[1]钱宏波a,郭 蕊a,赵汉东a,等.γ-干扰素体外释放试验在艾滋病并发结核感染诊断中的应用价值探讨[J].现代检验医学杂志,2016,31(04):35-37,40.[doi:10.3969/j.issn.16717-414.2016.04.008]
　QIAN Hong-boa,GUO Ruia,ZHAO Han-donga,et al.Application Value of γ-Interferon in Vitro Release Test in the Diagnosis of AIDS with Tuberculosis Infection[J].Journal of Modern Laboratory Medicine,2016,31(04):35-37,40.[doi:10.3969/j.issn.16717-414.2016.04.008]
点击复制

γ-干扰素体外释放试验在艾滋病并发结核感染诊断中的应用价值探讨()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第31卷
期数:
2016年04期
页码:
35-37,40
栏目:
论著
出版日期:
2016-08-10

文章信息/Info

Title:
Application Value of γ-Interferon in Vitro Release Test in the Diagnosis of AIDS with Tuberculosis Infection
文章编号:
1671-7414(2016)04-035-04
作者:
钱宏波a; 郭 蕊a; 赵汉东a; 杨 欢a; 康 立b; 刘红莉a
陕西省传染病院 西安市第八医院a.检验科;
b.感染一科,西安 710061
Author(s):
QIAN Hong-boa; GUO Ruia; ZHAO Han-donga; YANG Huana; KANG Lib; LIU Hong-lia
a.Department of Clinical Laboratory;
b.Department of Infectious Diseases, Shaanxi Provincial Infectious Diseases Hospital &
Xi'an Eighth Hospital,Xi'an 710061,China
关键词:
γ-干扰素;  体外释放;  艾滋病;  结核
分类号:
R512.91; R392.11
DOI:
10.3969/j.issn.16717-414.2016.04.008
文献标志码:
A
摘要:
目的 探讨艾滋病病毒(HIV)感染者γ-干扰素体外释放试验(TB-IGRA)对于并发结核分枝杆菌感染诊断的应用价值。方法 选取2015年1月～2016年2月期间确诊艾滋病病毒感染者共387例(其中男性320例,女性67例; 年龄15～81岁); 根据外周血CD4+T淋巴细胞计数分为三期四组:HIV感染Ⅰ期组(58例,CD4+细胞计数≥500 cell/μl); HIV感染Ⅱ期组(54例,CD4+细胞计数200～500 cell/μl); 艾滋病期A组(108例,CD4+细胞计数50～199 cell/μl); 艾滋病期B组(167例,CD4+细胞计数≤50 cell/μl)。按照《临床诊疗指南/结核病分册》标准,各组确诊并发结核分枝杆菌感染数分别为14,15,26和39例。采用TB-IGRA检测各组外周血结核分枝杆菌特异性γ-干扰素体外释放水平,判断试验的阴阳性结果。计数资料采用卡方检验,对TB-IGRA在艾滋病病毒并发结核分枝杆菌感染者中的诊断价值进行评价。结果 HIV感染者中确诊的结核感染率平均为24.29%,各期之间差异无统计学意义(χ2=0.440,P=0.932,95%可信区间0.928～0.938)。HIV感染四组的TB-IGRA试验阳性率分别为25.86%,27.78%,25.00%和14.37%,其中艾滋病期B组阳性率(14.37%)显著低于确诊感染率(23.35%),差异有统计学意义(χ2=4.402,P=0.036); 艾滋病期B组TB-IGRA试验阳性率低于其余三组,差异有统计学意义(χ2=3.967～5.047; P值均<0.05)。TB-IGRA试验对艾滋病并发结核感染的诊断灵敏度四组分别为92.86%,86.67%,88.46%和53.85%,前三组显著高于艾滋病期B组,差异有统计学意义(χ2=5.004～8.547; P值均<0.05); 特异度分别为95.45%,94.87%,95.12%和97.66%; 诊断效率分别为94.83%,92.59%,93.52%和87.43%,TB-IGRA试验诊断特异度和诊断效率四组差异无统计学意义(χ2=1.271,4.626; P=0.736,0.201)。结论 TB-IGRA对艾滋病感染者并发结核分枝杆菌的诊断具有较高灵敏度和特异度,但对于外周血CD4+T淋巴细胞计数≤50 cell/μl的患者诊断灵敏度相对较差。
Abstract:
Objective Discussing the diagnostic value of AIDS with tuberculosis infection about the test results of γ-interferon in vitrorelease test(TB-IGRA).Methods There were 387 patientsof HIV-infected in total in our study which choose from January 2015 to February 2016(including men 320 cases,women 67 cases,aged 15-81 years old).They were divided into three periods of four groups according to the CD4 + cell count,as shown below:HIV infection stage I group(58 cases,CD4 + cell count ≥500 cell/μl),HIV infection stage II group(54 cases,CD4 + cell count between 200 and 500 cell/μl),AIDS period in group A(108 cases,CD4 + cell count between50 and 199 cell/μl),AIDS period in group B(167 cases,CD4 + cell count ≤50cell/μl).The numbers of each group infected tuberculosis were 14,15,26,39 cases in order according to the Standard for Clinical Guidelines/Archies of Tuberculosis.Used TB-IGRA method to test the levels of the tuberculin specificity γ-interferon in vitro release in peripheral blood to estimate the results.Counted the data by chi-square test to evaluate the diagnostic value of HIV withtuberculosis infection.Results The average rate of infection with TB of people living with HIV was 24.29%,there were no difference between the different stages(χ2=0.440,P=0.932,95% CI 0.928～0.938).The TB-IGRA test positive rate of the four groups with AIDS were 25.86%,27.78%,25.00% and 14.37%,respectively.Among them,HIV positive rate of group B(14.37%)was significantly lower than confirmed infection rate(23.35%),and the difference was statistically significant(χ2=4.402,P=0.036).The positive rate of TB-IGRA test in AIDS period of group B was lower than the otherthree groups(χ2=3.967～5.047,P values<0.05).The diagnostic sensitivity of TB-IGRA test for HIV with TB were 92.86%,86.67%,88.46% and 53.85% respectively in order.The first three groups were significantly higher than AIDSperiod in group B,and the difference was significant(χ2=5.004～5.547,P values<0.05).The diagnostic specificity were 97.73%,97.73%,95.12% and97.66% respectively.The diagnostic efficiency were 96.55%,96.55%,92.59% and 87.42% respectively,and there were no difference between the four groups ofTB-IGRA test on diagnostic specificity and efficiency(χ2=1.271,4.626; P=0.736,0.201).Conclusion There are high sensitivity and specificity in diagnosis of B IGRA test for HIV infected patients with tuberculosis,but the diagnostic sensitivity is relatively poor for HIV infectedpatients with tuberculosis whose CD4+ cell count of peripheral blood are less than 50 cell/μl.

