lower in the cognitive impairment group, and the difference was statistically significant in the uncorrected between-group comparison (t=2.114, P=0.038); however, the difference was no longer significant after false discovery rate correction. Binary logistic regression analysis showed that CD4⁺ T lymphocyte count (OR=0.987, 95%CI: 0.980-0.994, P<0.001) and marital/partner status (single vs. non-single: OR=5.702, 95%CI: 1.193-27.251, P=0.029) were significantly associated with cognitive impairment. ROC curve analysis indicated that CD4⁺ T lymphocyte count had good discriminative performance for cognitive impairment, with an area under the curve of 0.886 (95%CI: 0.812-0.961, P<0.001). At a cutoff value of approximately 260 cells/μl, the sensitivity was 93.0% and the specificity was 67.9%. Conclusion Decreased CD4⁺ T lymphocyte count and being single were the main factors associated with cognitive impairment in patients with HIV/AIDS. CD4⁺ T lymphocyte count demonstrated good screening value for cognitive impairment and may serve as a reference indicator for early identification of high-risk patients and follow-up management.

Key words: Human immunodeficiency virus, Acquired immunodeficiency syndrome, Cognitive impairment, CD4⁺T lymphocyte count, Structural magnetic resonance imaging of the brain, Predictive value

中图分类号:

R446

熊磊, 张淑颖, 李桃, 何江林, 卢晓希, 万婷, 谢利秋, 杨佳, 高月琴, 熊维, 戈杨, 王印, 傅思琪, 张娜, 侯可可. HIV感染/AIDS患者认知障碍影响因素及CD4⁺T淋巴细胞计数水平的预测价值分析[J]. 新发传染病电子杂志, 2026, 11(4): 36-43.

Xiong Lei, Zhang Shuying, Li Tao, He Jianglin, Lu Xiaoxi, Wan Ting, Xie Liqiu, Yang Jia, Gao Yueqin, Xiong Wei, Ge Yang, Wang Yin, Fu Siqi, Zhang Na, Hou Keke. Analysis of factors influencing cognitive impairment and the predictive value of CD4⁺ T lymphocyte count in patients with HIV/AIDS[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(4): 36-43.

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HIV感染/AIDS患者认知障碍影响因素及CD4⁺T淋巴细胞计数水平的预测价值分析

Analysis of factors influencing cognitive impairment and the predictive value of CD4⁺ T lymphocyte count in patients with HIV/AIDS

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HIV感染/AIDS患者认知障碍影响因素及CD4+T淋巴细胞计数水平的预测价值分析

Analysis of factors influencing cognitive impairment and the predictive value of CD4+ T lymphocyte count in patients with HIV/AIDS

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HIV感染/AIDS患者认知障碍影响因素及CD4⁺T淋巴细胞计数水平的预测价值分析

Analysis of factors influencing cognitive impairment and the predictive value of CD4⁺ T lymphocyte count in patients with HIV/AIDS