艾滋病高流行地区HIV感染者结核潜伏性感染诊断方法比较  

Comparison of diagnostic methods for latent tuberculosis infection among HIV-infected people in high HIV prevalence areas

作　　者：黄欢[1] 高文凤[2] 苏茜 李京 李婷[2] 李运葵[2] 汪川[1] 高媛 徐进川 廖志鸿 何金戈[2] 杨文[2] HUANG Huan;GAO Wenfeng;SU Qian;LI Jing;LI Ting;LI Yunkui;WANG Chuan;GAO Yuan;XU Jinchuan;LIAO Zhihong;HE Jinge;YANG Wen(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;Sichuan Provincial Center for Disease Control and Prevention,Chengdu 610041)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院,成都610041 [2]四川省疾病预防控制中心,成都610041

出　　处：《中国艾滋病性病》2020年第3期239-242,共4页Chinese Journal of Aids & STD

基　　金：国家“十三五”科技重大专项(2018ZX10715-003);四川省科技厅国际合作项目(2017HH0080)。

摘　　要：目的探讨结核分枝杆菌感染T淋巴细胞斑点试验(T-SPOT.TB)和结核菌素皮肤试验(TST)两种方法在艾滋病高流行地区艾滋病病毒(HIV)感染者中诊断潜伏性结核感染的价值。方法以经HIV抗体确证试验确定为HIV感染的凉山彝族自治州布拖县272例彝族感染者为研究对象,询问临床症状,进行X线胸片检查,收集痰标本进行病原学检测,采集5 mL外周血进行T-SPOT.TB检测,并对其中205人进行结核菌素皮肤试验。采用Pearsonχ^2检验、Fisher确切概率法、McNemar对结果进行统计分析。结果在272例HIV感染人群中,活动性结核患者(HIV/TB)有45例,HIV/TB患者的T-SPOT.TB阳性率22/45,TST阳性率12/36,但差异无统计学意义(P> 0.05);CD4+T淋巴细胞(简称CD4细胞)数<200个/μL的HIV/TB患者的T-SPOT.TB阳性率4/6,而TST阳性率为0/5。227例无活动性结核的HIV感染者T-SPOT.TB阳性率高于TST阳性率,分别为24.9%(42/169)和18.3%(31/169),但差异无统计学意义(P=0.08);T-SPOT.TB和TST两方法诊断HIV感染者潜伏性结核感染的方法一致性中等,Kappa值为0.427;不同CD4细胞水平对T-SPOT.TB阳性率无影响(P> 0.05);当CD4细胞计数<200个/μL时,TST阳性率低于T-SPOT.TB阳性率,分别3/30和8/43,差异无统计学意义(P> 0.05)。结论在艾滋病高流行地区,T-SPOT.TB应用于HIV感染人群诊断潜伏性结核感染和活动性结核较TST更具优势,其敏感性更高,且在严重免疫缺陷时仍有诊断价值。Objective To evaluate the diagnostic value of enzyme-linked immunospot analysis(T-SPOT.TB) and tuberculin skin test(TST) in diagnosing latent tuberculosis infection(LTBI) in HIV infected patients in high HIV prevalence areas. Methods We recruited 272 HIV infected patients in Butuo county of Liangshan Yi autonomous prefecture. A survey was made for their clinical symptoms, and X-ray examination. Sputum samples and 5 mL peripheral blood were collected simultaneously for mycobacterium tuberculosis detection and for T-SPOT.TB test respectively. 205 cases of them were tested for tuberculin skin test. Statistical analysis was performed by using Pearson χ^2 test, Fisher’s exact probability test and McNemar test. Results Among the 272 HIV-infected people, 45 were active TB patients(HIV/TB). T-SPOT.TB positive rate(22/45) was higher than TST positive rate in HIV/TB patients(12/36), with the difference not significant(P > 0.05). The HIV/TB patients with peripheral blood CD4 T cell count below 200/μL had 4/6 T-SPOT.TB positives, and 0/5 TST positives. 227 HIV-infected patients without active TB had the T-SPOT.TB positive rate of 24.9%(42/169), higher than TST positive rate of 18.3%(31/169) respectively, with the difference not statistically significant(P=0.08). Two methods showed moderate consistence for diagnosing LTBI in HIV infected patients, with the Kappa value of 0.427. The level of CD4 T cell count could not affect T-SPOT.TB positive rate(P > 0.05). When CD4 cell count was < 200/μL, the patients had lower TST positive rate(3/30) than T-SPOT.TB positive rate(8/43), with no significant difference(P > 0.05). Conclusion In high HIV prevalence areas, T-SPOT.TB is more effective than TST in the diagnosis of LTBI and active tuberculosis in HIV-infected people, which is more sensitive and has diagnostic value in severe immunodeficiency situation.

关 键 词：艾滋病 潜伏性结核感染 诊断方法 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]