γ-干扰素释放试验对HIV感染者合并菌阴肺结核辅助诊断价值的探讨

Auxiliary diagnostic value of interferon-γ release assay in HIV and pulmonary tuberculosis with negative culture

目的探讨γ-干扰素释放试验(IGRAs)对人类免疫缺陷病毒(HIV)感染者合并菌阴肺结核(HIV/菌阴肺结核)的辅助诊断价值。方法对128例于2014年5月至2016年4月在河南省鹤壁市传染病医院感染科住院期间行IGRAs检测的HIV/菌阴肺结核、人类免疫缺陷病毒感染/获得性免疫缺陷综合征(HIV/AIDS)、菌阴肺结核患者的IGRAs测定结果和相关临床资料进行回顾性分析。组内及组间构成比或率的比较采用χ~2检验,计量资料采用t检验,以P<0.05的因素作为自变量,以IGRAs结果为阳性或阴性作为因变量,行Logistic回归(基于条件参数估计的后退法)分析。结果 (1)HIV/菌阴肺结核患者血γ-干扰素水平和阳性检出率高于HIV/AIDS患者(U=7.813,P=0.005;χ~2=8.486,P=0.004),但与菌阴肺结核患者相接近(U=1.109,P=0.292;χ~2=2.459,P=0.117)。(2)与IGRAs阴性的HIV/菌阴肺结核患者相比较,IGRAs阳性的HIV/菌阴肺结核患者的CD_4^+计数(t=5.349,P=0.002)、CD_4^+/CD_8^+(t=2.834,P=0.009)、淋巴细胞计数(t=5.576,P<0.001)增高,血沉(t=-2.317,P=0.029)降低。(3)logistic回归分析显示,仅CD_4^+计数是影响HIV/菌阴肺结核患者IGRAs结果的独立因素(Wald X2=4.434,P=0.035,OR=13.5,95%CI=1.197-152.211)。(4)不同检测方法比较,HIV/菌阴肺结核患者IGRAs检测的敏感度(35.7%)和诊断正确率(72.7%)高于结核抗体(21.4%,63.6%)和PPD(14.2%,67.0%)检测,其特异度(90.0%)与PPD相接近(91.7%),略高于结核抗体(83.3%)。IGRAs联合PPD和结核抗体检测可提高敏感度至60.7%。结论IGRAS检测有助于从HIV患者中早期筛出或发现HIV/结核病患者。HIV/菌阴肺结核患者CD_4^+<200/μL影响IGRAs的检测结果。IGRAs检测对HIV/菌阴肺结核的辅助诊断价值优于PPD和结核抗体,而三项联合检测也有助于HIV/菌阴肺结核的早期发现。

Objective To explore the auxiliary diagnostic value of interferon-γ release assays （IGRAs） for human immunodeficiency virus infection and pulmonary tuberculosis with negative culture. Methods The clinical data of 128 cases of negative HIV pulmonary tuberculosis, HIV/AIDS and pulmonary tuberculosis by IGRAs were ret- rospectively analyzed. Rate within the group and between groups were compared by chi-square test. T test was used for measurement data. Taking positive or negative results of IGRAs as the dependent variable factor, it used logistic regression （parameter estimation based on the condition of backward method） to analyze the results. Results （ 1 ） The level of blood interferon-~, and the positive detection rate were higher in HIV and pulmonary tuberculosis with negative culture patients than in patients with HIV/AIDS （ U = 7.813, P = 0. 005 ; chi-square = 8.486, P = 0. 004）, but it was close to pulmonary tuberculosis with negative culture patients （ U = 1. 109, P = 0. 292 ; chi-square = 2. 459, P = 0. 117）. （2） Compared with negative HIV! pulmonary tuberculosis patients, the level of of CD4＋,lymphocyte count and CD4/CDs increased obviously in IGRAs positive HIV/ pulmonary tuberculosis patients （t = 5. 349, P = 0. 002 ; t=2. 834, P = 0. 009 ; t = 5.576, P 〈 0. 001 ）, and blood sedimentation decreased （ t = - 2. 317, P =0. 029）. （3） Logistic regression analysis showed that CD4 was independent factor for HIV/ pulmonary tuberculosis with negative culture （ Waldx2 = 4. 434, P =0. 035, OR = 13.5, 95% CI = 1. 197 - 152. 211 ）. （4） The sensitivity of IGRAs detection was 35.7% , and the diagnosis accuracy was 72. 7% , which were higher than tu- berculosis antibody （21.4%, 63.6% ） and PPD （ 14. 2%, 67.0% ） in HIV! pulmonary tuberculosis with negative culture. Its specific degree was 90.0%, which was similar with PPD （91.7%） and slightly higher than tuberculosis antibody （83.3%）. The detection sensitivity of IGRAs joint PPD and tuberculosis antibody was up to 60. 7%. Con- clusion IGRAS can help to sieve out early from HIV patients or find HIV/TB patients. CD4＋ 〈 200/μl will influence IGRAs. IGRAs is better than PPD and tuberculosis antibody for diagnosing HIV/pulmonary tuberculosis with negative culture. The three joint detection also helps to early diagnose HIV and pulmonary tuberculosis with negative culture.