结核病与艾滋病共病患者中影响γ-干扰素释放试验检测结果的相关因素分析

doi:10.19982/j.issn.1000-6621.20250437

摘要/Abstract

摘要：

目的: 探讨结核病与艾滋病共病患者中可能影响γ-干扰素释放试验(interferon-gamma release assay,IGRA)检测结果的相关因素。方法: 以2020年1月1日至2023年6月30日在南宁市第四人民医院住院的268例结核病与艾滋病共病患者为研究对象,其中,IGRA检测阳性141例,阳性率为52.6%。根据IGRA检测结果,将141例IGRA检测阳性患者列入阳性组,127例IGRA检测阴性患者列入阴性组。收集所有研究对象的临床资料,并采用多因素logistic回归模型分析影响患者IGRA检测结果的相关因素。结果: IGRA检测阳性组并发其他机会性感染率为42.6%(60/141),低于阴性组的65.4%(83/127),差异有统计学意义(χ²=13.958,P<0.001);阳性组肺外结核发生率为24.8%,低于阴性组的37.8%,差异有统计学意义(χ²=5.260,P=0.022);阳性组气促发生率为24.8%(35/141),低于阴性组的36.2%(46/127),差异有统计学意义(χ²=4.116,P=0.042);阳性组浅表淋巴结肿大发生率为31.9%(45/141),高于阴性组的21.3%(27/127),差异有统计学意义(χ²=3.861,P=0.049);阳性组乳酸脱氢酶(lactate dehydrogenase,LDH)>250U/L的构成比为47.7%(63/141),低于阴性组的63.5%(75/127),差异有统计学意义(χ²=6.162,P=0.013);阳性组淋巴细胞计数<1.1×10⁹/L的构成比为52.5%(74/141),低于阴性组的71.7%(91/127),差异有统计学意义(χ²=10.379,P=0.001);阳性组CD4⁺ T淋巴细胞计数≤50个/μl的构成比为25.5%(36/141),低于阴性组的59.1%(75/127),差异有统计学意义(χ²=30.948,P<0.001);阳性组CD8⁺ T淋巴细胞计数<350个/μl的构成比为34.8%(49/141),低于阴性组的49.6%(63/127),差异有统计学意义(χ²=6.061,P=0.014)。多因素logistic回归分析显示,发生浅表淋巴结肿大[OR(95%CI)=0.359(0.181~0.712)]的结核病与艾滋病共病患者,IGRA检测结果阴性的概率较低,并发其他机会性感染[OR(95%CI)=0.359(0.181~0.712)]、有肺外结核[OR(95%CI)=2.080(1.105~3.916)]、CD4⁺ T淋巴细胞计数≤50个/μl[OR(95%CI)=2.957(1.466~5.966)]是结核病与艾滋病共病患者中IGRA检测结果阴性的独立危险因素。结论: 结核病与艾滋病共病患者中IGRA检测阳性率低,对于CD4⁺ T淋巴细胞计数低下、并发其他机会性感染、有肺外结核的结核病与艾滋病共病患者出现IGRA检测结果阴性时应考虑到假阴性的可能,临床应用IGRA检测辅助结核病与艾滋病共病诊断时需结合患者情况综合分析。

关键词: 结核, 获得性免疫缺陷综合征, γ-干扰素释放试验, 因素分析,统计学

Abstract:

