Xpert MTB/RIF检测方法在HIV/AIDS合并结核患者中的临床应用

Clinical Application of Xpert MTB/RIF Detection Method in Patients with HIV/AIDS Complicated Tuberculosis

艾滋病和结核病是全球两大感染性疾病,已成为人类关注的公共卫生问题。艾滋病病毒(human immunodeficiency virus,HIV)感染增加了潜伏结核感染者和新接触结核者发展为活动性结核病的风险。传统的临床筛查、胸部X光检查和痰抗酸染色涂片检查等诊断方法无法及时准确诊断HIV/AIDS患者中的结核病及结核耐药性。诊断金标准结核培养和药物敏感性检测需要数周时间完成,限制其在临床中的应用。2010年,世界卫生组织首次建议将Xpert(GeneXpert MTB/RIF)用于HIV/AIDS合并结核病患者的诊断。2014年,WHO指出Xpert优于常规检测(包括显微镜检查、结核杆菌培养或组织病理学检测)。Xpert检测的费用较传统检测费用高,可能会限制和阻碍其可持续发展及向其他地区的推广应用。本文就Xpert在HIV/AIDS合并结核病患者中的实际应用进行综述,进一步指导HIV/AIDS合并结核病的诊断。

Acquired immure deficiency syndrome(AIDS) and tuberculosis(TB) become the two major infectious diseases worldwide and have become public health problem for humankind.HIV infection increases the risk to development of active tuberculosis in latent tuberculosis infection and newly exposed tuberculosis patients.Traditional diagnostic methods such as clinical screening,chest X ray examination,sputum smears acid fast staining examination unable to diagnose tuberculosis in HIV infection(PLHIV) patients timely and accurately,nor can it diagnose the drug resistance of tuberculosis.However,accurate diagnostic methods such as tuberculosis culture and drug sensitivity test(DST) take weeks to complete,limiting their use in clinical settings.In 2010,the World Health Organization(WHO) first recommended to use Xpert(GeneXpert MTB/RIF) for TB diagnosis in HIV-infected patients.WHO stated that Xpert was superior to conventional tests(including conventional microscopy,culture or histopathology) in 2014.However,the cost of Xpert is higher than that of traditional tests,which may limit its promotion and application.This article reviews the clinical application of Xpert in AIDS and tuberculosis coinfection,and further guides the diagnosis of tuberculosis in HIV-infected patients.