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（ χ2=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( χ2=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（ χ2=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（ χ2=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 diagnostic value of T cells spot test of Tuberculosis infection （TSPOT.TB） in human immunodeficiency virus infection/acquired immuodeficiency syndrome patients with positive Mycobacteria culture. Methods: A retrospective study was conducted on 251 HIV infection/AIDS patients with Mycobacteria infection receiving TSPOT.TB test from July 2012 to Dec 2016 in Shanghai Public Health Center affiliated to Fudan University. MPB64 colloidal gold method was taken as the golden standard. The value of TSPOT.TB for diagnosing tuberculosis infection in HIV infection/AIDS patients with positive Mycobacteria culture was analyzed. Patients was divided into groups according the infection site and CD4+ T cell count, and the diagnostic value of TSPOT.TB in patients with extra-pulmonary and pulmonary infection and in patients with CD4+ T≤200/μL and CD4+ T>200/μL was analyzed. Results: Among the 251 HIV infection /AIDS patients with Mycobacteria infection, the diagnostic sensitivity and specificity of TSPOT.TB for Tuberculosis were 83.70% and 80.17%. The diagnostic sensitivity of TSPOT.TB in patients with extra-pulmonary and pulmonary Tuberculosis infection were 85.00% and 82.67%, respectively, and there was no statistical difference( χ2=0.133, P=0.715). The specificity of TSPOT.TB in these two groups were 93.10% and 75.86%, respectively, and there was a statistically significant difference between the two groups ( χ2=4.067, P=0.044). In HIV infection/ AIDS patients with CD4+ T≤200/μL and CD4+ T>200/μL, the diagnostic sensitivity of TSPOT.TB for Tuberculosis was 81.58% and 80.95%, respectively, and there was no statistical difference ( χ2=0.000, P=1.000) between the two groups, yet the specificity of TSPOT.TB were 85.86% and 47.06%, respectively, and the difference was statistically significant ( χ2=11.408, P=0.001). Conclusions: The diagnostic sensitivity of TSPOT.TB for HIV infection/AIDS patients with active Tuberculosis is high, and the infection site and CD4+ T cells counts might not be the impact factors of sensitivity of TSPOT.TB, but they can influence the specificity of TSPOT.TB.
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