An update on the diagnosis of tuberculosis infection
An update on the diagnosis of tuberculosis infection
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DOI：
10.1164/rccm.200509-1516pp
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发表时间：
2006-10-01
影响因子：
24.7
通讯作者：
Richeldi, Luca
中科院分区：
文献类型：
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作者：
Richeldi, Luca
对潜伏性结核病感染者进行有针对性的检测和治疗，使其有更大的发展为活动性疾病的风险，是结核病控制的一个关键因素。这一策略受到结核菌素皮肤试验在接种卡介苗人群中的特异性差以及在免疫抑制人群中敏感性低的限制，这些人群处于疾病进展的最高风险。两项血液检测（T-SPOT.TB和QuantiFERON-TB Gold），基于检测T细胞响应M.结核病特异性抗原，可能会改善皮肤测试。然而，由于缺乏诊断金标准，验证具有挑战性。对已发表证据的这一关键评价总结了新测试的诊断准确性。血液测试比皮肤测试具有操作优势，因为不需要回访，第二天就可以获得结果，重复测试不会导致增强。在接种卡介苗的人群中，两种试验的特异性均显著高于皮肤试验。数据表明，T-SPOT.TB可能比皮肤试验更敏感。疾病进展高危人群的数据很少，需要在这些人群中进行更多的研究，但很明显，T-S POT。在幼儿和艾滋病毒感染的活动性结核病患者中，结核病比皮肤试验效果更好。将这些检测纳入潜伏性结核感染的靶向检测计划将减少结核菌素检测中固有的假阳性和假阴性结果，为临床医生提供更准确的工具，以便在21世纪控制和消除结核病。
Targeted testing and treatment of individuals with latent tuberculosis infection at increased risk of progression to active disease is a key element of tuberculosis control. This strategy is limited by the poor specificity of the tuberculin skin test in populations vaccinated with bacille Calmette-Guerin and its low sensitivity in immunosuppressed persons, who are at highest risk of progression. Two blood tests (T-SPOT.TB and QuantiFERON-TB Gold), based on detection of IFN-gamma released by T cells in response to M. tuberculosis-specific antigens, may offer an improvement on the skin test. However, validation is challenging due to the lack of a diagnostic gold standard. This critical appraisal of published evidence summarizes the diagnostic accuracy of the new tests. The blood tests have operational advantages over the skin test because no return visit is required, results are available by the next day, and repeated testing does not cause boosting. Both tests are significantly more specific than the skin test in populations vaccinated with bacille Calmette- Guerin. The data suggest that T-SPOT.TB may be more sensitive than the skin test. Data in groups at high risk of progression to disease are scarce, and more research is needed in these populations, but it is clear that T-S POT. TB performs better than the skin test in young children and HIV-infected people with active tuberculosis. Incorporation of these tests into programs for targeted testing of latent tuberculosis infection will reduce false-positive and false-negative results inherent in tuberculin testing, equipping clinicians with more accurate tools for tuberculosis control and elimination in the 21st century.