Xpert MTB/RIF在人类免疫缺陷病毒感染/艾滋病患者中诊断结核病的价值

为探讨利福平耐药结核分枝杆菌实时荧光定量核酸扩增检测技术(Xpert Mycobacterium tuberculosis/rifampicin，Xpert MTB/RIF)在人类免疫缺陷病毒感染/艾滋病(human immunodeficiency virus infection/acquired immunodeficiency syndrome，HIV/AIDS)患者中诊断结核病的价值，本研究回顾性分析了2018年1月1日—2020年12月31日复旦大学附属公共卫生临床中心感染与免疫科收治的801例HIV/AIDS合并疑似结核病患者的临床资料。801例患者中，657例进行了Xpert MTB/RIF、外周血结核感染T细胞斑点试验(tuberculosis T cell spot test，T-SPOT.TB)、抗酸染色涂片镜检和BACTEC MGIT 960液体培养等检测。以液体培养及菌型鉴定结果作为结核病诊断的“金标准”，确诊结核病92例，Xpert MTB/RIF、T-SPOT.TB、抗酸染色涂片镜检在HIV/AIDS患者中诊断结核病(包括肺结核和肺外结核)的灵敏度分别为72.8%、55.4%和69.6%，特异度分别为96.8%、90.3%和84.4%，与“金标准”行一致性检验，Kappa值分别为0.719 (P<0.01)、0.430(P<0.01)和0.424(P<0.01)。Xpert MTB/RIF检测502份呼吸道样本，结果显示其诊断肺结核的灵敏度和特异度分别为66.7%和96.0%；在痰涂片阳性和阴性的患者中，Xpert MTB/RIF诊断肺结核的灵敏度分别为77.4%和35.2%，特异度分别为87.7%和 97.8%。采用Xpert MTB/RIF检测343份肺外标本，结果显示其诊断肺外结核的灵敏度和特异度分别为63.3%和95.2%。以上结果提示，Xpert MTB/RIF在HIV/AIDS患者中诊断结核病(包括肺结核和肺外结核)具有较高的灵敏度和特异度，诊断肺结核的灵敏度高于肺外结核，因此推荐将其作为HIV/AIDS患者疑似结核病的首选检测方法。

Diagnostic value of Xpert MTB/RIF for tuberculosis in human immunodeficiency virus infection/acquired immunodeficiency syndrome patients

The clinical data of 801 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) patients with suspected tuberculosis were collected to explore the diagnosis value of Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) for tuberculosis in HIV/AIDS patients admitted to the Department of Infection and Immunology of Shanghai Public Health Clinical Center affiliated to Fudan University between January 1, 2018 and December 31, 2020. Among 801 HIV/AIDS patients with suspected tuberculosis, 657 patients received tuberculosis screening tests including Xpert MTB/RIF, peripheral blood tuberculosis T cell spot test (T-SPOT.TB), smear microscopy and BACTEC MGIT 960 liquid culture. When the results of liquid culture and Mycobacterium identification and typing were set as the diagnostic criterion for tuberculosis, the sensitivities of Xpert MTB/RIF, T-SPOT.TB, smear microscopy in tuberculosis diagnosis among HIV/AIDS patients (including pulmonary tuberculosis and extra-pulmonary tuberculosis) were 72.8%, 55.4%, 69.6%, respectively, the specificities were 96.8%, 90.3%, 84.4%, respectively, and Kappa values were 0.719 (P<0.01), 0.430 (P<0.01), 0.424 (P<0.01), respectively. The sensitivity and specificity of Xpert MTB/RIF in the diagnosis of pulmonary tuberculosis were 66.7% and 96.0%, respectively. Among sputum smear-positive and sputum smear-negative tuberculosis patients, the sensitivity of Xpert MTB/RIF was 77.4% and 35.2%, respectively, and the specificity was 87.7% and 97.8%, respectively. The sensitivity and specificity of Xpert MTB/RIF in the diagnosis of extra-pulmonary tuberculosis were 63.3% and 95.2%, respectively. The results indicate that Xpert MTB/RIF has high sensitivity and specificity in the diagnosis of tuberculosis in HIV/AIDS patients, and the sensitivity in the diagnosis of pulmonary tuberculosis is higher than that of extra-pulmonary tuberculosis. It is recommended that Xpert MTB/RIF should be used as the preferred testing technique for suspected tuberculosis in HIV/AIDS patients.