γ干扰素释放试验在艾滋病合并结核感染人群中的诊断价值研究

Study on the Diagnostic Value of Interferon-gamma Release Test in AIDS Patients with Tuberculosis Infection

目的探讨针对艾滋病合并结核病患者应用γ干扰素释放试验的诊断价值。方法方便选取2019年1月—2020年2月该院收治的60例艾滋病合并结核感染患者纳入研究,所有患者均接受γ干扰素释放试验(IGRA)、结核菌素试验(PPD)、结核抗体(T-SPOT TB)等一系列检查方式进行诊断,将T-SPOT TB检查结果作为金标准,观察患者应用不同试验检测的诊断结果,并加以分析比较。结果对比不同诊断方式检测结果,IGRA检测方式敏感度、特异性、阳性预测值、阴性预测值、准确性(87.50%、75.00%、87.50%、75.00%、83.33%)较PPD检测结果(62.50%、50.00%、71.43%、40.00%、58.33%)更高;影响IGRA阳性率相关因素在经过分析后,结果显示男性阳性占比为75.00%,女性阳性占比为25.00%,不同性别因素比较差异无统计学意义(χ^(2)=1.428,P>0.05),异性接触阳性占比为20.00%,同性接触阳性占比为40.00%,注射、血液接触占比为25.00%,其他原因占比为15.00%,不同感染方式因素比较结果差异无统计学意义(χ^(2)=0.996,P>0.05),淋巴细胞CD4^(+)计数在200 mm^(3)以下及以上的占比分别为25.00%和75.00%,不同淋巴细胞CD4^(+)计数因素比较差异无统计学意义(P>0.05),抗逆转录病毒治疗后患者IGRA阴性发生率与阳性率相较明显更高,差异有统计学意义(P<0.05)。结论临床上针对艾滋病合并结核感染的诊断中应用γ干扰素释放试验具有较高的应用价值,其敏感性相对较高,而在对患者实施抗逆转录病毒治疗后在一定程度上会影响诊断结果。

Objective To explore the diagnostic value of interferon-gamma release test for AIDS patients with tuberculosis.Methods From January 2019 to February 2020,60 AIDS patients with tuberculosis infection were conveniently selected in the study.All patients received interferon gamma release test(IGRA),tuberculin test(PPD),tuberculosis antibody(T-SPOT TB)and a series of inspection methods for diagnosis,using T-SPOT TB inspection results as the gold standard,observing the diagnosis results of patients using different tests,and analyzing and comparing them.Results Comparing the test results of different diagnostic methods,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of the IGRA test method(87.50%,75.00%,87.50%,75.00%,83.33%)were higher compared with the PPD test results(62.50%,50.00%,71.43%,40.00%,58.33%);after analysis of related factors affecting the positive rate of IGRA,the results showed that the proportion of male positive was 75.00%,and the proportion of female positive was 25.00%.There was no statistically significant difference between different gender factors(χ^(2)=1.428,P>0.05),the proportion of positive contact with the opposite sex was 20.00%,the proportion of positive contact with the same sex was 40.00%,the proportion of injection and blood contact was 25.00%,and the proportion of other reasons was 15.00%,the different was no statistically significant difference in the factors of infection mode(χ^(2)=0.996,P>0.05).The percentages of lymphocyte CD4^(+) counts below 200 mm^(3) and above were 25.00%and 75.00%,respectively.There was no statistically significant difference between different lymphocyte CD4^(+) count factors(P>0.05).After antiretroviral treatment,the incidence of IGRA negative and positive rate of IGRA was significantly higher,and the difference was statistically significant(P<0.05).Conclusion The clinical application of interferon-gamma release test in the diagnosis of AIDS complicated with tuberculosis infection has high application value,and its sensitivity is relatively high,and it will affect the diagnosis to a certain extent after antiretroviral therapy is applied to the patient.