Impact of a Mycobacterium tuberculosis-specific interferon-γ release assay in bronchoalveolar lavage fluid for a rapid diagnosis of tuberculosis
Impact of a Mycobacterium tuberculosis-specific interferon-γ release assay in bronchoalveolar lavage fluid for a rapid diagnosis of tuberculosis
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DOI：
10.1111/j.1365-2796.2011.02378.x
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发表时间：
2011-09-01
影响因子：
11.1
通讯作者：
Lange, C.
中科院分区：
文献类型：
--
作者：
Jafari, C.;Kessler, P.;Lange, C.
Jafari C、Kessler P、Sotgiu G、Ernst M、Lange C（Borstel 研究中心，Borstel，德国；萨萨里大学卫生和预防医学研究所，萨萨里，意大利；Borstel 研究中心，Borstel，德国）。支气管肺泡灌洗液中结核分枝杆菌特异性干扰素 C 释放测定对结核病快速诊断的影响。实习医学杂志, 2011; 270：254-262。目标。评估疑似肺结核患者初始治疗决策的不同方法。背景。最近，肺结核诊断方面取得了重要进展，这影响了开始抗结核治疗的决定。方法。为了评估不同方法对结核病推定诊断的影响，按照特定的算法前瞻性地招募疑似结核病的个体，包括初始涂片显微镜检查和痰中结核分枝杆菌特异性核酸扩增（NAAT）。如果初始检测结果为阴性，则进行结核菌素皮试、支气管镜检查和经支气管活检以及外周血和支气管肺泡灌洗（BAL）液中的干扰素γ释放测定（IGRA）。结果。在 135 名疑似结核病患者中，42 人患有结核病，10 人患有非结核分枝杆菌肺部感染/定植（1 人同时患有结核病和非结核分枝杆菌肺部感染/定植），84 人有其他最终诊断。痰镜检查的敏感性和特异性分别为 41% 和 99% [阳性似然比 (LR+) = 40]，BAL 核酸扩增的敏感性和特异性分别为 31% 和 98% (LR+ = 16)。在抗酸杆菌涂片阴性结核病患者中（25/42，59.5%），结核分枝杆菌特异性 BAL 液 IGRA 对结核病诊断的敏感性为 92%，特异性为 87%（LR+ = 7）。结论。旨在在等待结核分枝杆菌培养结果确认的同时提供结核病快速诊断的微生物学或免疫学方法本身不足以准确地诊断或排除肺结核。痰镜检查和结核分枝杆菌特异性 NAAT 结果呈阴性，应提示对疑似肺结核患者进行支气管镜检查，包括进行支气管肺泡灌洗（BAL）检查，以检测结核分枝杆菌特异性 IGRA。
Jafari C, Kessler P, Sotgiu G, Ernst M, Lange C (Research Center Borstel, Borstel, Germany; Hygiene and Preventive Medicine Institute, University Sassari, Sassari, Italy; Research Center Borstel, Borstel, Germany). Impact of a Mycobacterium tuberculosis-specific interferon-c release assay in bronchoalveolar lavage fluid for a rapid diagnosis of tuberculosis. J Intern Med 2011; 270: 254-262.Objectives. Evaluation of different methods for an initial treatment decision in individuals with suspected pulmonary tuberculosis.Background. Recently, important advances regarding the diagnosis of pulmonary tuberculosis have been introduced, which influence the decision to initiate anti-tuberculosis treatment.Methods. To evaluate the impact of different methods for the presumed diagnosis of tuberculosis, individuals with suspected tuberculosis were prospectively enrolled following a specific algorithm including initial smear microscopy and Mycobacterium tuberculosis-specific nucleic acid amplification (NAAT) from sputum. In cases of negative initial test results, tuberculin skin testing, bronchoscopy with transbronchial biopsies and interferon-gamma release assays (IGRAs) in peripheral blood and bronchoalveolar lavage (BAL) fluid were performed.Results. Amongst 135 individuals with suspected tuberculosis, 42 had tuberculosis, 10 had nontuberculous mycobacteria pulmonary infection/colonization (one had both tuberculosis and nontuberculous mycobacteria pulmonary infection/colonization) and 84 had an alternative final diagnosis. The sensitivity and specificity were 41% and 99% [positive likelihood ratio (LR+) = 40] for sputum microscopy and 31% and 98% (LR+ = 16) for BAL nucleic acid amplification, respectively. In patients with acid-fast bacilli smear-negative tuberculosis (25/42, 59.5%), M. tuberculosis-specific BAL fluid IGRA was 92% sensitive and 87% specific (LR+ = 7) for the diagnosis of tuberculosis.Conclusion. None of the microbiological or immunological methods that aim to provide a rapid diagnosis of tuberculosis whilst waiting the confirmation of the M. tuberculosis culture results is on its own accurate enough to diagnose or exclude pulmonary tuberculosis. Negative sputum microscopy and M. tuberculosis-specific NAAT results should prompt bronchoscopy including BAL for M. tuberculosis-specific IGRA in individuals with suspected pulmonary tuberculosis.