MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

CD4-8

Double CD4+CD8+ cells - DP phenotype

  • Can be a hallmark of lymphoma
  • Can also be seen in the normal T-cell repertoire
    • Very small fraction of T cells, but it can be expanded in certain reactive conditions
      • Autoimmune diseases, such as
        • Myasthenia gravis
        • Rheumatoid arthritis
        • Multiple sclerosis [7]
      • Other chronic inflammatory conditions
      • Inflammatory infiltrate of tumors, such as
        • Nodular lymphocyte-predominant Hodgkin lymphoma [7]
  • Artifact
    • Doublets (two lymphocytes sticking to each other) can appear to be DP T cells, when in fact they are just two cells [7]
  • Discovery of a DP T-cell population in flow cytometry analysis
    • Should appropriately raise concern for T-cell neoplasms, including [7]
      • T-ALL
      • T-PLL [7]

Absolutní počet CD4

  • At reduction of CD4 less than 200 mcl-1
    • Necessary to search the reason of serious immunodeficiency
    • Joining of secondary, atypical flora and to prescribe adequate therapy [1]
  • CD4 counts alone do not predict the risk of NAEs u HIV+ [2]
  • CD4 is expressed in a T-cell subset (helper/inducer) found in approximately 80% of thymocytes and in 45% of peripheral blood lymphocytes
  • CD4 is expressed in the majority of T-cell lymphomas including
    • Mycosis fungoides,
    • Common form of cutaneous T-cell lymphoma [4]

CD8

  • CD8 has been shown to be an important
    • T-cell mediated inflammatory dermatoses marker in the analysis
    • Mycosis fungoides useful marker [4]

CD4/CD8 = helper:suppressor/killer ratio (CD4:CD8)

  • Used as a surrogate marker of immunosenescence in both the general population [2] and HIV
  • CD4/CD8 ratio is considered normal when the value is between 1.0 and 4.0 [6]
    • Cca 30 - 60 % CD4 T-cells : 10 - 30 % CD8 T-cells [6]

HIV+ jedinci

  • Normalization was defined as CD4/CD8 ratio nad?1 on two consecutive visits
  • Complete immune recovery is uncommon in an Asian setting
    • Earlier ART initiation at higher CD4 counts may have increased the ratio sooner
  • CD4/CD8 ratio as a prognostic marker for clinical progression of non-AIDS defining events (NAEs) [2]
    • (NAEs) include: cardiovascular disease, cerebrovascular disease, renal disease and non-ADIS-related cancers [2]
  • Studies have reported the ratio remains low, with a slow rate of recovery in a substantial proportion of patients
    • Including those with adequate CD4+ T cell count recovery, over years of cART [2]
    • Clinical significance of this ongoing immune dysfunction needs further exploration [2]
  • Improvement of CD4/CD8 ratio was seen in both normalization and non-normalization groups after having suppressed viremia [2]
  • In a large collaborative study of European and North American cohorts failed to show a link between low CD4/CD8 ratio and non-AIDS related mortality among virologically suppressed patients on cART [2]
    • Study showed low ratio and high CD8 counts were associated with AIDS-related mortalities [2]
  • Very low CD4/CD8 ratio (<0.4) despite antiretroviral therapy (ART) also correlates with higher measures of immunosenescence. [3]
  • Combination of CD4(+) and CD8(-) is helpful in distinguishing mycosis fungoides [4]
  • It can also be used to predict the likelihood of immune reconstitution inflammatory syndrome (IRIS)
    • A serious reaction that can sometimes occur when a person starts HIV therapy
    • If the baseline CD4 count is low and is accompanied by a CD4/CD8 ratio below 0.20, the risk of IRIS increases significantly. [6]

Sarkoidoza

BAL - broncho-alveolárné laváž

  • CD4+/CD8+ ratio can be helpful in the diagnosis of sarcoidosis
  • Sarcoidosis is characterized by an increased CD4/CD8 ratio nad 3.5
    • Compared with other interstitial lung diseases [5]
  • Sensitivity of the CD4+/CD8+ ratio lies between 54% and 80% [5]
  • Specificity varies from 59% to 80% [5]
  • Ratio appears to have value as an indicator for the severity of the disease/extend of organ involvement.
  • Some studies found higher CD4+/CD8+ ratio and higher sensitivity of CD4+/CD8+ ratio in less advanced Scadding stages
  • Higher CD4+/CD8+ ratio is found in patients who carry HLA-DRB1 03, a genotype
    • Correlated with favorable outcome in sarcoidosis [5]
  • Many studies have reported relatively high CD4+/CD8+ ratio in patients with acute onset sarcoidosis
    • Usually has a favorable prognosis
    • Measurement of CD4+/CD8+ ratio in BAL fluid also appears to have some prognostic value
    • Although this has limited clinical value [5]

Mycosis fungoides

O úroveň výše

Poslední aktualizace: 5. 10. 2020 18:37:59