HIV感染者行γ-干扰素释放试验用于筛查潜伏性结核感染的临床价值-东南大学学报医学版

HIV感染者行γ-干扰素释放试验用于筛查潜伏性结核感染的临床价值

单位：1. 重庆市第五人民医院感染性疾病科, 重庆 400062;
2. 重庆医科大学附属第一医院院感科, 重庆 404000

关键词：人类免疫缺陷病毒潜伏性结核感染结核菌素皮肤试验干扰素-γ释放试验风险分层

分类号：R446.1;R521

出版年·卷·期（页码）：2022·41·第四期（471-476）

摘要：

目的：探讨人类免疫缺陷病毒（HIV）感染者行γ-干扰素释放试验（IGRA）用于筛查潜伏性结核感染（LTBI）的临床价值。方法：于2018年3月至2021年4月在重庆市第五人民医院招募了90例有LTBI风险、年龄≥18岁的HIV感染者，行结核菌素皮肤试验（TST）和IGRA，诊断HIV感染者LTBI。LTBI被定义为有LTBI风险和至少1个阳性结果（TST或IGRA），并且没有活动性肺结核病（TB）的临床证据。我们还评估了TST和IGRA用于HIV感染者LTBI风险分层（家庭内接触风险和家庭外接触风险）的准确性。结果：90例HIV感染者中，80例符合LTBI的诊断标准，只有21例（26.3%）为TST阳性，75例（93.7%）为IGRA阳性。TST与LTBI诊断一致性差（Kappa值=0.073），而IGRA结果与LTBI诊断则表现出良好的一致性（Kappa值=0.769）。在69例具有家庭内接触风险者和21例具有家庭外接触风险者中，TST阳性者分别为19例（27.5%）和2例（9.5%），而IGRA阳性者分别为68例（98.5%）和7例（33.3%）。TST结果与LTBI风险一致性较差（Kappa值=0.180，95%CI 0.000~0.375），相反，IGRA结果与LTBI风险一致性较高（Kappa值=0.724，95%CI 0.555~0.894）。结论：与TST相比，IGRA阳性与LTBI感染风险一致，是用于HIV感染者LTBI筛查更优的诊断工具。

Objective: To investigate the clinical value of gamma-interferon release test(IGRA) in screening latent tuberculosis infection(LTBI) in human immunodeficiency virus(HIV) infected patients.Methods: A total of 90 HIV infected patients aged ≥ 18 years old at risk for LTBI were recruited into the cross-sectional study during March 2018 to April 2021 in the Fifth People's Hospital of Chongqing. The tuberculin skin test(TST) and IGRA were used to diagnose LTBI among patients with HIV. LTBI is defined by having LTBI risk(risk of exposure within or outside the home) and at least one positive test(TST or IGRA), without clinical evidence of active TB. The accuracy of TST and IGRA for screening the LTBI risk stratification among HIV patients was assessed. Results: Among 90 HIV patients, 80 met the study criteria for LTBI, 21 patients(26.3%) were TST positive and 75 patients(93.7%) were IGRA positive. TST showed poor agreement with the diagnosis of LTBI(Kappa=0.073), while IGRA demonstrated good agreement(Kappa=0.769). Among 69 patients with the risk of exposure within the home and 21 with the risk of exposure outside the home, TST was positive in 19(27.5%) and 2(9.5%), while IGRA was positive in 68(98.5%) and 7(33.3%) patients, respectively. The consistency between TST results and LTBI risk was poor(Kappa=0.180, 95% CI 0.000-0.375). On the contrary, IGRA results were highly consistent with LTBI risk(Kappa=0.724, 95% CI 0.555-0.894). Conclusion: Compared to TST, IGRA positivity is consistent with the risk of LTBI infection and seems to be a better diagnostic tool for LTBI screening in HIV-infected patients.

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