凉山州布拖县HIV/AIDS病人中结核病病原学筛查阳性率分析

Study of etiological positive rate of TB screening in HIV/AIDS patients in Butuo Liangshan

目的探讨实验室检测方法在艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)中发现结核病患者的作用,提高结核病筛查病原学阳性率。方法收集322名HIV/AIDS病人的痰标本,进行痰涂片、痰培养和实时荧光定量聚合酶链反应(FQ-PCR)检测。通过抗酸染色与FQ-PCR初步鉴定培养阳性菌株菌种。采用χ^2检验比较三种方法的检出率。以临床诊断为金标准,评价三种检测方法的检测效能。分析不同CD4+T淋巴细胞水平对三种方法检出率的影响。结果322名HIV/AIDS病人中,确诊活动性肺结核病例74例,病原学阳性46例,占确诊病人的62.16%。痰涂片阳性6例,阳性率1.86%;FQ-PCR阳性36例,阳性率11.18%;痰培养阳性25例,阳性率7.76%。痰涂片和痰培养及FQ-PCR的阳性检出率差异有统计学意义(χ^2=12.234,P<0.05;χ^2=22.924,P<0.05),痰培养和FQ-PCR的阳性检出率差异无统计学意义(χ^2=2.191,P=0.139)。痰涂片、痰培养和FQ-PCR的灵敏度、特异度和Kappa值分别为4.05%、98.79%、0.042,25.68%、97.58%、0.303和48.64%、100.00%、0.593。三种方法阳性检出率均不受CD4+T淋巴细胞水平影响(χ^2涂片=0.531,P=1.000;χ^2培养=0.101,P=0.800;χ^2 PCR=0.876,P=0.831)。初步菌种鉴定检出结核分枝杆菌(MTB)19株,非结核分枝杆菌(NTM)6株。结论FQ-PCR和痰培养提升了HIV/AIDS病人中结核病病人的病原学阳性率,临床应用推广价值大,对结核菌/HIV的防治具有重要意义。

Objective To explore the laboratory testing methods in detecting positive TB among the patients with HIV/AIDS and to improve the positive rate of TB screening.Methods Sputum specimens were collected from 322 HIV/AIDS patients for sputum smear,culture and real-time fluorescent quantitative PCR(FQ-PCR)detection.The positive strains were identified by acid fast staining and FQ-PCR.The detection rates of the three methods were compared by chi-square test.Clinical diagnosis was used as the gold standard,to evaluate the efficacy of the three detection methods.The influence of different of CD4+T cell levels on the detection rate was analyzed.Results Among 322 HIV/AIDS patients,74 were confirmed as active TB cases,and 46(62.16%)were etiologically positive.There were 6(1.86%)smear positive cases,and 36(11.18%)FQ-PCR positive cases,and 25(7.76%)sputum culture positive cases,with the difference between smear and culture,smear and FQ-PCR statistically significant(χ^2=12.234,P<0.05;χ^2=22.924,P<0.05)and the difference between culture and FQPCR not statistically significant(χ^2=2.191,P=0.139).The sensitivity of smear,culture and FQ-PCR was 4.05%,25.68%and 48.64%.The specificity was 98.79%,97.58%and 100.00%.The kappa value was 0.042,0.303 and 0.593.The positive detection rates of the three methods were not affected by the level of CD4+T cells.19 strains of MTB and 6 strains of NTM were identified.Conclusion FQ-PCR and sputum culture have improved the positive rate of etiology and have great clinical application value,which is of great significance for prevention and control of TB/HIV.