TB⁃IGRA在艾滋病合并肺结核患者中的诊断价值及其与CD4^(+)T淋巴细胞计数的相关性  

Diagnostic value of TB⁃IGRA in AIDS patients with pulmonary tuberculosis and its correlation with CD4^(+)T lymphocyte count

作　　者：陈影影 张觅 施旭东 胡春梅 李金龙 CHEN Yingying;ZHANG Mi;SHI Xudong;HU Chunmei;LI Jinlong(Department of Clinical Laboratory,the Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210000,China;Department of Tuberculosis,the Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210000,China)

机构地区：[1]南京中医药大学附属南京医院/南京市第二医院检验科,江苏南京210000 [2]南京中医药大学附属南京医院/南京市第二医院结核科,江苏南京210000

出　　处：《热带医学杂志》2024年第9期1294-1297,共4页Journal of Tropical Medicine

基　　金：江苏省基础研究计划自然科学基金面上项目(BK20221172);无锡市卫生健康委面上项目(M202201)。

摘　　要：目的探讨结核T细胞γ-干扰素释放试验(TB⁃IGRA)在艾滋病合并肺结核患者中的诊断价值,并分析不同水平CD4^(+)T淋巴细胞计数对TB⁃IGRA诊断结果的影响。方法整群选取2019年1月-2022年12月南京市第二医院收治的艾滋病合并可疑肺结核患者283例作为研究对象,依据临床诊断确诊为艾滋病合并肺结核患者111例为合并组,单纯艾滋病患者172例为单纯组。对两组患者均进行TB⁃IGRA检测,同时行结核抗体(TB⁃Ab)检查,并利用流式细胞仪测定合并组外周血CD4^(+)T淋巴细胞计数。结果合并组TB⁃IGRA阳性率75.68%,明显高于单纯组15.12%,差异有统计学意义(χ^(2)=104.127,P<0.001);合并组和单纯组TB⁃Ab阳性率分别为27.93%、20.35%,差异无统计学意义(χ^(2)=2.167,P=0.141)。合并组中TB⁃IGRA试验的敏感性、阳性预测值、阴性预测值、诊断准确性分别为75.68%、76.36%、84.39%、81.27%,均高于TB⁃Ab检测的27.93%、46.97%、63.13%、59.36%,差异均有统计学意义(P均<0.05);两种方法的特异性比较差异无统计学意义(χ^(2)=1.614,P=0.204)。合并组中CD4^(+)T淋巴细胞计数≥200个/μL时TB⁃IGRA检测阳性率(92.59%)显著高于CD4^(+)T淋巴细胞计数<200个/μL(70.24%),差异有统计学意义(χ^(2)=5.547,P=0.019)。结论TB⁃IGRA检测方法有较高的诊断效能,且敏感性受外周血CD4^(+)T淋巴细胞计数的影响,CD4^(+)T淋巴细胞计数≥200个/μL时TB⁃IGRA对艾滋病合并肺结核患者的阳性率明显提高。Objective To explore the diagnostic value of tuberculosis⁃interferon gamma release assay(TB⁃IGRA)in acquired immunodeficiency syndrome(AIDS)patients with pulmonary tuberculosis,and analyze the effect of different levels of CD4^(+)T lymphocyte count on the diagnosis of TB⁃IGRA.Methods A cluster of 283 AIDS patients with suspected pulmonary tuberculosis admitted to the Second Hospital of Nanjing from January 2019 to December 2022 was selected as the study object.According to clinical diagnosis,111 patients with AIDS and pulmonary tuberculosis were included in the combined group,and 172 patients with simple AIDS were included in the simple group.Both groups of patients were tested for TB⁃IGRA,and tuberculosis antibody(TB⁃Ab).CD4^(+)T lymphocyte count in peripheral blood was measured by flow cytometry.Results The positive rate of TB⁃IGRA in the combined group was 75.68%,which was significantly higher than that in the simple group(15.12%)(χ^(2)=104.127,P<0.001);The positive rates of TB⁃Ab in the combined group and the simple group were 27.93%and 20.35%,respectively,with no significant difference(χ^(2)=2.167,P=0.141).In the combined group,the sensitivity,positive predictive value,negative predictive value and diagnostic accuracy of TB⁃IGRA test were 75.68%,76.36%,84.39%and 81.27%respectively,which were higher than those of TB⁃Ab test(27.93%,46.97%,63.13%,59.36%),the difference was significant(all P<0.05),and there was no significant difference between the specificity of the two methods(χ^(2)=1.614,P=0.204).The positive rate of TB⁃IGRA in the combined group when CD4^(+)T lymphocyte count≥200 cell/μL(92.59%)was significantly higher than that of CD4^(+)T lymphocyte count<200 cell/μL(70.24%)(χ^(2)=5.547,P=0.019).Conclusion TB⁃IGRA detection method had high diagnostic efficiency,and its sensitivity was affected by CD4^(+)T lymphocyte count in peripheral blood,and CD4^(+)T lymphocyte count≥200 cell/μL could improve the positive rate of TB⁃IGRA in AIDS patients with pulmonary tuberculosis.

关 键 词：艾滋病合并肺结核 TB⁃IGRA 结核抗体 CD4^(+)T淋巴细胞计数 

分 类 号：R512.91[医药卫生—内科学] R521[医药卫生—临床医学]