CAJ | 학술논문

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190×106/L,显著低于HIV合并潜伏性结核组的484×106/L(t=6.665,P＜0.01).根据CD4+T淋巴细胞计数＞500×106/L、200×106～500×106/L、＜200×106/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＜200×106/L,5例为200×106/L～500×106/L,1例＞500×106/L.59例潜伏性结核患者中,52例CD4+T淋巴细胞计数＞200×106/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CD4ˉT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＜200×106/L时,对T-SPOT.TB检测结果可能有影响.
목적 탐토HIV합병결핵분지간균감염환자외주혈CD4+T림파세포적변화급기대매련면역반점시험(ELISPOT)적영향.방법 응용결핵매련면역반점시험(T-SPOT.TB)대운남성화상해지구193례명학진단적HIV감염자적혈표본진행결핵분지간균특이성T림파세포검측,동시응용류식세포의검측외주혈CD4+T림파세포계수,채용t검험진행통계학분석.결과 HIV감염자중잠복성결핵발생솔체30.6％.HIV합병활동성결핵환자적외주혈CD4+T림파세포계수평균치위190×106/L,현저저우HIV합병잠복성결핵조적484×106/L(t=6.665,P＜0.01).근거CD4+T림파세포계수＞500×106/L、200×106～500×106/L、＜200×106/L진행분층분석발현,활동성결핵조화잠복성결핵조구성비의차위1∶16.2、1∶1.3、5.6∶1.79례T-SPOT.TB양성적병례중,공유20례HIV합병활동성결핵환자,기중14례환자CD4+T림파세포계수평균치＜200×106/L,5례위200×106/L～500×106/L,1례＞500×106/L.59례잠복성결핵환자중,52례CD4+T림파세포계수＞200×106/L.결론 아국HIV감염인군중유교고적잠복성결핵발생솔,HIV합병활동성결핵환자적총체세포면역응답공능엄중수손,수착CD4ˉT림파세포계수적하강,HIV환자합병적잠복성결핵경역진전위활동성결핵.당CD4+T림파세포＜200×106/L시,대T-SPOT.TB검측결과가능유영향.
Objective To evaluate the relationship between CD4+ T lymphocyte count and results of enzyme-linked immunospot (ELISPOT) assay in human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (M.tb) coinfected 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 190×106/L,which were significantly lower than those in HIV-infected individuals with latent tuberculosis (484×106/L; t=6.665,P＜0.01).The HIV-infected individuals were stratified according to CD4+ T lymphocyte counts of ＞500×106/L,200×106-500×106/L,and ＜200×106/L and the constituent ratios 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 ×106/L,5 had 200×105-500×106/L and 1 had ＞500×106/L.Fifty-two in 59 HIV/latent tuberculosis patients individuals had CD4+ T lymphocyte counts of ＞200×106/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 200×106/L.