T细胞斑点试验在人类免疫缺陷病毒合并肺结核感染中不同T细胞水平临床诊断价值

The Value of T Cells Spots Test in the Diagnosis of Human Immunodeficiency Virus Amalgamative Tuberculosis Pateints with Different Levels of T cells

目的探讨结核感染T细胞斑点试验(T.SPOT-TB)在HIV/AIDS合并肺结核患者中的诊断运用价值.方法对收治的94例HIV/AIDS合并肺结核患者进行T.SPOT-TB检测,分析比较患者CD4+T淋巴细胞计数在≤50 cells/uL,51 cells/uL～200 cells/uL,≥201 cells/uL条件下,T.SPOT-TB与痰结核菌(涂片/培养)结果及与CD4+T淋巴细胞计数三者间的相关性.结果 94例患者中T.SPOT-TB阳性64例(68.09%),痰菌阳性(涂片/培养)40例(42.55%).CD4≤50 cells/uL 43例(T.SPOT-TB阳性25例,占58.14%;痰菌阳性20例,占46.51%),51 cells/uL≤CD4≤200 cells/uL 29例(T.SPOT-TB阳性20例,占68.97%;痰菌阳性14例,占48.28%),CD4≥201 cells/uL 22例(T.SPOT-TB阳性19例,占86.36%;痰菌阳性7例,占31.82%).在94例患者中,随CD4+T淋巴细胞计数升高,T.SPOT-TB阳性率显著增高,(58.14%、68.97%、86.36%P<0.05).痰菌阳性率49.38%,T.SPOT-TB的敏感性79.01%,二者比较(P<0.01).结论 CD4+T淋巴水平对T.SPOT-TB阳性率有一定影响,尤其是在CD4细胞计数≤50 cells/μL的AIDS感染人群中敏感性降低,作为结核感染诊断的一种新方法,在HIV/AIDS合并肺结核感染的快速诊断中是可行的,但应注意患者的免疫水平以及是否有抗结核药物使用背景.

Objective To explore the value of T.SPOTt-TB testing in diagnosis of HIV/AIDS amalgamative tuberculosis patients.Methods From June 2009 to May 2011,94 cases of HIV/AIDS patients with tuberculosis in the third people＇s hospital of Kunming were given T.SPOT-TB testing,and T.SPOT-TB and sputum n/med tuberculosis bacterium（smear/training）results and and CD4 ＋ T lymphocyte count were analyzed and compared among patients with CD4 T lymphocytes count≤50 cells/uL,51～200 cells/uL,and ≥201cells/uL.Results In 94 patients,positive T.SPOT-TB was found in 64 cases（68.09%）,positive phlegm germ（smear/training） was found in 40 cases（42.55%）.CD4 ≤50 cells/uL was found in 43 cases（25 cases of positive T.S POT-TB,accounting for 58.14%;20 cases of positive phlegm germ,accounting for 46.51%）.51 cells/uL≤CD4≤200 cells/uL was found in 29 cases（20 cases of positive T.S POT-TB,accounting for 68.97%,and 14 cases of positive phlegm germ,accounting for 48.28%）.CD4≥201 cells/uL was found in 22 cases（19 cases of positive T.S POT-TB,accounting for 686.36%,and 7 cases of positive phlegm germ,accounting for 31.82%）.In 94 patients,with the elevation of CD4 ＋ T lymphocytes count,positive rate of T.SPOT-TB was significantly higher（58.14%,68.97%,86.36% and,P0.05）.The positive rate of Phlegm germ was 49.38%,the sensitivity of T.SPOT-TB was 79.01%,and there was a difference between them（P0.01）.Conclusion CD4＋T lymphocyte level has certain influence on the positive rate of T.SPOT-TB,especially in AIDS patients with CD4 ≤50 cells/μL,and can be as a new method for rapid diagnosis of HIV/AIDS amalgamative tuberculosis infection,but we should pay attention to patients＇ immune level and any anti-tuberculosis drugs use background.