结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值  

Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County,Sichuan Province

作　　者：李婷[1] 何金戈[1] 苏茜 李京 李运葵[1] 高文凤[1] 高媛 杨文[2] LI Ting;HE jinge;SU Qian;LI Jing;LI Yunkui;GAO Wen-feng;GAO Yuan;YANG Wen(Tuberculosis Preum tion and Control Department,Sich uan Center for Disase Com trod and Prevention.Chengdu 610041,China)

机构地区：[1]四川省疾病预防控制中心结核病预防控制所,成都610041 [2]四川省疾病预防控制中心重大专项办公室

出　　处：《中国防痨杂志》2020年第9期931-936,共6页Chinese Journal of Antituberculosis

基　　金：“十三五”国家科技重大专项(2018ZX10715003-002)。

摘　　要：目的分析结核菌素(PPD)试验对凉山彝族自治州布拖县HIV感染/AIDS患者结核感染筛查的应用价值。方法2018年12月至2019年8月从布拖县九都乡、木尔乡、特木里镇"十三五"国家科技重大专项课题已管理的2159例HIV感染/AIDS患者中,纳入可随访且已接受免疫抑制剂治疗>1个月的688例患者开展问卷调查、PPD试验、胸部X线摄影(简称"胸片")等肺结核现场筛查和全血CD4+T淋巴细胞计数检测,对符合条件者进行MTB病原学检测。排除175例未进行PPD试验结果核验、40例未行胸片检查且无结核病病原学诊断依据和7例非结核分枝杆菌感染的患者后,最终纳入466例患者;统计PPD试验结果(皮肤硬结平均直径≥5mm为阳性)及专家组判定活动性肺结核或潜伏性结核感染(LTBI)情况。采用SPSS 21.0软件对数据进行分析,以专家组确诊的活动性肺结核为参考标准评价PPD试验对活动性肺结核的检测效能(包括敏感度、特异度、阳性预测值、阴性预测值、一致率);PPD阳性率与是否并发活动性肺结核及不同CD4+T淋巴细胞计数患者间率的比较采用χ~2检验,以P<0.05为差异有统计学意义。结果466例患者中,PPD试验阴性377例(80.90%)、一般阳性14例(3.00%)、中度阳性29例(6.23%)、强阳性46例(9.87%),阳性率为19.10%(89/466),均符合结核感染。经结核病筛查程序和专家组定诊,466例患者中活动性肺结核为89例,检出率为19.10%;而89例PPD试验阳性患者中,57例为LTBI,检出率为12.23%(57/466)。以专家组确诊的活动性肺结核作为参考标准,PPD试验检测活动性肺结核的敏感度、特异度和一致率分别为35.96%(32/89)、84.88%(320/377)和75.54%(352/466)。HIV感染/AIDS并发活动性肺结核患者的PPD试验阳性率[35.96%(32/89)]明显高于未并发者[15.12%(57/377)](χ~2=20.827,P=0.000),且并发活动性肺结核患者仅在血CD4+T淋巴细胞计数≥500个/μl时[52.00%(13/25)]明显高于未并发者[16.67%(19/11Objective To analyze the application value of tuberculin(PPD)test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo,Liangshan Yi Autonomous Prefecture. Methods A total of 688 patients who were followed up and had taken immunosuppressant therapy >1 month were enrolled,among 2159 HIV/AIDS patients managed in the"Thirteenth Five-Year Plan"National Science and Technology Major Project in Jiudu,Mu’er and Te Muli Town in Butuo between December 2018 and August 2019.Questionnaire,PPD test,X-ray chest and CD4+T lymphocyte count were conducted.MTB etiology test was performed on eligible subjects.Of the 688 cases,175 were without verification of PPD test results,40 were not examed by X-ray and had no etiology basis,7 were infected by nontuberculous mycobacteria,and 466 cases were included finally.SPSS 21.0 software was used to analyze the PPD test results(the average diameter of skin scleroma≥5 mm was positive)and the status of active pulmonary tuberculosis or latent tuberculosis infection(LTBI)judged by the expert group,to detect the efficiency of PPD test for active pulmonary tuberculosis(including sensitivity,specificity,positive predictive value,negative predictive value,agreement rate)based on diagnosed active pulmonary tuberculosis cases.The relationship between positive rate of PPD test and whether complicated with active pulmonary tuberculosis or not,as well as comparison of different CD4+T lymphocyte counts and prevalence,were detected byχ~2 test.P<0.05 was statistically significant. Results Among the 466 patients,377(80.90%)were negative in PPD test,14(3.00%)were generally positive,29(6.23%)were moderately positive,46(9.87%)were strongly positive and the positive rate was 19.10%(89/466),all of them were consistent with tuberculosis infection.By tuberculosis screening and diagnosis from expert group,89 cases(19.10%)were active pulmonary tuberculosis,including57 LTBI cases(12.23%(57/466)).Based on diagnosis from expert group,the sensitivity,specificity and consistent rate of PPD test fo

关 键 词：结核 肺 HIV感染 获得性免疫缺陷综合征 潜伏性结核病 结核菌素试验 结果评价(卫生保健) 小地区分析 

分 类 号：R512.91[医药卫生—内科学] R52[医药卫生—临床医学]