Improved diagnostic evaluation of suspected tuberculosis.
Improved diagnostic evaluation of suspected tuberculosis.
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DOI：
10.7326/0003-4819-148-5-200803040-00003
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发表时间：
2008-03-04
影响因子：
39.2
通讯作者：
Lalvani A
中科院分区：
文献类型：
--
作者：
Dosanjh DP;Hinks TS;Innes JA;Deeks JJ;Pasvol G;Hackforth S;Varia H;Millington KA;Gunatheesan R;Guyot-Revol V;Lalvani A
新的基于T细胞的结核病血液检测在诊断活动性结核病中的作用尚不清楚。比较2种干扰素-γ测定法和结核菌素皮试法在成人疑似结核病患者中的性能。在常规实践中进行的前瞻性研究。英国2家城市医院。389例成人，主要是南亚和黑人，临床怀疑中度至高度活动性结核病。在诊断评估期间，由对其他试验结果不知情的独立人员进行了Escheroculin皮肤试验、掺入早期分泌抗原靶标-6和培养滤液蛋白-10（标准ELISpot）的酶联免疫斑点试验（ELISpot）以及掺入新抗原Rv 3879 c（ELISpotPLUS）的ELISpot。敏感性、特异性、预测值和似然比。194例患者最终诊断为活动性结核病，其中79%经培养确诊。对培养确诊和高可能性结核病的敏感性为89%（95% CI，84%-93%），ELISpotPLUS，85%（CI，79%至90%），标准ELISpot，79%（CI，72%至85%）与15毫米阈值结核菌素皮肤试验，和83%（CI，77%至89%）与15和10毫米阈值接种疫苗和未接种疫苗的患者分别。ELISpotPLUS检测比结核菌素皮肤试验敏感，15 mm的临界点（P = 0.01），但不是分层10 mm的临界点（P = 0.10）。ELISpotPLUS检测的诊断灵敏度比标准ELISpot高4%（P = 0.02）。ELISpotPLUS和结核菌素皮肤试验的联合灵敏度为99%（CI，95%至100%），当两种试验结果均为阴性时，阴性似然比为0.02（CI，0至0.06）。结核菌素皮肤试验的当地标准与国际上使用的其他标准不同。研究样本包括少数免疫抑制患者。ELISpotPLUS是一种比标准ELISpot更灵敏的检测方法，当与结核菌素皮试联合使用时，可以快速排除中至高检测前结核病概率患者的活动性感染。
The role of new T-cell–based blood tests for tuberculosis in the diagnosis of active tuberculosis is unclear. To compare the performance of 2 interferon-γ assays and tuberculin skin testing in adults with suspected tuberculosis. Prospective study conducted in routine practice. 2 urban hospitals in the United Kingdom. 389 adults, predominantly of South Asian and black ethnicity, with moderate to high clinical suspicion of active tuberculosis. Tuberculin skin testing, the enzyme-linked immunospot assay (ELISpot) incorporating early secretory antigenic target-6 and culture filtrate protein-10 (standard ELISpot), and ELISpot incorporating a novel antigen, Rv3879c (ELISpotPLUS) were performed during diagnostic assessment by independent persons who were blinded to results of the other test. Sensitivity, specificity, predictive values, and likelihood ratios. 194 patients had a final diagnosis of active tuberculosis, of which 79% were culture-confirmed. Sensitivity for culture-confirmed and highly probable tuberculosis was 89% (95% CI, 84% to 93%) with ELISpotPLUS, 85% (CI, 79% to 90%) with standard ELISpot, 79% (CI, 72% to 85%) with 15-mm threshold tuberculin skin testing, and 83% (CI, 77% to 89%) with thresholds of 15 and 10 mm in vaccinated and unvaccinated patients, respectively. The ELISpotPLUS assay was more sensitive than tuberculin skin testing with 15-mm cutoff points (P = 0.01) but not with stratified 10-mm cutoff points (P = 0.10). The ELISpotPLUS assay had 4% higher diagnostic sensitivity than standard ELISpot (P = 0.02). Combined sensitivity of ELISpotPLUS and tuberculin skin testing was 99% (CI, 95% to 100%), conferring a negative likelihood ratio of 0.02 (CI, 0 to 0.06) when both test results were negative. Local standards for tuberculin skin testing differed from others used internationally. The study sample included few immunosuppressed patients. The ELISpotPLUS is a more sensitive assay than standard ELISpot and, when used in combination with tuberculin skin testing, enables rapid exclusion of active infection in patients with moderate to high pretest probability of tuberculosis.
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影响因子：
3.8
作者：
Chapman, ALN;Munkanta, M;Lalvani, A
通讯作者：
Lalvani, A
DOI：
10.1164/rccm.200608-1099oc
发表时间：
2007-03-15
影响因子：
24.7
作者：
Arend, Sandra M.;Thijsen, Steven F. T.;Bossink, Ailko W. J.
通讯作者：
Bossink, Ailko W. J.
影响因子：
11.8
作者：
Lee, E;Holzman, RS
通讯作者：
Holzman, RS
DOI：
10.1164/rccm.200502-196oc
发表时间：
2005-09-01
影响因子：
24.7
作者：
Ferrara, G;Losi, M;Richeldi, L
通讯作者：
Richeldi, L
影响因子：
168.9
作者：
Ewer, K;Deeks, J;Lalvani, A
通讯作者：
Lalvani, A