结核感染T细胞斑点试验在HIV/AIDS合并结核病诊断中的应用

Clinical application of T-SPOT. TB in diagnosis of tuberculosis in patients with HIV infection

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)检测在HIV/AIDS合并结核病诊断中的应用价值。方法选取HIV阳性结核病患者44例、同期住院的HIV阴性结核病患者42例和HIV阳性非结核病患者28例。对3组患者的T-SPOT.TB、血结核抗体试验及外周血CD4+T细胞绝对计数等结果进行回顾性分析。结果 TSPOT.TB对HIV阳性患者诊断结核病的灵敏度、特异度、阳性预测值、阴性预测值分别为81.82%、85.71%、90.00%、75.00%,其中灵敏度、阳性预测值与阴性预测值明显高于结核抗体检查,差异有统计学意义(P<0.01)。HIV阳性结核病组T-SPOT.TB灵敏度(81.82%)与HIV阴性结核病组T-SPOT.TB灵敏度(83.33%)比较,差异无统计学意义(P=0.54),但HIV阳性结核病组结核抗体检查的灵敏度(25.00%)明显低于HIV阴性结核病组(57.14%)(P<0.01)。HIV阳性结核病组中,T-SPOT.TB在菌阳肺结核、菌阴肺结核、肺外结核3种不同类型结核病患者中的灵敏度分别是71.43%、85.71%、88.89%,三者之间差异无统计学意义(P=0.586)。T-SPOT.TB在CD4+T淋巴细胞≤200个/μl的HIV合并结核病患者中的灵敏度为62.50%,低于CD4+T淋巴细胞>200个/μl组(92.86%),差异有统计学意义(P=0.019)。结论 T-SPOT.TB灵敏度和特异度较高,对HIV/AIDS合并结核病具有较大的辅助诊断价值。CD4+T淋巴细胞的数量对T-SPOT.TB灵敏度有一定影响。

Objective To evaluate the effectiveness of T-SPOT. TB in diagnosis of tuberculosis in patients with HIV infection. Methods Forty-four patients diagnosed as pulmonary tuberculosis and HIV infection were admitted; 28 HIV positive patients without tuberculosis and 42 non-HIV positive patients with tuberculosis were admitted in the same period. T-SPOT. TB,blood TB antibody test and peripheral blood CD4＋T cell counts were retrospectively analyzed in three groups. Results The sensitivity,specificity,positive predictive value and negative predictive value of T-SPOT. TB test in HIV positive patients with tuberculosis were 81. 82%,85. 71%,90. 00% and 75. 00%,respectively,which were significantly higher than those of TB antibody test（ P〈0. 0 1）. The sensitivity of T-SPOT.TB test in HIV positive patients with tuberculosis was not significantly different from that in HIV negative patients with tuberculosis（ P = 0. 54）. The sensitivity of TB antibody in HIV positive patients with tuberculosis（ 25. 00%） was significantly lower than that in HIV negative patients with tuberculosis（ 57. 14%）（ P〈0. 0 1）. The sensitivity of T-SPOT. TB test in smear positive pulmonary tuberculosis,smear negative pulmonary tuberculosis and extra-pulmonary tuberculosis in the group of HIV positive patients with tuberculosis were 71. 43%,85. 71% and 88. 89%,respectively（ P = 0. 586）. The sensitivity of T-SPOT. TB test in HIV positive patients with tuberculosis and CD4＋T cells 200 / ml was 62. 5%,and that in patients in the same group but CD4＋T cells 200 / ml was 92. 86%（ P =0. 019）. Conclusion T-SPOT. TB is effective in diagnosis of tuberculosis in patients with HIV infection with high sensitivity and specificity,however,the number of CD4＋T cells may reduce the diagnostic sensitivity to some extent.