摘要
目的探讨HIV合并结核分枝杆菌感染患者外周血CD4＋T淋巴细胞的变化及其对酶联免疫斑点试验（ELISPOT）的影响。方法应用结核酶联免疫斑点试验（T-SPOT．TB）对云南省和上海地区193例明确诊断的HIV感染者的血标本进行结核分枝杆菌特异性T淋巴细胞检测，同时应用流式细胞仪检测外周血CD4’T淋巴细胞计数，采用t检验进行统计学分析。结果HIV感染者中潜伏性结核发生率达30．6％。HIV合并活动性结核患者的外周血CD4＋T淋巴细胞计数平均值为190×10^8／L，显著低于HIV合并潜伏性结核组的484×10^6／L（t=6．665，P〈0．01）。根据CD4’T淋巴细胞计数〉500×10^6／L、200×10^6～500×10^6／L、〈200×10^6／L进行分层分析发现，活动性结核组和潜伏性结核组构成比依次为1：16．2、1：1．3、5．6：1。79例T—SPOT．TB阳性的病例中，共有20例HIV合并活动性结核患者，其中14例患者CD4＋。T淋巴细胞计数平均值〈200×10^6／L，5例为200×10^6／L～500×10^6／L，1例〉500×10^6／L。59例潜伏性结核患者中，52例CD4＋T淋巴细胞计数〉200×10^6／L。结论我国HIV感染人群中有较高的潜伏性结核发生率，HIV合并活动性结核患者的总体细胞免疫应答功能严重受损，随着CD4＋T淋巴细胞计数的下降，HIV患者合并的潜伏性结核更易进展为活动性结核。当CD4＋T淋巴细胞〈200×10^6／L时，对T—SPOT．TB检测结果可能有影响。
Objective To evaluate the relationship between CD4＋ T lymphocyte count and results of enzyme-linked immunospot （ELISPOT） assay in human immunodefieieney virus （HIV）- Mycobacterium tuberculosis （M. tb） coinfeeted patients. Methods A total of 193 HIV-infected individuals in Yunnan Province and Shanghai were enrolled. T-SPOT. TB assay was employed to detect M. tb specific T lymphocyte in the peripheral blood mononuclear cells （PBMC）. CD4＋ T lymphocyte in PBMC from the enrolled subjects was detected by flow cytometry. Data were analyzed using t test. Results The incidence of latent tuberculosis in HIV-infected individuals was 30. 6%. The CD4＋ T lymphocyte counts in HIV-infected individuals with active tuberculosis were 190 × 10^6/L, which were significantly lower than those in HIV-infected individuals with latent tuberculosis （484× 10^6/L; t= 6.665, P〈0.01）. The HIV-infeeted individuals were stratified according to CD4＋ T lymphocyte counts of〉500× 10^6/L, 200× 10^6-500× 10^6/L, and 〈200×10^6/L and the constituentratios of active tuberculosis/latent tuberculosis were 1 ： 16.2, 1 ： 1.3 and 5.6 ： 1, respectively. Among 79 subjects with positive T-SPOT. TB results, 20 were coinfected with active tuberculosis, in which 14 had CD4＋ T lymphocyte counts of 〈200 × 10^6/L, 5 had 200×10^6-500 ×10^6/L and had 〉500×10^6/L. Fifty-two in 59 HIV/latent tuberculosis patients individuals had CD4＋ T lymphocyte counts of 〉200 ×10^6/L. Conclusions The prevalence of latent tuberculosis in HIV-infected individuals is high in China. Cellular immunity in HIV-infected individuals with active tuberculosis is severely impaired. With the decrease of CD4＋ T lymphocyte counts, patients with latent tuberculosis are prone to develop active tuberculosis in HIV-infected individuals. The negative predictive value of T-SPOT. TB is significantly diminished in patient with low CD4＋ T lymphocyte counts, especially less than 200×10^6/L.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2012年第6期363-367,共5页
Chinese Journal of Infectious Diseases