Objective: To investigate the related factors influencing interferon-gamma release assay (IGRA) results in patients having coexistent tuberculosis and acquired immune deficiency syndrome (AIDS). Methods: We enrolled 268 patients with coexistent tuberculosis and AIDS admitted to The Fourth People’s Hospital of Nanning from January 1, 2020 to June 30, 2023, including 141 cases with positive IGRA results showing a positivity rate of 52.6%, and the other 127 IGRA-negative patients. Clinical data and factors affecting the IGRA test results in patients were analyzed by establishing a multivariable logistic regression model. Results: The rate of concurrent other opportunistic infections was 42.6% (60/141) among the positive group, lower than that of the negative group at 65.4% (83/127), with a statistically significant difference (χ²=13.958, P<0.001). The incidence of extra-pulmonary tuberculosis in the positive group was 24.8% (35/141), lower than that of the negative group at 37.8%, with a statistically significant difference (χ²=5.260, P=0.022). The incidence of shortness of breath was 24.8% (35/141), lower than that of the negative group at 36.2% (46/127), with a statistically significant difference (χ²=4.116, P=0.042). The incidence of superficial lymph node enlargement was 31.9% (45/141), higher than that of the negative group at 21.3% (27/127), with a statistically significant difference (χ²=3.861, P=0.049). The rate of lactate dehydrogenase (LDH) >250U/L was 47.7% (63/141), lower than that of the negative group at 63.5% (75/127), with a statistically significant difference (χ²=6.162, P=0.013). The rate of lymphocyte count <1.1×10⁹/L was 52.5% (74/141), lower than that of the negative group at 71.7% (91/127), with a statistically significant difference (χ²=10.379, P=0.001). The rate of CD4⁺ T cell count ≤50 cells/μl was 25.5% (36/141), lower than that of the negative group at 59.1% (75/127), with a statistically significant difference (χ²=30.948, P<0.001). The rate of CD8⁺ T cell count <350 cells/μl was 34.8%(49/141), lower than that of the negative group at 49.6% (63/127), with a statistically significant difference (χ²=6.061, P=0.014). Multivariable logistic regression analysis showed that the presence of superficial lymph node enlargement (OR (95%CI)=0.359 (0.181-0.712)) was an independent protective factor for negative IGRA results in patients with co-morbid tuberculosis and AIDS, while concurrent other opportunistic infections (OR (95%CI)=0.359 (0.181-0.712)), the presence of extrapulmonary tuberculosis (OR (95%CI)=2.080 (1.105-3.916)), and CD4⁺ T cell count ≤50 cells/μl (OR (95%CI)=2.957 (1.466-5.966)) were independent risk factors for negative IGRA results in patients having coexistent tuberculosis and AIDS. Conclusion: Among patients having coexistent tuberculosis and AIDS, the positive rate of IGRA is low. For those with low CD4⁺ T-cell counts, concurrent other opportunistic infections, or having extra-pulmonary tuberculosis, when IGRA test results are negative, the possibility of false negative should be considered. In clinical application, when using IGRA to assist in the diagnosis of AIDS combined with tuberculosis, it is necessary to conduct a comprehensive analysis based on the patient’s condition.

Key words: Tuberculosis, Acquired immune deficiency syndrome, Interferon-gamma release assay, Factor analysis, statistical

中图分类号:

R52
R512.91

黄爱春, 兰艳群, 许超艳, 张洁, 李维文, 朱庆东, 谢周华. 结核病与艾滋病共病患者中影响γ-干扰素释放试验检测结果的相关因素分析[J]. 中国防痨杂志, 2026, 48(6): 849-855. doi: 10.19982/j.issn.1000-6621.20250437

Huang Aichun, Lan Yanqun, Xu Chaoyan, Zhang Jie, Li Weiwen, Zhu Qingdong, Xie Zhouhua. Analysis of related factors influencing interferon-gamma release assay results in patients having coexistent tuberculosis and acquired immune deficiency syndrome[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 849-855. doi: 10.19982/j.issn.1000-6621.20250437