参考文献/References:

[1] 蓝 珂,吴秋蝉,覃善芳,等.艾滋病经高效抗逆转录病毒治疗后发生免疫重建综合征并发肺结核的临床特点研究[J].中国全科医学,2012,15(19):2191-2192. Lan K,Wu QC,Qin SF,et al.Clinical characteristics research of immune reconstitution syndrome complicated with pulmonary tuberculosis in AIDS patients after highly active anti-retroviral therapy[J].Chinese Generd Practice,2012,15(19):2191-2192.
[2] Kobashi Y,Abe M,Mouri K,et al.Usefulness of tuberculin skin test andthree interferon-gamma release assays for the differential diagnosis of pulmonary tuberculosis[J].Intern Med,2012,51(10):1199-1205.
[3] 钱 晨.结核感染T细胞酶联免疫斑点试验与结核抗体试验在诊断骨关节结核中的临床应用价值[J].现代检验医学杂志,2015,30(4):74-76. Qian C.Clinical value of tuberculosis infection T cell ELISPOT andTB antibody test in experimental tuberculosis of bones and joints[J].J Mod Lab Med,2015,30(4):74-76.
[4] 鲁 曦,李王平,谢永宏,等.γ-干扰素释放试验在肺外结核诊断中的应用与评价[J].中华肺部疾病杂志(电子版),2016,9(1):20-25. Lu X,Li WP,Xie YH,et al.Evaluation of interferon-gamma releasetechnique in extra-pulmonary tuberculosis detection[J].Chin J Lung Dis(Electronic Edition),2016,9(1):20-25.
[5] 段 静,王 艳,袁 杭,等.结核杆菌五种实验室检测方法比较[J].现代检验医学杂志,2014,29(4):79-82. Duan J,Wang Y,Yuan H,et al.Comparison of mycobacterium tuberculosis in five kinds of laboratory tests[J].J Mod Lab Med,2014,29(4):79-82.
[6] 李 珊,刘媛媛,李 宁,等.住院艾滋病患者并发巨细胞病毒感染特点分析[J].中国病毒病杂志,2015,5(3):185-188. Li S,Liu YY,Li N,et al.Cytomegalovirus infection among hospitalized AIDS patients in Wuhan city of China[J].Chin J Viral Dis,2015,5(3):185-188.
[7] 童学成,陈国春,濮翔科,等.结核感染T细胞斑点试验对艾滋病合并肺结核的临床诊断价值[J].中华医院感染学杂志,2014,24(14):3632-3634. Tong XC,Chen GC,Pu XK,et al.Clinical value of T-cell enzyme-linked immunospot test in diagnosis of AIDS complicated with tuberculosis[J].Chin J Nosocomiol,2014,24(14):3632-3634.
[8] 陈仁芳,杨琦恩,陆宇红,等.T-SPOT.TB在艾滋病合并结核感染诊断中的应用[J].江苏医药,2014,40(5):532-534. Chen RF,Yang QE,Lu YH,et al.Application of T-SPOT.TB in diagnosis of tuberculosis in AIDS patients in advanced stag[J].Jangsu Med J,2014,40(5):532-534.
[9] 中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第3版(2015版)[J].中华临床感染病杂志,2015,8( 5):385-401. AIDS Professional Group,Society of Infectious Diseases,Chinese Medical Association.Third edition of the guidelines for diagnosia and treatment ofHIV/AIDS(2015)[J].Chin J Clin Infect Dis,2015,8(5):385-401.

备注/Memo

备注/Memo:
基金项目:陕西省社会发展科技攻关项目(2016SF-218)。
作者简介:钱宏波(1976-),男,学士,主管检验技师,主要从事传染病临床免疫学检验工作,E-mail:qianhb1027@163.com。
通讯作者:刘红莉,女,博士,主任检验技师,E-mail:liuhonglili@sina.com。
更新日期/Last Update: 2016-08-10