目的 探讨结核分枝杆菌抗原特异性IFN-γ酶联免疫斑点(ELISPOT)检测技术在HIV感染者中用于诊断结核潜伏感染的应用价值.方法 运用自行研发的结核分枝杆菌抗原特异性IFN-γ ELISPOT检测方法对110例确诊的HIV感染者及205例HIV阴性健康志愿者的外周血结核特异性IFN-γ释放水平进行检测,并同时进行结核菌素皮肤试验(研).结果 ELISPOT在HIV感染和HIV/AIDS正在接受抗病毒治疗人群中的阳性率分别为24.5%和29.8%,明显高于HIV阴性健康人群7.3%(P＜0.001);对多种不同部位多肽抗原刺激以P8.10的敏感性最高,但与其他抗原的差异无统计学意义(P＞0.05);不同CD4细胞计数水平对ELISPOT检测结果尤影响(P＞0.05);PPD试验在HIV感染人群中的阳性率远远低于ELISPOT检测方法,其差异有统计学意义(P＜0.0001).结论 结核分枝杆菌抗原特异性IFN-γ ELISPOT检测技术在艾滋病合并结核潜伏感染的早期诊断中有很大的应用价值,推荐用于艾滋病合并结核潜伏感染的辅助诊断.%Objective To assess the validity of a newly developed in-house ELISPOT IFN-γ release assay (IGRA) for the detection of latent tuberculosis infection among HIV infected individuals. Methods In-house ELISPOT assay were performed, together with a tuberculin skin test in 205 health controls and 110 HIV infected individuals , who had no signs of active tuberculosis at time of enrolment . Results Using the ELISPOT assay, positivity rates for the 205 health controls, 110 HIV infected individuals and 47 AIDS patients on highly active antiretrovial therapy (HAART) were 7. 3% , 24.5% , 29. 8% , respectively. These results indicated that the positive rates obtained from HIV infected individuals (include patient on HAART) was significantly higher than health controls( P ＜ 0.001). We found no significant correlation between the CD4 cell count and positivity of ELISPOT assay (P ＞0.05 ). The proportion of subjects with a positive response to ELISPOT assay were higher than the proportion of tuberculin skin test(TST) responders(P＜0.0001) in HIV infected individuals. Conclusion Our study indicates that IGRA using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals.
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