脂阿拉伯甘露糖抗体检测对AIDS合并肺结核患者的诊断价值

目的 探讨脂阿拉伯甘露糖(lipoarabinomanna,LAM)抗体检测在获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)合并肺结核患者中的诊断价值.方法 收集我院2013年3月至2016年3月就诊的AIDS感染肺结核患者38例(研究组)及无肺结核的AIDS患者38例(对照组),对两组患者均进行LAM抗体检测及PPD试验,比较两组患者LAM抗体阳性率及PPD阳性率.同时对所有患者行CD4+T淋巴细胞计数.根据CD4+T淋巴细胞计数,将研究组患者进一步分为CD4+T淋巴细胞≥200/μl组和CD4+T淋巴细胞＜200/μl组,比较两组患者LAM抗体阳性率及PPD阳性率.比较LAM抗体检测及PPD试验对AIDS合并肺结核的诊断价值.结果 研究组患者LAM抗体检测阳性率为84.2％,对照组LAM抗体检测阳性率为l0.5％,两组患者比较差异有统计学意义(P＜0.05).研究组患者PPD阳性率为42.1％较对照组(23.7％)高,但差异无统计学意义(P＞0.05).CD4+T淋巴细胞≥200/μl组患者LAM抗体阳性率92.9％,较CD4+T淋巴细胞＜200/μl组(79.2％)高,但差异无统计学意义(P＞0.05).CD4+T淋巴细胞≥200/μl组患者PPD阳性率为92.9％,较CD4+T淋巴细胞＜200/μl组(12.5％)高,且差异有统计学意义(P＜0.05).LAM抗体检测诊断AIDS合并肺结核的敏感度为84.2％,特异度为89.5％,阳性预测值为94.1％、阴性预测值为85.7％、阳性似然比为15.9、阴性似然比为0.17.LAM抗体诊断AIDS合并肺结核阳性似然比＞10,即表示LAM抗体诊断AIDS合并肺结核的可能性显著增加.结论 LAM抗体检测在AIDS患者合并肺结核的诊断中特异度及敏感度高,有利于AIDS合并肺结核患者的诊断.值得临床进一步地推广应用.

Diagnostic value of lipoarabinomanna antibody in patients with AIDS complicated with pulmonary tuberculosis

Objective To observe the diagnostic value of lipoarabinomanna(LAM) antibody in patients with acquired immune deficiency syndrome(AIDS) complicated with pulmonary tuberculosis.Methods 38 patients with AIDS combined with pulmonary tuberculosis from March 2013 to March 2016 in our hospital (study group) and 38 AIDS patients without pulmonary tuberculosis (control group) were collected.Two groups of patients were accepted LAM antibody test,PPD test.LAM antibody positive rate and PPD positive rate were compared between the two groups.CD4+T lymphocyte count were also performed in all patients.According to the CD4+ T lymphocyte count,study group patients were divided into CD4+ T lymphocytes ≥ 200/tμl group and CD4+ T group of ＜200/μtl lymphocytes.LAM antibody positive rate and PPD positive rate were compared between the two groups.To compare the diagnostic value of LAM antibody test and PPD test in AIDS complicated with pulmonary tuberculosis.Results The positive rate of LAM antibody in study group was 84.2％.The positive rate of LAM antibody in control group was 10.5 ％.There showed significant difference between the two groups (P ＜0.05).PPD positive rate of study group (42.1 ％) was higher than that in control group (23.7 ％),but the difference was not statistically significant (P ＞0.05).The positive rate of patients with LAM antibody CD4+ T lymphocytes≥ 200/μl (92.9％) was higher than in CD4+T lymphocytes in group ＜200/μl (79.2％),but the difference was not statistically significant(P ＞0.05).The positive rate of PPD in patients CD4-T lymphocyte ≥ 200/μl (92.9 ％) was significantly higher than in CD4+T lymphocytes in group ＜200/μl (12.5 ％)(P ＜ 0.05).The sensitivity of LAM antibody detection in diagnosis of AIDS with pulmonary tuberculosis was 84.2％,the specificity was 89.5 ％,the positive predictive value was 94.1 ％,the negative predictive value was 85.7％,the positive likelihood ratio was 15.9,the negative likelihood ratio was 0.17.LAM diagnosis of AIDS with pulmonary tuberculosis positive likelihood ratio＞10,which indicated that LAM diagnosis of AIDS with pulmonary tuberculosis was significantly increased.Conclusions The specificity and sensitivity of lipid Arabia mannose antibody detection in the diagnosis of AIDS patients with pulmonary tuberculosis were high.Detection of ILAM antibody was helpful for the diagnosis of pulmonary tuberculosis in AIDS patients,which worths further clinical application.