艾滋病合并结核病人的诊断与病人γ-干扰素释放试验检测结果差异的分析

Investigation of the difference between the clinical diagnosis of tuberculosis and the result of gamma-interferon release assay in AIDS patients

目的评价艾滋病(AIDS)合并结核的临床诊断与病人γ-干扰素释放试验检出率的差异,以及不同CD4+T淋巴细胞(简称CD4细胞)水平和抗结核治疗对γ-干扰素释放试验检测的影响。方法采用回顾性分析的方法,收集2012年10月1日至2015年9月30日,在北京地坛医院感染科诊断艾滋病合并结核(TB)感染住院病人的临床及实验室信息。对临床诊断、γ-干扰素释放试验结果的一致性,CD4细胞对检测结果的影响,以及抗结核治疗前后TB特异性细胞免疫反应的变化进行分析。结果共收集287例符合入组标准病人的数据,其中男性267例(占93.0%),女性20例(占7.0%)。病人CD4细胞中位数为56个/mm3,γ-干扰素释放试验阳性率为55.4%。当对于取得病原学证据的病例进行分析时,γ-干扰素释放试验的阳性率会增高(67.4%),γ-干扰素释放试验阳性率与CD4细胞水平之间存在一致性。对γ-干扰素释放试验与淋巴细胞进行相关分析,γ-干扰素释放试验A和B与CD4细胞均呈正相关(P=0.000,P=0.000)。分析短期抗结核治疗对于γ-干扰素释放试验的影响,抗结核治疗后3个月内的γ-干扰素释放试验A与B的斑点形成单位值变化的差异无统计学意义(P=0.214,P=0.426)。结论 AIDS合并结核感染病人中,在CD4细胞较低时,γ-干扰素释放试验与临床诊断一致性较差,并与CD4细胞水平有一定相关性,抗结核治疗后3个月内γ-干扰素释放试验TB特异性细胞反应水平不会改变。

Objective To evaluate the difference between the clinical diagnosis and the positive rate of the interferon gamma release assay,and to analyze the influence of the CD4 levels and the anti-tuberculosis treatment on interferon gamma release assay.Methods A retrospective study was conducted to review the clinical records of the hospitalized AIDS/TB coinfected patients in Beijing Ditan Hospital from October 2012 to September 2015.The difference between the clinical diagnosis and the result of the interferon gamma release assay was analyzed,as well as the influence of different CD4 cell levels on the interferon gamma release assay and the change of it with the anti-tuberculosis treatment.Results 287 patients were enrolled with 267male（93%）and 20female（7%）.The median CD4 cell count was 56cells/mm3.Among all the patients,the positive rate of interferon gamma release assay was 55.4%（159/287）and among the patients with microbiologic evidence,the positive rate of the interferon gamma release assay increased to 67.4%.No matter whether the patients had microbiologic evidence or not,the positive rates of interferon gamma release assay corresponded to the different CD4 cell levels.The analysis of the correlation between interferon gamma release assay and lymphocyte showed that both interferon gamma release assay A and B results correlated with the CD4 cell counts（P〈0.05）.The analysis of influence of short-time anti-tuberculosis therapy on the interferon gamma release assay showed no statistical difference in SFU（Spot Forming Unite）within three months of the therapy.Conclusion In AIDS/TB co-infected patients with low CD4 cell counts,the interferon gamma release assay was in poor agreement with the clinical diagnosis.The interferon gamma release assay results correlated with the CD4 cell counts mildly.Within three-month anti-tuberculosis therapy,there was no statistical difference in the interferon gamma release assay results.