酶联免疫吸附试验在诊断HIV感染并发结核病患者中的价值

doi:10.3969/j.issn.2095-3755.2018.04.013

摘要/Abstract

摘要：

目的探讨酶联免疫吸附试验(ELISA)在HIV感染并发结核病患者中的临床诊断价值。方法收集2015年1月至2018年9月在湖南省胸科医院临床确诊的HIV感染并发结核病患者95例,HIV感染并发非结核性肺疾病患者19例。分析采用GeneXpert MTB/RIF检测技术(简称“GeneXpert”)、BACTEC MGIT 960检测技术(简称“MGIT 960”)及ELISA法检测全血标本诊断结核病的阳性检出率;以临床诊断为标准,分析3种检测技术诊断HIV感染并发结核病患者的敏感度、特异度、阳性预测值和阴性预测值。结果 GeneXpert、MGIT 960 法及ELISA 3种检测技术对95例HIV感染并发结核病患者的检测阳性率分别为 42.11%(40/95),47.37%(45/95),67.37%(64/95)。ELISA检测的阳性率明显高于GeneXpert和MGIT 960,差异有统计学意义(χ ²=50.031,P=0.000)。19例HIV并发非结核性肺疾病患者中GeneXpert检测阳性者0例; MGIT 960检测阳性者0例; ELISA检测阳性者 3例。以临床诊断为标准,GeneXpert检测的敏感度为42.11%(40/95),特异度为100.00%(19/19),阳性预测值为100.00%(40/40),阴性预测值为25.68%(19/74);MGIT 960法检测的敏感度为47.37%(45/95),特异度为100.00%(19/19),阳性预测值为100.00%(45/45),阴性预测值为27.54%(19/69);ELISA法检测的敏感度为73.56%(64/87),特异度为84.21%(16/19),阳性预测值为95.52%(64/67),阴性预测值为41.03%(16/39)。结论 ELISA方法有着较高的敏感度且检测快速便捷,适用于临床上对HIV感染并发结核病患者进行辅助诊断。

关键词: HIV感染, 结核, 共病现象, 酶联免疫吸附测定, 实验室技术和方法, 对比研究

Abstract:

Objective To investigate the clinical diagnostic value of enzyme-linked immunosorbent assay (ELISA) in HIV-infected patients with tuberculosis.Methods 95 HIV-infected patients with tuberculosis and 19 HIV-infected patients with non-tuberculosis lung disease were selected as subjects who were diagnosed in Hunan Chest Hospital from January 2015 to September 2018. The positive detection rates of tuberculosis were analyzed with GeneXpert MTB/RIF detection technology (“GeneXpert”), BACTEC MGIT 960 detection technology (“MGIT 960”) and ELISA in whole blood sample. Analyzing the sensitivity, specificity, positive and negative predictive value of the three detection techniques for diagnosing HIV-infected patients with tuberculosis based on clinical diagnosis.Results In 95 HIV-infected patients with tuberculosis, the positive rates of GeneXpert, MGIT 960 and ELISA were 42.11% (40/95), 47.37% (45/95), and 67.37% (64/95) respectively, the positive rate of ELISA was significantly higher than that of GeneXpert and MGIT 960, and the difference was statistically significant (χ ²=50.031,P=0.000). In 19 HIV-infected patients with no-tuberculosis lung disease, the number of positive detection patients were 0, 0 and 3 in three groups. Based on clinical diagnosis, the sensitivity of GeneXpert was 42.11% (40/95), the specificity was 100.00% (19/19), the positive predictive value was 100.00% (40/40), and the negative predictive value was 25.68% (19/74); the MGIT 960 assay was 47.37% (45/95), 100.00% (19/19), 100.00% (45/45), 27.54% (19/69); and the ELISA was 73.56% (64/87), 84.21% (16/19), 95.52% (64/67), and 41.03% (16/39) respectively.Conclusion The detection of ELISA method is rapid and convenient with a high sensitivity, and it is suitable for clinical diagnosis of HIV-infected patients with tuberculosis.

Key words: HIV infections, Tuberculosis, Comorbidity, Enzyme-linked immunosorbent assay, Laboratory techniques and procedures, Comparative study

余艳艳,谭云洪,陈振华,陈忠南,刘彬彬,王珏. 酶联免疫吸附试验在诊断HIV感染并发结核病患者中的价值[J]. 结核病与肺部健康杂志, 2018, 7(4): 288-292. doi: 10.3969/j.issn.2095-3755.2018.04.013

Yan-yan YU,Yun-hong TAN,Zhen-hua CHEN,Zhong-nan CHEN,Bin-bin LIU,Jue WANG. Diagnostic value of ELISA in HIV-infected patients with tuberculosis[J]. Journal of Tuberculosis and Lung Health, 2018, 7(4): 288-292. doi: 10.3969/j.issn.2095-3755.2018.04.013

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检测方法	临床诊断(例)		敏感度(%) (95%CI)	特异度(%) (95%CI)	阳性预测值(%) (95%CI)	阴性预测值(%) (95%CI)
检测方法	HIV并发结核病	HIV并发非结核性肺疾病	敏感度(%) (95%CI)	特异度(%) (95%CI)	阳性预测值(%) (95%CI)	阴性预测值(%) (95%CI)
GeneXpert检测			42.11 (32.68~52.16)	100.00	100.00	25.68 (17.1~36.66)
阳性	40	0
阴性	55	19
MGIT 960培养			47.37 (37.63~57.32)	100.00	100.00	27.54 (18.4~39.05)
阳性	45	0
阴性	50	19
ELISA试验			73.56 (63.44~81.69)	84.21 (62.43~94.48)	95.52 (87.64~98.46)	41.03 (25.98~56.59)
阳性	64	3
阴性	23	16