| 15 | 0 | 32 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨化学发光法结核感染T细胞试验(chemiluminescence-based tuberculosis interferon-gamma release assay, TB-IGRA)对人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染合并活动性肺结核的诊断价值，并分析其敏感度、特异度及相关影响因素。方法 选取2021年1月至2023年3月期间孝感市第一人民医院收治的108例HIV感染住院患者为研究对象，其中76例临床确诊为活动性肺结核(研究组)，其余32例排除结核感染(对照组)。所有患者均接受TB-IGRA检测，比较2组检测结果的差异，评估TB-IGRA在HIV感染者中对结核病的诊断效能。进一步将研究组依据TB-IGRA检测结果分为阴性组和阳性组，采用Spearman相关分析探讨HIV载量、CD4~+T淋巴细胞计数与TB-IGRA结果的相关性。同时，采用多因素Logistic回归分析TB-IGRA敏感度的独立影响因素。结果 TB-IGRA在HIV感染人群中诊断活动性肺结核的敏感度为71.05%，特异度为90.63%，阳性预测值为94.74%，阴性预测值为56.86%，准确度为76.85%。多因素分析显示，年龄、CD4~+T淋巴细胞计数及HIV载量是影响TB-IGRA敏感度的独立影响因素。结论 TBIGRA在HIV感染人群中诊断活动性肺结核具有较高的特异度和准确度，但敏感度相对较低，其检测结果受年龄、HIV载量及CD4~+T淋巴细胞计数等因素的影响。
Abstract：Objective To evaluate the diagnostic value of the chemiluminescence-based tuberculosis interferon-gamma assay(TB-IGRA) for active pulmonary tuberculosis in HIV-infected populations, and to analyze its sensitivity, specificity,and related influencing factors. Methods We retrospectively collected the clinical and laboratory data from 108 HIV-infected inpatients admitted to Xiaogan First People's Hospital between January 2021 to March 2023. Among them, 76 cases were clinically diagnosed with active pulmonary tuberculosis(study group), while the remaining 32 patients without tuberculosis infection served as the control group. By comparing TB-IGRA test results between the 2 groups, we aimed to evaluate the diagnostic performance of TB-IGRA for tuberculosis in HIV-infected individuals. Furthermore, the study group was subdivided into negative group and the positive group based on TB-IGRA results. Spearman'rank correlation analysis was performed to assess the associations between HIV viral load, CD4+ T-lymphocyte count, and TB-IGRA outcomes. Additionally, multivariate logistic regression analysis was conducted to indentify independent predictors of TB-IGRA sensitivity in this population. Results The sensitivity of TB-IGRA for diagnosing active pulmonary tuberculosis in HIV-infected individuals was 71.05%, with a specificity of 90.63%, positive predictive value(PPV) of 94.74%, negative predictive value(NPV) of 56.86%, and overall accuracy of 76.85%. Multivariate analysis revealed that age, CD4+ T-lymphocyte count, and HIV viral load were independent predictors of TB-IGRA sensitivity. Conclusion TB-IGRA demonstrates high specificity and accuracy for diagnosing active pulmonary tuberculosis in HIV-infected individuals, but its sensitivity is relatively low. The test results are significantly by age, HIV viral load, and CD4+ T-lymphocyte count.
[1]刘雷丹，张龙燕.湖北荆州地区结核分枝杆菌/人类免疫缺陷病毒双重感染流行病学特征及治疗转归分析[J].传染病信息，2024,37(5):405-407. DOI:10.3969/j.issn.1007-8134.2024.05.004.
[2]郑志刚，耿文奎，陆珍珍，等.艾滋病病毒与结核分枝杆菌双重感染对死亡的影响[J].中华流行病学杂志，2018,39(10):1362-1367.DOI:10.3760/cma.j.issn.0254-6450.2018.10.014.
[3]高伟，何霞，陈涛，等.安图TB-IGRA产品对结核病的诊断价值研究[J].检验医学与临床，2019,16(1):57-59. DOI:10.3969/j.issn.1672-9455.2019.01.017.
[4]中华人民共和国国家卫生健康委员会.中华人民共和国卫生行业标准-《艾滋病和艾滋病病毒感染诊断》（W2013-2019）[S].北京：中华人民共和国国家卫生健康委员会. 2019.
[5]中华人民共和国国家卫生和计生委员会.肺结核诊断标准（WS 288-2017）[J].新发传染病电子杂志，2018,3(1):59-61.DOI:10.3877/j.issn.2096-2738.2018.01.017.
