Yusuph H, Garbati M A, Gashau W
Department of Medicine, University of Maiduguri Teaching Hospital, Nigeria.
Afr J Med Med Sci. 2005 Jun;34(2):125-8.
Tuberculin skin testing is used for the identification of individuals with infection by Mycobacterium tuberculosis and other non-tuberculous mycobacteria. However, its value in immunosuppressed individuals due to human immunodeficiency virus (HIV) infection is controversial. This study was aimed at determining the relationship between Mantoux reaction and CD4+ cell counts; and whether the test can be used to predict CD4+ counts in patients dually infected with Human Immunodeficiency Virus and M. tuberculosis. Eighty patients, comprising 42 males (52.5%) and 38 females (47.5%) confirmed to be having antibodies to HIV who also had sputum smear positive pulmonary tuberculosis were recruited over a period of 16 months. They were Mantoux-tested with 0.1 ml of 5TU of PPD which was interpreted thus: <5 mm = negative, =5 mm = positive. CD4+ counts were determined using Dynabeads technique. The ages of all the patients ranged between 18 and 55 years (mean +/- SD: 33.9+/-8.42 years). The males had a mean age of 35.4 +/- 7.7 years while that of the females was 29.6+/-53 years (P<0.05). The CD4+ counts ranged between 73 and 512 cells/microl with a mean of 235.05 +/- 112.8 cells/microl. Fifty seven (71%) patients had negative PPD tests while 23 (29%) tested positive. Of the 37 with CD4+ counts <200 cells/microl, 32 (86.48%) had negative reaction (<5 mm) and 5 (13.51%) were positive (=5 mm) as compared to those with CD4 counts =200 cells/microl, among whom 25 (58.13%) were negative and 18 (41.86%) were positive (P<0.05). The positive predictive value was low at 56.14%. The difference in mean indurations between those with CD4+ count <200 cells/microl versus those with CD4+ count =200 cells/microl was statistically significant (P<0.05). On the whole, Mantoux indurations were noted to weakly correlate positively with CD4+ counts (Pearson's correlation, r=+0.36, P=0.001. It was concluded that there is a weak positive correlation between Mantoux reaction and CD4+ cell counts and that the Mantoux test is a poor predictor of CD4+ cell count.
结核菌素皮肤试验用于识别感染结核分枝杆菌和其他非结核分枝杆菌的个体。然而，其在因人类免疫缺陷病毒（HIV）感染而免疫抑制个体中的价值存在争议。本研究旨在确定曼托试验反应与CD4+细胞计数之间的关系；以及该试验是否可用于预测同时感染人类免疫缺陷病毒和结核分枝杆菌患者的CD4+计数。在16个月的时间里，招募了80名患者，其中包括42名男性（52.5%）和38名女性（47.5%），他们被确诊为HIV抗体阳性且痰涂片阳性的肺结核患者。用0.1 ml含5 TU结核菌素纯蛋白衍生物（PPD）进行曼托试验，结果判断如下：<5 mm为阴性，≥5 mm为阳性。采用磁珠技术测定CD4+计数。所有患者年龄在18至55岁之间（平均±标准差：33.9±8.42岁）。男性平均年龄为35.4±7.7岁，女性为29.6±5.3岁（P<0.05）。CD4+计数范围为73至512个细胞/微升，平均为235.05±112.8个细胞/微升。57名（71%）患者PPD试验为阴性，23名（29%）试验为阳性。在CD4+计数<200个细胞/微升的37名患者中，32名（86.48%）反应为阴性（<5 mm），5名（13.51%）为阳性（≥5 mm）；而CD4计数≥200个细胞/微升的患者中，25名（58.13%）为阴性，18名（41.86%）为阳性（P<0.05）。阳性预测值较低，为56.14%。CD4+计数<200个细胞/微升的患者与CD4+计数≥200个细胞/微升的患者之间平均硬结的差异具有统计学意义（P<0.05）。总体而言，发现曼托试验硬结与CD +计数呈弱正相关（皮尔逊相关系数，r = +0.36，P = 0.001）。得出的结论是，曼托试验反应与CD4+细胞计数之间存在弱正相关，且曼托试验对CD4+细胞计数的预测能力较差。
