The Clinical Value Of T Cell Spot Test In Patients With AIDS And Tuberculosis

Objective:To explore the clinical diagnostic value of T-cell SPOT test(T-SPOT.TB)in patients with acquired immune deficiency syndrome(AIDS)and tuberculosis(TB),so as to provide more reliable academic reference for the clinical diagnosis and early treatment of this disease.Methods:nalyze the positive rate,sensitivity and specificA total of 150 patients with AIDS in Qingdao infectious disease hospital,Qingdao chest hospital and Yantai infectious disease hospital from January 2014 to August 2018 were collected as subjects of this study.All patients received absolute count of CD4~+T cells after admission.According to the examination results of TB and the absolute count of CD4~+T test results,the included subjects were divided into 6 groups:control group A(30 patients)were AIDS patients without TB and whose CD4~+T lymphocyte absolute count≤50 cells/μL;observation group A(46 patients):were AIDS patients with TB and whose CD4~+T lymphocyte absolute count≤50 cells/μL;control group B(20 patients)were AIDS patients without TB and whose CD4~+T lymphocyte absolute count ranged from51cells/μL to 200 cells/μL;observation group B(31 patients):were AIDS patients with TB and whose CD4~+T lymphocyte absolute count ranged from51cells/μL to 200 cells/μL;control group C(10 patients)were AIDS patients without TB and whose CD4~+T lymphocyte absolute count≥201 cells/μL;observation group C(13 patients):were AIDS patients with TB and whose CD4~+T lymphocyte absolute count≥201 cells/μL.T-SPOT.TB,tuberculin bacillus skin test and sputum smear bacteriological examination were performed on all patients.Aity of 3detection(T-SPOT.TB,TB skin test and sputum smear bacteriological examination)methods for the diagnosis of AIDS complicated with pulmonary tuberculosis.Spearman correlation analysis was used to analyze the correlation between the absolute count of CD4~+T lymphocytes and the positive rate of 3 detection methods.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of 3 detection methods in patients with AIDS complicated with TB.Results:The positive rate of 3 detection method:in observation group A:the positive rate of T-SPOT.TB was 13.04%,which was higher than the results of TB skin test(6.52%)and sputum smear test(10.87%),but there was no significant difference(?~2=1.113,P>0.05).In observation group B:the positive rate of T-SPOT.TB was 64.52%,which was higher than the results of TB skin test(48.39%)and sputum smear test(12.90%),the difference was statistically significant(?~2=24.541,P<0.05).In observation group C:the positive rate of T-SPOT.TB was 84.62%,which was higher than the results of TB skin test(61.54%)and sputum smear test(61.54%),the difference was statistically significant(?~2=24.541,P<0.05).Sensitivity and specificity analysis showed that the sensitivity and specificity of T-SPOT.TB in the diagnosis of TB in group A were 75.00%and41.18%respectively.The sensitivity and specificity in the diagnosis of TB in group B were 95.24%and 63.33%respectively.The sensitivity and specificity in the diagnosis of TB in group C were 91.67%and 81.82%respectively.Correlation analysis showed that CD4~+T lymphocyte absolute count was moderately positively with T-SPOT.TB(r=0.596,P<0.01);weakly positively correlated with TB skin test(r=0.390,P<0.01),sputum bacterial smear test(r=0.454,P<0.01).ROC curve suggested that T-SPOT.TB had a high diagnostic value for TB in AIDS patients whose absolute count of CD4~+T lymphocytes ranged from51cells/μL to 200 cells/μL[AUC=0.80,95%CI(0.67,0.92),P<0.01]and≥201 cells/μL[AUC=0.87,95%CI(0.71,0.99),P<0.01].Conclusion:T-SPOT.TB has a high diagnostic value for TB in AIDS patients whose absolute count of CD4+T lymphocytes>50 cells/μL.