摘要
目的探讨γ-干扰素释放试验(IGRA试验)在HIV/AIDS患者中诊断结核病应用价值及CD4^+T淋巴细胞对IGRA试验结果影响程度。方法选取789例HIV/AIDS患者血标本和痰标本,进行IGRA试验、CD4^+T淋巴细胞计数及结核分枝杆菌培养,并对检测结果加以分析。结果 789例HIV/AIDS患者中,结核分枝杆菌培养阳性有42例,其中IG-RA阳性率为50.00%(21/42);HIV/AIDS合并活动性肺结核患者中,结核分枝杆菌培养阳性率为29.20%(33/113),IGRA阳性率为30.09%(34/113);无肺结核主要临床症状和胸片无肺结核病灶的HIV/AIDS患者中,结核分枝杆菌培养阳性率为1.22%(6/490),IGRA检测阳性率为26.94%(132/490);在CD4^+T淋巴细胞等级计数≥300个/mm^3组、200～<300个/mm^3组、100～<200个/mm^3组及0～<100个/mm^3组中,IGRA阳性率分别为30.58%、20.18%、25.42%、17.02%,IGRA阳性率有随CD4^+T淋巴细胞计数降低而降低的趋势(χ~2=14.852,P<0.05);IGRA结果不确定率分别为5.81%、10.09%、9.32%、20.43%,IGRA结果不确定率有随CD4^+T淋巴细胞计数降低而增高的趋势(χ~2=30.021,P<0.05)。结论 IGRA试验作为HIV/AIDS感染者合并结核病的辅助诊断有一定临床使用价值,但作用非常有限,患者免疫力下降对IGRA试验结果影响较大,出现不确定性结果也随着免疫力下降而增高。
Objective To discuss the application of interferon-gamma release assays(IGRAs)in the detection of HIV infected person,and the effect of CD4T lymphocytes on IGRA results.Methods The blood and sputum samples of 789 patients with HIV/AIDS were selected for IGRA test,the count of CD4T lymphocyte and the culture of Mycobacterium tuberculosis(MTB),and the result was analyzed.Results Among the 789 HIV/AIDS patients,42 cases were cultured positive of MTB,and the positive rates of IGRA in these 42 cases was 50.00%(21/42).Among the TB/HIV(AIDS)co-infection patients,the positive rate of sputum culture was 29.20%(33/113)and the positive rate of IGRA was 30.09%(34/113).The positive rate of MTB culture was 1.22%(6/490)and the positive rate of IGRA was 26.94%(132/490)in HIV/AIDS patients without pulmonary tuberculosis main clinical symptoms and without pulmonary tuberculosis lesions in chest radiography.The positive rate of IGRA were 30.58%,20.18%,25.42%,17.02%,respectively in 300 cells/mm^3 group,200 cells/mm^3 group,100 cells/mm^3 group and0 cells/mm^3 group of CD4^+T lymphocyte grade count,the positive rate of IGRA decreased with the decrease of CD4 T lymphocyte count(χ~2=14.852,P<0.05);the uncertainty rates of IGRA were 5.81%,10.09%,9.32%and 20.43%,respectively in the above 4 groups.The uncertainty rate of IGRA increased with the decrease of CD4 cells count(χ~2=30.021,P<0.05).Conclusion IGRA can be used as an auxiliary diagnosis of HIV/AIDS infected patients with tuberculosis,but its effect is very limited.Patients’immunity has a great impact on the results of the IGRA,and the uncertainty results increase with the decline of immunity.
作者
蓝如束
黄莉雯
叶婧
覃慧芳
罗丹
崔哲哲
林玫
LAN Rushu;HUANG Liwen;YE Jing;QIN Huifang;LUO Dan;CUI Zeze;LIN Mei(Guangxi Center for Disease Control and Prevention,Nanning,Guangxi 530028,China)
出处
《中国热带医学》
CAS
2019年第4期364-368,共5页
China Tropical Medicine
基金
广西医药卫生适宜技术推广项目(No.S201310-04)
广西卫生厅自筹经费课题(No.Z2015447)
