HIV/AIDS合并结核感染患者中分枝杆菌检测技术比较和耐药表型研究

目的 对HIV/AIDS合并结核分枝杆菌(MTB)感染实验室诊断技术进行比较研究,分析患者MTB的药物敏感性和耐药表型.方法 应用T-SPOT.TB试剂盒和rRNA扩增直接检测(MTD)试剂盒对HIV/AIDS合并MTB感染患者进行检测,同时做抗酸杆菌涂片、TB-DNA和结核菌培养,比较以上几种实验方法 阳性检出率.对MTB培养阳性的患者做五种药物(异烟肼、利福平、链霉素、乙胺丁醇、吡嗪酰胺)敏感性试验.结果 T-SPOT.TB对HIV/AIDS合并MTB感染阳性检出率为68.1%(64/94),明显高于其他四种实验方法,MTD的阳性检出率为40.0%(30/75),涂片查抗酸杆菌阳性率18.1%(17/94),TB-DNA阳性率35.5%(27/76),结核菌培养阳性检出率为26.6%(25/94);T-SPOT.TB与其他四种实验方法 比较有明显统计学差异(P<0.01);MTD阳性检出率高于其他三种方法,但与TB-DNA、结核菌培养比较无差异,与涂片查抗酸杆菌比较有统计学差异(P<0.05).T-SPOT.TB、PPD检测结核的敏感度随CD4 T淋巴细胞水平的升高而增强.25例确诊HIV/AIDS合并结核患者中,五种药全敏感76.0%(19/25),耐多药耐药率为16.0%(4/25),单耐异烟肼耐药率8.0%(2/25).结论 T-SPOT.TB和MTD在HIV/AIDS合并MTB感染中是一种快速敏感的检测方法,可作为HIV/AIDS合并结核感染的辅助诊断.大部分HIV/AIDS合并结核患者对目前一线抗结核药仍敏感,但耐药患者多为耐多药.

Studies on the diagnostic techniques in HIV/AIDS complicated with mycobacterium tuberculosis infection and resistant phenotype

Objective To study the diagnostic techniques of HIV/AIDS complicated with mycobactefium tuberculosis infection, and to analysis the drug sensitivity and resistance phenotype of mycobactefium tuberculosis. Methods The blood samples of HIV/AIDS patients complicated with mycobacterium tuberculosis infection all were detected by T-SPOT. TB assay, MTD assay, acid-fast bacillus test of sputum smear, TB-DNA and mycobacterium tuberculosis culturing, and the positive rates of these several detection methods were compared. The mycobactefium tuberculosis positive patients were tested drug sensitivity （Isoniazid, Rifampin, Streptomycin, Ethambutol, Pyrazinamide）. Results The positive rate of T-SPOT. TB detection was 68. 1% （64/94）, obviously higher than the other four kinds of detection methods （ P 〈 0. 01 ）. The positive rates of MTD, TB-DNA, AFB and mycobacterium tuberculosis culturing were 40. 0% （ 30/75 ） ,35.5% （ 27/76 ）, 18. 1% （ 17/94 ） and 26.6% （ 25/94 ） respectively. The positive rate of MTD detection was higher than TB-DNA, AFB test and mycobaeterium tuberculosis culturing, and had statistically significant compared with AFB ,but had no statistically significant differences with others. In 25 cases of HIV/AIDS complicated with mycobacterium tuberculosis infection, the sensitivity rates of five drug all were 76. 0% （ 19/25 ）, the multi-drug resistance rate （MDR） was 16. 0% （4/25）, the rate of Isoniazid-resistance was 8.0% （ 2/ 25 ）. Conclusions T-SPOT. TB and MTD beth were fast sensitive diagnostic method in HIV/AIDS complicated with mycobacterium tuberculosis infection, and these two detection methods could be used as assistant diagnosis methods for HIV/AIDS with tuberculosis. Most of HIV/AIDS patients with tuberculosis were still sensitive to first-line drugs,but drug resistance patients were multi-drug resistance.