Les nouveaux tests immunologiques dans le diagnostic de la tuberculose (TB or not TB)
Les nouveaux tests immunologiques dans le diagnostic de la tuberculose (TB or not TB)
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DOI：
10.1016/s0761-8425(07)91569-7
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发表时间：
2007-04
影响因子：
0.6
通讯作者：
P. Lagrange;N. Simonney;J. Herrmann
中科院分区：
文献类型：
--
作者：
P. Lagrange;N. Simonney;J. Herrmann
背景目前，结核菌素皮肤试验（TST）的阳性程度对LTBI诊断的帮助是有限的，无论是在操作上还是在逻辑上，在接种BCG或非典型分枝杆菌致敏的人群中，以及在那些免疫抑制的人中，其敏感性低，进展的风险最大。此外，TST还有其他与回访、重复测试有关的操作限制，导致了助推效应和主观解释。一种新的方法遵循两种用于诊断LTBI的生物学测试（QuantiFERON-TB和T-SPOT-TB）的可用性，其测量响应于M的血液单核细胞体外产生干扰素γ（IFN-γ）。结核特异性抗原（ESAT-6和CFP 10）。本文分析了已发表的研究，这些研究对不同数量的患者进行了评估，并将这两种检测与TST进行了比较。然而，由于缺乏诊断LTBI的“金标准”，验证受到阻碍。这些研究表明，两种生物学试验的特异性水平相似。它们在统计学上高于TST，特别是在接种BCG的人群中。另一方面，它们的敏感性至少与TST相当，在某些研究中，T-SPOT-TB的敏感性上级。最后，已经进行了几项接触研究，目的是测量这些生物测试和TST之间的一致性。基本的发现是，生物测试的阳性率与接触者的接触程度之间存在很好的相关性。与TST相比，这些测试具有额外的操作优势：在一次访视中完成，24小时内获得结果，没有观察者间和观察者内的差异，检测潜在的免疫抑制和避免重复测试的加强。
BackgroundThe help currently given to the diagnosis of LTBI by the degree of positivity of the tuberculin skin test (TST) is limited, both operationally and logistically, in populations vaccinated with BCG or sensitised by atypical mycobacteria, and by its low sensitivity in those immuno-suppressed persons who are at greatest risk of progression. Moreover the TST has other operational limitations linked to return visits, repeat testing causing a boosting effect and subjective interpretation. A new approach follows the availability of two biological tests for the diagnosis of LTBI (QuantiFERON-TB and T-SPOT-TB) that measure the in-vitro production of interferon gamma (IFN-gamma) by the blood mononuclear cells in response to M. tuberculosis specific antigens (ESAT-6 and CFP10). This revue analyses the published studies, undertaken with varying numbers of patients, that evaluate the diagnostic accuracy of these two tests in comparison with TST. However, validation is handicapped by the lack of a" gold standard" for the diagnosis of LTBI. These studies demonstrate similar levels of specificity for the two biological tests. They are statistically higher than those for TST, particularly in populations vaccinated by BCG. On the other hand, their sensitivity was at least equivalent to that of TST and, in certain studies, superior with T-SPOT-TB. Finally, several studies in contacts have been undertaken with the aim of measuring the concordance between these biological tests and TST. The essential finding is of a very good correlation between positivity of the biological tests and the degree of exposure of the contacts. These tests have additional operational advantages over TST: completed in one visit, results available in 24 hours, absence of inter and intra observer divergence, detection of potential immuno-depression and avoidance of boosting by repeat testing.