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目的 :探讨结核感染T细胞斑点试验(T cells spot test of Tuberculosis infection,TSPOT.TB)在人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/获得性免疫缺乏综合征(acquired immune deficiency syndrome,AIDS)合并分枝杆菌感染患者中诊断结核杆菌感染的价值。方法:回顾性调查2012年7月至2016年12月复旦大学附属上海市公共卫生临床中心251例行TSPOT.TB检测的HIV感染/AIDS患者的临床资料,以MPB64胶体金菌型鉴定法为金标准,251例患者中135例诊断为结核分枝杆菌感染,116例诊断为非结核分枝杆菌感染,分析TSPOT.TB诊断HIV感染/AIDS合并分枝杆菌感染患者是否为结核分枝杆菌感染的价值,并将患者按感染部位分为肺外感染与肺部感染2组,按CD4+T细胞数目分为CD4+T≤200个/μL和CD4+T>200个/μL 2组,探讨TSPOT.TB在不同感染部位和不同CD4+T细胞数目患者中的诊断灵敏度和特异度。结果:251例HIV感染/AIDS合并分枝杆菌感染患者中,TSPOT.TB诊断结核分枝杆菌感染的灵敏度和特异度分别为83.70%和80.17%。其在肺外和肺部分枝杆菌感染患者中的诊断灵敏度分别为85.00%和82.67%,差异无统计学意义(χ~2=0.133,P=0.715);而其特异度分别为93.10%和75.86%,差异有统计学意义(χ~2=4.067,P=0.044)。在CD4+T≤200个/μL组和CD4+T>200个/μL组患者中,TSPOT.TB的诊断灵敏度分别为81.58%和80.95%,差异无统计学意义(χ~2=0.000,P=1.000);而其特异度则分别为85.86%和47.06%,差异有统计学意义(χ~2=11.408,P=0.001)。结论 :在HIV感染/AIDS合并分枝杆菌感染患者中,TSPOT.TB诊断结核分枝杆菌感染的灵敏度较高,在不同感染部位、不同CD4+T细胞数患者间,其诊断灵敏度均较稳定,不存在统计学差异;但其诊断特异度在肺外感染与肺部感染、CD4+T≤200个/μL与CD4+T>200个/μL组间差异存在统计学意义,提示其诊断特异度可能受感染部位和CD4+T细胞数目影响。
Objective: To investigate the effect of T cell spot test of Tuberculosis infection (TSPOT.TB) on human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) Diagnostic value of Mycobacterium tuberculosis infection in patients with mycobacterium tuberculosis infection. Methods: The clinical data of 251 HIV / AIDS patients tested by TSPOT.TB from 251 patients admitted to Shanghai Public Health Clinical Center affiliated to Fudan University from July 2012 to December 2016 were retrospectively analyzed. Standard, 135 out of 251 patients were diagnosed as Mycobacterium tuberculosis infection, 116 were diagnosed as non-tuberculous mycobacteria infection, and TSPOT.TB was used to diagnose whether Mycobacterium tuberculosis infection was found in HIV-infected / AIDS-infected patients with Mycobacterium tuberculosis According to the number of CD4 + T cells, the patients were divided into 2 groups: CD4 + T≤200 cells / μL and CD4 + T> 200 cells / μL. TSPOT Diagnostic sensitivity and specificity of TB in patients with different sites of infection and different numbers of CD4 + T cells. Results: The sensitivity and specificity of TSPOT.TB in the diagnosis of Mycobacterium tuberculosis infection were 83.70% and 80.17% in 251 HIV / AIDS patients with mycobacterial infection. The diagnostic sensitivity of mycobacterium tuberculosis in patients with mycobacterium tuberculosis and pulmonary mycobacterium infection were 85.00% and 82.67% respectively, with no significant difference (χ ~ 2 = 0.133, P = 0.715), while the specificity was 93.10% and 75.86 %, The difference was statistically significant (χ ~ 2 = 4.067, P = 0.044). The diagnostic sensitivity of TSPOT.TB was 81.58% and 80.95% in CD4 + T≤200 cells / μL group and CD4 + T> 200 cells / μL group respectively, with no significant difference (χ ~ 2 = 0.000, P = 1.000), while the specificity was 85.86% and 47.06% respectively, with significant difference (χ ~ 2 = 11.408, P = 0.001). CONCLUSION: TSPOT.TB has a high sensitivity for the diagnosis of Mycobacterium tuberculosis infection in patients with HIV / AIDS complicated with mycobacteria infection. The diagnostic sensitivity of TSPOT.TB is stable in patients with different infection sites and different CD4 + T cell counts, There was no statistical difference between the two groups. However, the diagnostic specificity was significantly different between extrapulmonary and pulmonary infections. The differences of CD4 + T≤200 / μL and CD4 + T> 200 / μL were statistically significant, suggesting that the diagnostic specificity It may be affected by the number of infected sites and CD4 + T cells.