结核分枝杆菌特异性细胞免疫反应检测对HIV/AIDS患者结核病的诊断价值

To evaluate the diagnostic value of Mycobacterium tuberculosis specific cellular immune response test for tuberculosis in HIV/AIDS

目的评价结核分枝杆菌特异性细胞免疫反应检测(酶联免疫法)对艾滋病病毒(HIV)/艾滋病(AIDS)患者结核病的诊断价值。方法选取在武汉市金银潭医院就诊的HIV/AIDS患者419例,进行γ-干扰素释放试验(IGRA)和结核菌素试验(TST),IGRA采用的是结核分枝杆菌特异性细胞免疫反应检测(酶联免疫法)试剂盒,同时进行结核病筛查和诊断,依据是否合并结核病分为无活动性结核组(HIV组)(n=327)和HIV合并活动性结核病组(HIV&ATB组)(n=92),然后收集人口学特征、CD4^(+)T淋巴细胞、IGRA、TST等数据并分析,从整体、不同类型结核病、CD4^(+)T淋巴细胞水平三个维度评价IGRA(酶联免疫法)对HIV/AIDS患者结核病的诊断价值。结果419例HIV/AIDS患者中IGRA总阳性率为38.2%(160/419),TST总阳性率为12.4%(52/419),差异有统计学意义(χ^(2)=38.814,P<0.05)。在IGRA阳性者中HIV组有86例(26.3%),HIV&ATB组有74例(80.4%)。IGRA在肺结核组和肺外结核组的阳性率分别为77.1%(54/70)和90.9%(20/22),两组TST和IGRA阳性率差异均无统计学意义(χ^(2)_(TST)=1.09,PTST=0.30;χ^(2)_(IGRA)=2.02,PIGRA=0.16)。CD4^(+)T<100个/μL、100个/μL≤CD4^(+)T<200个/μL和200个/μL≤CD4^(+)T组IGRA阳性率差异无统计学意义(χ^(2)=2.63,P=0.27)。结论对于HIV/AIDS患者结核病的诊断,IGRA较TST具有更高的敏感度,同时IGRA的结果与结核病类型、CD4^(+)T淋巴细胞计数水平无相关性,具有较高的诊断价值,值得临床推广。

Objective To evaluate the diagnostic value of Mycobacterium tuberculosis specific cellular immune response test for tuberculosis in HIV/AIDS patients.Methods HIV/AIDS Patients attending Jinyintan Hospital in Wuhan were selected for the interferon-gamma release assay(IGRA)and tuberculin skin test(TST),and IGRA was performed using the Mycobacterium tuberculosis specific cell immune response test(ELISA)kit for both TB screening and diagnosis,and divided into HIV group(n=327)and HIV&ATB group(n=92)based on whether with or without TB.And then the demographic characteristics,CD4^(+)T lymphocytes,IGRA,TST and other data were collected and analyzed.The diagnostic value of IGRA for tuberculosis in HIV/AIDS patients was evaluated from three dimensions:overall,different types of tuberculosis and CD4^(+)T lymphocytes levels.Results IGRA and TST were performed in 419 HIV/AIDS patients.The total positive rate of IGRA was 38.2%(160/419),and that of TST was 12.4%(52/419).The difference was statistically significant(χ^(2)=38.814,P<0.05).Among the IGRA positive individuals,86 cases(26.3%)were in the HIV group,and 74 cases(80.4%)were in the HIV&ATB group.HIV&ATB group was divided into two subgroups by pulmonary tuberculosis and extrapulmonary tuberculosis;there was no significant statistical difference in TST and IGRA between the two groups(χ^(2)_(TST)=1.09,PTST=0.30;χ^(2)_(IGRA)=2.02,PIGRA=0.16).The HIV&ATB group was divided into three groups according to CD4^(+)T<100/μL,100/μL≤CD4^(+)T<200/μL,and 200/μL≤CD4^(+)T.The positive rates of IGRA were 76.0%,91.6%,and 77.8%,respectively.It was found that the differences among the three groups were not statistically significant(χ^(2)=2.63,P=0.27).Conclusion In the diagnosis of tuberculosis in HIV/AIDS patients,IGRA had higher sensitivity than TST,and IGRA had no correlation with tuberculosis type and CD4^(+)T lymphocyte count level,which had high diagnostic value and was worthy of clinical promotion.