早期诊断艾滋病患者合并淋巴结结核临床常用实验室方法的比较分析  

Clinically⁃common laboratory testing for early diagnosis of lymph node tuberculosis in AIDS patients:A comparative analysis

作　　者：范少峰 张辉[1] Fan Shaofeng;Zhang Hui(Department of Hepatobiliary Surgery,Guangzhou Eighth People􀆳s Hospital,Guangzhou Medical University,Guangzhou 510440,China)

机构地区：[1]广州医科大学附属市八医院肝胆外科,广东广州510440

出　　处：《广州医科大学学报》2022年第2期30-34,共5页Academic Journal of Guangzhou Medical University

基　　金：广州市卫计委科技攻关项目(20181A010033)。

摘　　要：目的:探讨能早期诊断艾滋病患者合并淋巴结结核临床常用实验室方法,从而实现早期诊断、早期结核治疗。方法:选取2016年2月~2018年10月的206例广州市第八人民医院已行淋巴结活检艾滋病患者。术后病理为“淋巴结结核”的作为观察组(n=106),非“淋巴结结核”的作为对照组(n=100);其中男性166例,女性40例,通过回顾分析其临床常用实验室方法:术前CD4计数、术前HIV RNA计量、T⁃spot、结核DNA、结核抗原检测、结核菌培养、白蛋白/球蛋白(A/G)、TST结果、结核抗体(IgG及IgM),统计、比较出有统计学意义的实验室方法,得出各方法对淋巴结结核的确诊意义(灵敏度、特异性、准确度、阳性预测值和阴性预测值)。结果:T⁃spot在淋巴结结核诊断中的灵敏度、特异度、准确度的整体评价均高于术前CD4计数、术前HIV RNA计量、结核DNA、结核抗原检测、结核菌培养、A/G、TST结果、结核抗体(IgG及IgM)的检查方法;除CD4计数、术前HIV、RNA计量外,T⁃spot等检测方法均对诊断淋巴结结核感染及非结核感染有统计学意义(P<0.05)。结论:T⁃spot对诊断艾滋病患者早期合并淋巴结结核感染的临床实用价值较高;另外A/G比值也有辅助诊断意义,是重要参考指标,值得推广。Objective:To investigate the clinically⁃common laboratory testing for early diagnosis of lymph node tuberculosis in AIDS patients,so as to facilitate early diagnosis and treatment of tuberculosis.Methods:A total of 206 AIDS patients who underwent lymph node biopsy in Guangzhou Eighth People′s Hospital between February 2016 and October 2018 were included.The patients with lymph node tuberculosis by post⁃procedural pathology were recruited as the study group(n=106),and those with non⁃lymph node tuberculosis as the control group(n=100).All subjects comprised 166 males and 40 females.A retrospectively approach was used to investigate the clinically common⁃used laboratory testing in these subjects,including pre⁃procedural CD4 count,HIV RNA quantification,T⁃spot test,tuberculosis DNA,tuberculosis bacilli antigen detection,tuberculosis bacilli culture,albumin/globulin ratio(A/G),tuberculin skin test(TST),and tuberculosis bacilli antibodies(IgG and IgM).Statistic and comparative efforts were exerted to determine the significantly useful laboratory testing.All these testing methods were evaluated for their value(sensitivity,specificity,accuracy,positive predictive value and negative predictive value)in determining a diagnosis of lymph node tuberculosis.Results:Overall,the sensitivity,specificity and accuracy of T⁃spot in diagnosing lymph node tuberculosis were higher than those of pre⁃procedural CD4 count,HIV RNA quantification,tuberculosis DNA,tuberculosis bacilli antigen detection,tuberculosis bacilli culture,A/G ratio,TST,and tuberculosis bacilli antibodies(IgG and IgM).Except CD4 count and pre⁃procedural HIV RNA quantification,T⁃spot and other testing methods yielded statistically significant findings in distinguishing tuberculosis and non⁃tuberculosis infections of the lymph nodes(P<0.05).Conclusion:T⁃spot has a high clinical value in diagnosing early lymph node tuberculosis infection in AIDS patients.In addition,A/G ratio is also helpful as an auxiliary diagnostic tool and important referen

关 键 词：T⁃spot 淋巴结结核 艾滋病 艾滋病并发症 

分 类 号：R512.91[医药卫生—内科学]