图/表 3

表1

IGRA检测结果阳性组和阴性组患者的各项临床特征比较

临床特征	IGRA检测阳性组 (141例)	IGRA检测阴性组 (127例)	统计检验值	P值
性别(男性(例)/女性(例)	110/31	103/24	χ²=0.391	0.532
年龄组[例(构成比,%)]			χ²=1.531	0.216
≤60岁	97(68.8)	96(75.6)
>60岁	44(31.2)	31(24.4)
并发其他机会性感染[例,发生率(%)]	60(42.6)	83(65.4)	χ²=13.958	0.000
肺外结核[例,发生率(%)]	35(24.8)	48(37.8)	χ²=5.260	0.022
咳嗽、咳痰[例,发生率(%)]	98(69.5)	96(75.6)	χ²=1.239	0.266
体质量下降[例,发生率(%)]	65(46.1)	73(57.5)	χ²=3.465	0.063
食欲缺乏[例,发生率(%)]	68(48.2)	56(44.1)	χ²=0.459	0.498
乏力[例,发生率(%)]	77(54.6)	67(52.8)	χ²=0.092	0.761
咯血[例,发生率(%)]	8(5.7)	5(3.9)	χ²=0.437	0.509
头晕、头痛[例,发生率(%)]	28(19.9)	20(15.7)	χ²=0.768	0.381
发热[例,发生率(%)]	74(52.5)	75(59.1)	χ²=1.118	0.290
盗汗[例,发生率(%)]	14(9.9)	14(11.0)	χ²=0.086	0.770
气促[例,发生率(%)]	35(24.8)	46(36.2)	χ²=4.116	0.042
浅表淋巴结肿大[例,发生率(%)]	45(31.9)	27(21.3)	χ²=3.861	0.049
体质量指数[例(构成比,%)]			χ²=0.495	0.482
<18.5kg/m²	54(38.3)	54(42.5)
≥18.5kg/m²	87(61.7)	73(57.5)
LDH[例(构成比,%)]			χ²=6.162	0.013
≤250U/L	69(52.3)	42(36.5)
>250U/L	63(47.7)	75(63.5)
白细胞计数[例(构成比,%)]			χ²=7.246	0.007
<3.5×10⁹个/	11(7.8)	24(18.9)
≥3.5×10⁹个/	130(92.2)	103(81.1)
淋巴细胞计数[例(构成比,%)]			χ²=10.379	0.001
<1.1×10⁹个/	74(52.5)	91(71.7)
≥1.1×10⁹个/	67(47.5)	36(28.3)
血红蛋白(g/L,$\overline{x}$±s)	100.13±23.32	95.20±21.83	t=1.781	0.076
ADA[U/L,M(Q₁,Q₃)]	24(9,67)	24(9,123)	Z=-0.756	0.449
血清白蛋白[g/L,($\overline{x}$±s)]	29.74±6.14	28.99±6.46	t=0.971	0.332
ESR(mm/1h,$\overline{x}$±s)	90.32±34.57	89.28±38.03	t=0.229	0.819
病原学阳性[例,发生率(%)]	78(55.3)	56(44.1)	χ²=3.367	0.066
肺部有空洞[例,发生率(%)]	25(17.7)	16(12.6)	χ²=1.358	0.244
胸腔积液[例,发生率(%)]	37(26.2)	35(27.6)	χ²=0.059	0.808
CD4⁺ T淋巴细胞计数[例(构成比,%)]			χ²=30.948	0.000
≤50个/μl	36(25.5)	75(59.1)
>50个/μl	105(74.5)	52(40.9)
CD8⁺ T淋巴细胞计数[例(构成比,%)]			χ²=6.061	0.014
<350个/μl	49(34.8)	63(49.6)
≥350个/μl	92(65.2)	64(50.4)

表1

表2

表3

参考文献 18

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变量	赋值	变量	赋值
年龄(岁)	0=≤60,1=>60	有无浅表淋巴结肿大	0=无,1=有
性别	0=女性,1=男性	LDH(U/L)	0=≤250,1=>250
BMI(kg/m²)	0=≥18.5,1=<18.5	白细胞计数(×10⁹个/L)	0=≥3.5,1=<3.5
是否并发其他机会性感染	0=否,1=是	淋巴细胞计数(×10⁹个/L)	0=≥1.1,1=<1.1
有无肺外结核	0=无,1=有	CD4⁺ T淋巴细胞计数(个/μl)	0=>50,1=≤50
有无气促	0=无,1=有	CD8⁺ T淋巴细胞计数(个/μl)	0=≥350,1=<350

相关因素	β值	s${}_{\overline{x}}$值	Wald χ²值	OR(95%CI)值	P值
年龄>60岁	0.071	0.342	0.043	0.932(0.476~1.822)	0.836
男性	0.380	0.373	1.036	0.684(0.329~1.421)	0.309
BMI<18.5kg/m²	-0.158	0.308	0.263	0.854(0.467~1.561)	0.608
并发其他机会性感染	0.830	0.305	7.414	2.294(1.262~4.169)	0.006
有肺外结核	0.732	0.323	5.149	2.080(1.105~3.916)	0.023
气促	0.546	0.316	2.979	1.727(0.929~3.211)	0.084
有浅表淋巴结肿大	-1.023	0.349	8.603	0.359(0.181~0.712)	0.003
LDH>250U/L	0.274	0.319	0.739	1.315(0.704~2.457)	0.390
白细胞计数<3.5×10⁹个/L	0.821	0.449	3.338	2.272(0.942~5.480)	0.068
淋巴细胞计数<1.1×10⁹个/L	0.229	0.364	0.395	1.257(0.616~2.563)	0.530
CD4⁺ T淋巴细胞计数≤50个/μl	1.084	0.358	9.167	2.957(1.466~5.966)	0.002
CD8⁺ T淋巴细胞计数<350个/μl	-0.342	0.377	0.820	0.711(0.339~1.488)	0.365