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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (9): 931-936.doi: 10.3969/j.issn.1000-6621.2020.09.009

• 论著 • 上一篇    下一篇


李婷, 何金戈*, 苏茜, 李京, 李运葵, 高文凤, 高媛, 杨文   

  1. 610041 成都,四川省疾病预防控制中心结核病预防控制所(李婷、何金戈、苏茜、李京、李运葵、高文凤、高媛),重大专项办公室(杨文)
  • 收稿日期:2020-06-09 出版日期:2020-09-10 发布日期:2020-09-18
  • 通信作者: 何金戈,杨文
  • 基金资助:

Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County, Sichuan Province

LI Ting, HE Jin-ge*, SU Qian, LI Jing, LI Yun-kui, GAO Wen-feng, GAO Yuan, YANG Wen   

  1. Tuberculosis Prevention and Control Department, Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
  • Received:2020-06-09 Online:2020-09-10 Published:2020-09-18
  • Contact: HE Jin-ge,YANG Wen


目的 分析结核菌素(PPD)试验对凉山彝族自治州布拖县HIV感染/AIDS患者结核感染筛查的应用价值。方法 2018年12月至2019年8月从布拖县九都乡、木尔乡、特木里镇“十三五”国家科技重大专项课题已管理的2159例HIV感染/AIDS患者中,纳入可随访且已接受免疫抑制剂治疗>1个月的688例患者开展问卷调查、PPD试验、胸部X线摄影(简称“胸片”)等肺结核现场筛查和全血CD4+T淋巴细胞计数检测,对符合条件者进行MTB病原学检测。排除175例未进行PPD试验结果核验、40例未行胸片检查且无结核病病原学诊断依据和7例非结核分枝杆菌感染的患者后,最终纳入466例患者;统计PPD试验结果(皮肤硬结平均直径≥5mm为阳性)及专家组判定活动性肺结核或潜伏性结核感染(LTBI)情况。采用SPSS 21.0软件对数据进行分析,以专家组确诊的活动性肺结核为参考标准评价PPD试验对活动性肺结核的检测效能(包括敏感度、特异度、阳性预测值、阴性预测值、一致率);PPD阳性率与是否并发活动性肺结核及不同CD4+T淋巴细胞计数患者间率的比较采用χ2检验,以P<0.05为差异有统计学意义。结果 466例患者中,PPD试验阴性377例(80.90%)、一般阳性14例(3.00%)、中度阳性29例(6.23%)、强阳性46例(9.87%),阳性率为19.10%(89/466),均符合结核感染。经结核病筛查程序和专家组定诊,466例患者中活动性肺结核为89例,检出率为19.10%;而89例PPD试验阳性患者中,57例为LTBI,检出率为12.23%(57/466)。以专家组确诊的活动性肺结核作为参考标准,PPD试验检测活动性肺结核的敏感度、特异度和一致率分别为35.96%(32/89)、84.88%(320/377)和75.54%(352/466)。HIV感染/AIDS并发活动性肺结核患者的PPD试验阳性率[35.96%(32/89)]明显高于未并发者[15.12%(57/377)](χ2=20.827,P=0.000),且并发活动性肺结核患者仅在血CD4+ T淋巴细胞计数≥500个/μl时 [52.00%(13/25)]明显高于未并发者[16.67%(19/114)](χ2=14.444,P=0.000)。结论 PPD试验检测布拖县HIV感染/AIDS患者并发活动性肺结核的敏感度不高,需与其他检查方法联合使用;但PPD试验阳性率随患者CD4+T淋巴细胞计数的增多而增高,加之特异度较高,阴性结果可提示非结核感染,仍可作为HIV感染高流行和卫生资源有限地区的有效筛查方法。

关键词: 结核,肺, HIV感染, 获得性免疫缺陷综合征, 潜伏性结核病, 结核菌素试验, 结果评价(卫生保健), 小地区分析


Objective To analyze the application value of tuberculin (PPD) test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo, Liangshan Yi Autonomous Prefecture. Methods A total of 688 patients who were followed up and had taken immunosuppressant therapy >1 month were enrolled, among 2159 HIV/AIDS patients managed in the “Thirteenth Five-Year Plan” National Science and Technology Major Project in Jiudu, Mu’er and Te Muli Town in Butuo between December 2018 and August 2019. Questionnaire, PPD test, X-ray chest and CD4+ T lymphocyte count were conducted. MTB etiology test was performed on eligible subjects. Of the 688 cases, 175 were without verification of PPD test results, 40 were not examed by X-ray and had no etiology basis, 7 were infected by nontuberculous mycobacteria, and 466 cases were included finally. SPSS 21.0 software was used to analyze the PPD test results (the average diameter of skin scleroma ≥5 mm was positive) and the status of active pulmonary tuberculosis or latent tuberculosis infection (LTBI) judged by the expert group, to detect the efficiency of PPD test for active pulmonary tuberculosis (including sensitivity, specificity, positive predictive value, negative predictive value, agreement rate) based on diagnosed active pulmonary tuberculosis cases. The relationship between positive rate of PPD test and whether complicated with active pulmonary tuberculosis or not, as well as comparison of different CD4+ T lymphocyte counts and prevalence, were detected by χ2 test. P<0.05 was statistically significant. Results Among the 466 patients, 377 (80.90%) were negative in PPD test, 14 (3.00%) were generally positive, 29 (6.23%) were moderately positive, 46 (9.87%) were strongly positive and the positive rate was 19.10% (89/466), all of them were consistent with tuberculosis infection. By tuberculosis screening and diagnosis from expert group, 89 cases (19.10%) were active pulmonary tuberculosis, including 57 LTBI cases (12.23% (57/466)). Based on diagnosis from expert group, the sensitivity, specificity and consistent rate of PPD test for active tuberculosis were 35.96% (32/89), 84.88% (320/377), and 75.54% (352/466), respectively. The positive rate of PPD test in HIV/AIDS patients complicated with active pulmonary tuberculosis was significantly higher than that in patients without active pulmonary tuberculosis (35.96% (32/89) vs. 15.12% (57/377);χ2=20.827, P=0.000). Furthermore, only when CD4+ T lymphocyte count was more than 500 count/μl, the complicated rate was significantly higher (52.00% (13/25) vs. 16.67% (19/114); χ2=14.444, P=0.000). Conclusion As the sensitivity of PPD test to detect active tuberculosis was not high, other examinations should be combined.But the positive rates of PPD test was positively correlated with the count of CD4+T lymphocytes,and the specificity was high, negative results may also indicate non-tuberculosis infection. Therefore, it may still be used as an effective method in areas with high HIV prevalence and limited health resources.

Key words: Tuberculosis,pulmonary, HIV infections, Acquired immunodeficiency syndrome, Latent tuberculosis, Tuberculin test, Outcome assessment (health care), Small-area analysis