HIV/AIDS患者感染结核病早期诊断方法研究
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摘要
目的评价痰涂片、线性探针、改良罗氏培养与药敏试验、血清结核抗体、PPD皮肤试验等方法在HIV/AIDS中早期诊断结核病的优缺点,为基层一线医护工作者提供参考依据。方法选择HIV/TB双重感染患者346例、350例单纯结核病采用成组设计的病例对照研究,分别用5种方法开展检测,比较两组患者的阳性检出率、敏感度、特异度以及检出时间周期等,以及在HIV/TB组中不同的CD4细胞计数人群的5种方法受影响情况,用统计学方法评价何种方法更适合基层卫生机构的工作。结果 5种检测方法中阳性检出率为线性探针检查最高,检出率最低的是痰涂片;检出周期最长的是痰培养(需要近个月的培养才能得到结果),检出周期最快的是血清结核抗体和痰涂片(当天就可以得到结果),结性探针方法在24 h左右可以得到检测结果;线性探针敏感度为61.56%、特异度为100.00%,而且其检测水平不受HIV/TB患者不同CD4细胞水平的影响,是各种检测方法中最理想的方法。结论从稳定性、敏感度以及检出结果周期等综合考虑,线性探针技术是当前县一级卫生机构对HIV/AIDS中早期诊断结核病的适宜技术,虽然需要特殊设备和环境,操作技术和防污染措施要求严格,必须下大力气去推广应用,从疾病防控的角度力求突破。
Objective To evaluate the advantages and disadvantages of the early diagnosis of tuberculosis in HIV/AIDS, such as sputum smear, linear probe, improved Roche culture and drug sensitivity test, serum tuberculosis antibody and PPD skin test,It can provide reference for medical workers at the grass-roots level. Methods 346 cases of HIV/TB double infection and 350 cases of pure TB were selected as case control study,Five methods were used respectively to compare the positive detection rate, sensitivity, specificity and detection time cycle between the two groups,And the impact of the five methods on the CD4 cell count population in group HIV/TB, Statistical methods are used to evaluate which method is more suitable for the work of primary health institutions. Results The positive rate of the five detection methods is the highest linear probe, the lowest detection rate is sputum smear, the longest cycle in the detection period is the sputum culture(which needs a month of culture to get the results). The fastest detection cycle is the serum tuberculosis antibody and sputum smear(the results can be obtained on the day), and the nodal probe method is 24 small,The sensitivity of linear probe is 61.56 %, the specificity is 100 %, and its detection level is not affected by the level of different CD4 cells in HIV/TB patients. It is the most ideal method of various detection methods.Conclusions Linear probe technology is a suitable technique for the early diagnosis of tuberculosis in HIV/AIDS from the first level health institutions of the county, from the comprehensive consideration of stability, sensitivity and detection result cycle,Although special equipment and environment are needed, operation technology and pollution prevention measures are strictly required, we must make great efforts to promote the application and make a breakthrough from the point of view of disease prevention and control.
Objective To evaluate the advantages and disadvantages of the early diagnosis of tuberculosis in HIV/AIDS, such as sputum smear, linear probe, improved Roche culture and drug sensitivity test, serum tuberculosis antibody and PPD skin test,It can provide reference for medical workers at the grass-roots level. Methods 346 cases of HIV/TB double infection and 350 cases of pure TB were selected as case control study,Five methods were used respectively to compare the positive detection rate, sensitivity, specificity and detection time cycle between the two groups,And the impact of the five methods on the CD4 cell count population in group HIV/TB, Statistical methods are used to evaluate which method is more suitable for the work of primary health institutions. Results The positive rate of the five detection methods is the highest linear probe, the lowest detection rate is sputum smear, the longest cycle in the detection period is the sputum culture(which needs a month of culture to get the results). The fastest detection cycle is the serum tuberculosis antibody and sputum smear(the results can be obtained on the day), and the nodal probe method is 24 small,The sensitivity of linear probe is 61.56 %, the specificity is 100 %, and its detection level is not affected by the level of different CD4 cells in HIV/TB patients. It is the most ideal method of various detection methods.Conclusions Linear probe technology is a suitable technique for the early diagnosis of tuberculosis in HIV/AIDS from the first level health institutions of the county, from the comprehensive consideration of stability, sensitivity and detection result cycle,Although special equipment and environment are needed, operation technology and pollution prevention measures are strictly required, we must make great efforts to promote the application and make a breakthrough from the point of view of disease prevention and control.
引文
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[9]刘光初,肖人鸿,曾爱群.对早期发现HIV/AIDS合并肺结核双重感染者抗痨抗病毒效果分析[J].河南预防医学杂志,2017,28(10):753-755,775.
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[11]张波.影响TB/HIV病人临床结核病治疗效果多因素分析[J].河南预防医学杂志,2016,27(3):177-179,183.
[12]王学燕,张振开,韦兴强,等.广西两市2014-2015年新入组抗艾滋病病毒治疗者合并HBV、HCV感染的流行病学研究[J].应用预防医学,2017,23(6):439-444.
[13]郑志刚.Xpert MTB/RIF检测结核杆菌和利福平耐药的研究及应用进展[J].应用预防医学,2014,20(2):120-123.
[14]路丽苹,陆斌,刘梅,等.GeneXpert MTB/RIF技术在结核病早诊断中的应用[J].中国防痨杂志,2017,39(1):71-75.
[2]Web Source:WHO website-[DB/OL].http://www.who.int/tb/hiv/faq/en/.
[3]TB/HIV:The Facts[R].UNAIDS,December 1,2000.
[4]Web Source:http://www.tballiance.org/2_1_1_TBandHIV.asp[DB/OL].
[5]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006:1-117.
[6]中国疾病预防控制中心国家结核病参比实验室.线形探针耐多药检测方法应用评估实施细则[Z].北京:中国疾病预防控制中心,2010:37-47.
[7]方积乾.卫生统计学(第五版)[M].北京:人民卫生出版社,2003:33-40.
[8]甄新安,庄严.2014-2016年河南省结核病人中HIV筛查状况[J].河南预防医学杂志,2017,28(12):888-890.
[9]刘光初,肖人鸿,曾爱群.对早期发现HIV/AIDS合并肺结核双重感染者抗痨抗病毒效果分析[J].河南预防医学杂志,2017,28(10):753-755,775.
[10]甄新安.河南省结核病人中HIV检测结果分析[J].河南预防医学杂志,2015,26(3):193-195.
[11]张波.影响TB/HIV病人临床结核病治疗效果多因素分析[J].河南预防医学杂志,2016,27(3):177-179,183.
[12]王学燕,张振开,韦兴强,等.广西两市2014-2015年新入组抗艾滋病病毒治疗者合并HBV、HCV感染的流行病学研究[J].应用预防医学,2017,23(6):439-444.
[13]郑志刚.Xpert MTB/RIF检测结核杆菌和利福平耐药的研究及应用进展[J].应用预防医学,2014,20(2):120-123.
[14]路丽苹,陆斌,刘梅,等.GeneXpert MTB/RIF技术在结核病早诊断中的应用[J].中国防痨杂志,2017,39(1):71-75.