[6]刘彪，何香溪，谢小馨，等.宏基因组二代测序对人类免疫缺陷病毒感染者/艾滋病患者疑似结核病诊断价值研究[J].传染病信息,2024, 37(5):401-404. DOI:10.3969/j.issn.1007-8134.2024.05.003.
[7]王爱彬，杨思园，蒋荣猛，等.结核感染T淋巴细胞斑点试验检测艾滋病合并结核病患者的敏感度及影响因素[J].中华传染病杂志，2016,34(11):660-663. DOI:10.3760/cma.j.issn.1000-6680.2016.11.005.
[8]夏青，桂淑玉，韩莙.结核感染T细胞斑点试验在结核病诊断中的价值及影响因素[J].实用医学杂志，2018,34(20):3469-3473.DOI:10.3969/j.issn.1006-5725.2018.20.035.
[9]梁丽丽，吕娅敏，马芸，等.结核感染T细胞斑点试验假阴性影响因素回归分析[J].医学研究杂志，2019,48(1):42-46.DOI:10.11969/j.issn.1673-548X.2019.01.012.
[10]Liao CH, Lai CC, Tan CK, et al. False-negative results by enzyme-linked immunospot assay for interferon-gamma among patients with culture-confirmed tuberculosis[J]. J Infect, 2009, 59(6):421-423.DOI:10.1016/j.jinf.2009.09.012.
[11]邹兴武，周华，符一骐，等.结核感染T细胞斑点试验在结核性胸膜炎患者中假阴性的危险因素分析[J].中国感染与化疗杂志，2018,18(5):467-471. DOI:10.16718/j.1009-7708.2018.05.004.
[12]耿丽琴，周翠红，李擎宇.结核感染T细胞斑点试验诊断结核感染的价值及结果假阴性的相关影响因素[J].实用医技杂志，2022,29(3):267-270. DOI:10.19522/j.cnki.1671-5098.2022.03.010.
[13]Tochaeng C, Eksombatchai D, Boonsarngsuk V. Factors associated with false-negative for T-SPOT.TB in patients with TB disease[J]. Int J Tuberc Lung Dis, 2023, 27(2):128-134. DOI:10.5588/ijtld.22.0368.
[14]崔中锋，刘春礼，史继静，等. T细胞酶联免疫斑点试验在HIV感染合并结核潜伏性感染筛查诊断中的研究[J]．中国实用医刊，2015,(20):1-3. DOI:10.3760/cma.j.issn.1674-4756.2015.20.001.
[15]曾艳，洪可，阮连国，等.结核分枝杆菌特异性细胞免疫反应检测对HIV/AIDS患者结核病的诊断价值[J].热带医学杂志，2022,22(10):1367-1370. DOI:10.3969/j.issn.1672-3619.2022.10.009.
[16]邹丹凤，肖和平，尹洪云.结核感染T细胞斑点试验在HIV/AIDS合并结核病诊断中的应用[J].同济大学学报（医学版），2015,36(5):74-77. DOI:10.16118/j.1008-0392.2015.05.016.
[17]孙逊、凌虹、杨巍，等.医学免疫学[M].北京：高等教育出版社，2022:51.
[18]Shangguan Y, Fang H, Wang S, et al. Risk factors for negative TB-IGRA assay results in patients with confirmed active tuberculosis:a retrospective study[J]. J Infect Dev Ctries, 2020, 14(11):1288-1295.DOI:10.3855/jidc.12063.
[19]Ford N, Meintjes G, Pozniak A, et al. The future role of CD4 cell count for monitoring antiretroviral therapy[J]. Lancet Infect Dis,2015, 15(2):241-247. DOI:10.1016/S1473-3099(14)70896-5.
[20]邹诗，朱琦，郭卫，等. HIV合并结核患者外周血中结核特异性单个核细胞的动态分析[J].中华结核和呼吸杂志，2022,45(11):1109-1116. DOI:10.3760/cma.j.cn112147-20220823-00710.
[21]Chen J, Zhang R, Wang J, et al. Interferon-gamma release assays for the diagnosis of active tuberculosis in HIV-infected patients:a systematic review and meta-analysis[J]. PLoS One. 2011, 6(11):e26827.DOI:10.1371/journal.pone.0026827.
基本信息:
中图分类号:R52;R512.91
引用信息:
[1]蒋祖环,艾文彬,王之玺.化学发光法结核感染T细胞试验在HIV感染人群中的应用及其影响因素分析[J].传染病信息,2026,39(01):14-18+23.
2026-02-28
2026-02-28