T淋巴细胞斑点试验在诊断艾滋病合并结核病的临床价值探讨

Clinical application of T-lymphocyte spot test in the diagnosis of acquired immune deficiency syndrome with tuberculosis co-infection

目的探讨T淋巴细胞斑点试验(T-lymphocyte spot test, T-SPOT)诊断艾滋病(acquired immune deficiency syndrome,AIDS)合并结核病的临床价值,以指导T-SPOT在诊断AIDS合并结核病中的应用。方法回顾性分析2015年1月-2017年1月广州市第八人民医院收治的548例AIDS合并结核病患者临床资料,患者均经人类免疫缺陷病毒(HIV)初筛及免疫印迹法/HIV核酸检测确证HIV感染,且确诊或临床诊断为结核病。分析患者不同CD4^+T淋巴细胞计数水平时T-SPOT检测的灵敏度,探讨影响T-SPOT灵敏度的因素。结果 548例患者中,确诊结核病者166例(30.3%, 166/548),临床诊断结核病382例(69.7%, 382/548)。男性多于女性(4.9∶1),平均年龄为(39.8±12.4)岁,CD4^+T淋巴细胞计数中位数为84个/μl[IQR:(29.3~187.8)个/μl]。根据CD4^+T淋巴细胞计数水平分组(0~50、>50~100、>100~200、>200个/μl),其T-SPOT阳性率分别为48.0%(96/200)、55.6%(60/108)、54.5%(60/110)及56.2%(73/130),差异无统计学意义,且不受确诊或临床诊断影响。单因素和多因素logistic回归分析结果显示,AIDS合并肺外结核病可提高T-SPOT阳性率[OR(95%CI)为2.445(1.119~4.778),χ^2=5.125,P=0.024],但接受抗结核病治疗会降低T-SPOT阳性率[OR(95%CI)为2.206(1.099~5.897),χ^2=4.752,P=0.029]。结论 T-SPOT能够在一定程度上提高AIDS合并结核病的诊断率,患者CD4^+T淋巴细胞计数水平对其灵敏度影响不大,但合并肺外结核病和抗结核病治疗可能影响其灵敏度。

Objective To study the clinical value of T-lymphocyte spot test(T-SPOT) in the diagnosis of acquired immune deficiency syndrome(AIDS) complicated with tuberculosis(TB) infection. Methods Data of 548 AIDS patients with TB admitted to the Eighth People′s Hospital of Guangzhou City from January 2015 to January 2017 were analyzed retrospectively.All patients were confirmed HIV infection by HIV screening and Western blot/HIV nucleic acid test,meanwhile,were diagnosed or clinically diagnosed with TB.Sensitivity of T-SPOT at different CD4^+T levels and related impact factors were analyzed. Results Among the 548 AIDS patients, 382 cases(69.7%) were clinically diagnosed as TB, and 166 cases(30.3%) were confirmed as TB.There were 455 males and 93 females(4.9∶1), with an average age of 39.8±12.4 years and an average CD4^+T count of 84 cells/μl(IQR: 29.3-187.8).Patients were divided into 4 groups based on the CD4^+T lymphocyte levels,0-50,>50-100,>100-200 and >200 cells/μl,with the T-SPOT positive rate of 48.0%(96/200),55.6%(60/108),54.5%(60/110)and 56.2%(73/130),respectively.There was no significant difference in T-SPOT positive rates among different CD4^+T lymphocyte groups,whether in the confirmed tuberculosis group or in the clinically diagnosed tuberculosis group.Univariate and multivariate logistic regression analysis showed that combined extrapulmonary tuberculosis increased the positive rate of T-SPOT,but anti-tuberculosis treatment decreased the positive rate of T-SPOT. Conclusions TSPOT test can improve the diagnostic rate of AIDS complicated with tuberculosis.And CD4^+T count shows little effect on the sensitivity of T-SPOT in AIDS patients combined with tuberculosis while combined with extrapulmonary tuberculosis and anti-tuberculosis treatment may affect the sensitivity.