γ-干扰素释放试验联合GeneXpertMTB/RIF在艾滋病合并肺结核中的诊断价值

Diagnostic values of interferon-γ release test combined with GeneXpert mycobacterium tuberculosis/rifampicin for AIDS complicated with tuberculosis

目的探讨全血γ-干扰素释放试验联合GeneXpert结核分枝杆菌(MTB)/利福平(RIF)检测对艾滋病(AIDS)合并肺结核的诊断效能。方法选取2018年8月至2020年8月湖北省荆州市洪湖市人民医院收治的119例人类免疫缺陷病毒(HIV)/AIDS患者作为研究对象。分为HIV/AIDS组(n=22)、HIV/菌阴肺结核组(n=57)、HIV/菌阳肺结核组(n=40)。采用全血γ-干扰素释放试验检测三组血γ-干扰素水平,同时进行GeneXpertMTB/RIF检测。结果HIV/菌阴肺结核组、HIV/菌阳肺结核组血γ-干扰素水平、γ-干扰素释放试验阳性检出率及GeneXpertMTB/RIF阳性检出率均高于HIV/AIDS组,差异具有统计学意义(P<0.05)。阳性组和阴性组年龄、症状持续时间比较,差异具有统计学意义(P<0.05)。与GeneXpertMTB/RIF单独检测比较,γ-干扰素释放试验联合GeneXpertMTB/RIF检测HIV/肺结核的灵敏度、特异度、阳性预测值、阴性预测值较高,漏诊率、误诊率较低,差异具有统计学意义(P<0.05)。结论γ-干扰素释放试验联合GeneXpertMTB/RIF可有效诊断出HIV/AIDS患者中的肺结核患者。

Objective To investigate the diagnostic efficacy of whole blood interferon-γ(IFN-γ) release test combined with GeneXpert mycobacterium tuberculosis(MTB)/rifampicin(RIF) test for AIDS complicated with tuberculosis. Methods 119 HIV/AIDS patients admitted to Honghu People′s Hospital, Jingzhou City, Hubei from August 2018 to August 2020 were selected as the research subjects. They were divided into HIV/AIDS group(n=22), HIV/bacteria-negative tuberculosis group(n=57) and HIV/bacteria-positive tuberculosis group(n=40). Whole blood IFN-γ release test was used to detect the levels of IFN-γ in the three groups, and GeneXpert MTB/RIF was also performed. Results The levels of IFN-γ in blood, positive detection rate of IFN-γ release test and positive detection rate of GeneXpert MTB/RIF in HIV/negative tuberculosis group and HIV/positive tuberculosis group were higher than those in HIV/AIDS group(P<0.05). There were significant differences in age and symptom duration between positive group and negative group(P<0.05). Compared with GeneXpert MTB/RIF alone, the sensitivity, specificity, positive predictive value and negative predictive value of IFN-γ release test combined with GeneXpert MTB/RIF in the detection of HIV/tuberculosis were higher, and the missed diagnosis rate and misdiagnosis rate was lower(P<0.05). Conclusions IFN-γ release test and GeneXpert MTB/RIF is helpful for detection of tuberculosis in HIV/AIDS patients.