摘要
目的分析结核分枝杆菌γ-干扰素体外释放试验(TB-IGRA)联合结核分枝杆菌及利福平耐药检测(Xpert MTB/RIF)在CD4^(+)下降(CD4^(+)<200个/μl)艾滋病(AIDS)合并肺结核(PTB)患者中的诊断价值。方法回顾性分析2021年8月~2024年7月衡水市第二人民医院收治的110例疑似合并PTB的AIDS患者临床资料,以MTB培养及菌型鉴定结果为金标准进行分组,69例AIDS合并PTB患者纳入AIDS+PTB组,41例未合并PTB患者纳入AIDS未合并PTB组。比较TB-IGRA、Xpert MTB/RIF评估AIDS合并PTB的诊断效能。结果110例患者中共69例诊断为AIDS合并PTB,41例为AIDS未合并PTB。在AIDS合并PTB的诊断中,TB-IGRA、Xpert MTB/RIF与金标准中度一致(Kappa=0.590、0.450),联合检测与金标准一致性较好(Kappa=0.764)。TB-IGRA的准确度为80.91%,Xpert MTB/RIF的准确度为74.55%,联合检测的准确度为89.09%,TB-IGRA、Xpert MTB/RIF与联合检测的准确度比较,差异有统计学意义(χ^(2)=7.763,P<0.05)。联合检测的灵敏度、特异度、准确度及阴性预测值(92.75%、82.93%、89.09%和87.18%)均高于单独Xpert MTB/RIF检测(81.16%、63.41%、74.55%和87.18%)(χ^(2)=4.089、3.976、7.822、4.622,P<0.05)。TB-IGRA与Xpert MTB/RIF的灵敏度、特异度、准确度、阳性预测值及阴性预测值比较,差异无统计学意义(P>0.05)。TB-IGRA、Xpert MTB/RIF诊断AIDS合并PTB的AUC分别为0.793、0.723,二者联合的AUC为0.878,敏感度为92.75%,特异度为82.93%,联合因子AUC高于单独检测(Z=7.153、4.968,P<0.05)。结论TB-IGRA、Xpert MTB/RIF在CD4^(+)<200个/μl的AIDS合并PTB患者的诊断中均具有一定应用价值,联合检测有助于提高诊断准确性。
Objective To analyze the diagnostic value of tuberculosis-specific interferon-gamma release assay(TB-IGRA)combined with Xpert Mycobacterium tuberculosis/rifampicin(Xpert-MTB/RIF)in acquired immune deficiency syndrome(AIDS)patients with CD4^(+)decline and pulmonary tuberculosis(PTB).Methods A retrospective analysis was conducted on the clinical data of 110 AIDS patients with suspected PTB who were admitted to the hospital from August 2021 to July 2024.The patients were grouped according to the gold standard of MTB culture and bacterial type identification.69 AIDS patients with PTB were included in the AIDS with PTB group,and 41 AIDS patients without PTB were included in the AIDS without PTB group.The diagnostic efficacy of TB-IGRA and Xpert MTB/RIF for PTB in AIDS was compared.Results Among the 110 AIDS patients,there were 69 patients with PTB and 41 patients without.In the diagnosis of AIDS complicated with PTB,TB-IGRA and Xpert MTB/RIF showed moderate consistency with the gold standard(Kappa=0.590,0.450).Combination of the two showed good consistency with the gold standard(Kappa=0.764).The accuracy rates of TB-IGRA,Xpert MTB/RIF,and their combination were 80.91%,74.55%and 89.09%.Comparison of the accuracy between TB-IGRA,Xpert MTB/RIF and combined detection found statistically significant differences(χ^(2)=7.763,P<0.05).The sensitivity,specificity,accuracy and negative predictive value of combined detection(92.75%,82.93%,89.09%and 87.18%)were higher than those of Xpert MTB/RIF(81.16%,63.41%,74.55%and 87.18%)(χ^(2)=4.089,3.976,7.822,4.622,all P<0.05).There were no statistically significant differences in the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value between TB-IGRA and Xpert MTB/RIF(P>0.05).The AUC values of TB-IGRA and Xpert MTB/RIF for diagnosing AIDS complicated with PTB were 0.793 and 0.723,respectively.The combined AUC was 0.878.The sensitivity and specificity of combined diagnosis were 92.75%and 82.93%.The AUC of combined diagnosis was higher than that of separate diagnosis(Z=7.153,4.968,both P<0.05).Conclusion TB-IGRA and Xpert MTB/RIF both demonstrate significant diagnostic value in AIDS patients with PTB and CD4^(+)<200 cells/μl.The combined assay significantly improves diagnostic accuracy.
作者
刘灿
曹亚伟
赵月
Liu Can;Cao Yawei;Zhao Yue(Department of General Medicine,the Second People's Hospital of Hengshui,Hengshui 053000,China)
出处
《中华保健医学杂志》
2025年第3期419-423,共5页
Chinese Journal of Health Care and Medicine
基金
衡水市2023年度科技计划项目(2023014004z)。
关键词
结核分枝杆菌γ-干扰素体外释放试验
结核分枝杆菌及利福平耐药检测
艾滋病
肺结核
诊断价值
Tuberculosis-specific interferon-gamma release assay
Xpert Mycobacterium tuberculosis/rifampicin assay
Acquired immune deficiency syndrome
Pulmonary tuberculosis
Diagnostic value
