Utility of the antigen-specific interferon-γ assay for the management of tuberculosis
Utility of the antigen-specific interferon-γ assay for the management of tuberculosis
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DOI：
10.1097/01.mcp.0000158726.13159.5e
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发表时间：
2005-05-01
影响因子：
3.3
通讯作者：
Rook, GAW
中科院分区：
文献类型：
--
作者：
Dheda, K;Udwadia, ZF;Rook, GAW
综述目的结核菌素皮肤试验已有世纪的历史，其结果易受阅片者变异性的影响，并受与环境分枝杆菌的交叉反应性、既往卡介苗（BCG）接种以及免疫抑制个体的无反应性的影响。最近，基于T细胞的干扰素-γ对结核分枝杆菌特异性抗原的反应已经被研究了它们在诊断潜伏性结核infection. Recent finding中的作用。我们回顾了支持在低流行率国家中使用干扰素-γ检测诊断潜伏性结核感染（LTBI）的证据。我们讨论了与性能相关的测试技术因素的原理，及其在活动性结核病中的实用性，在免疫功能低下患者等特殊亚组中的实用性，以及其在发展中国家的适用性。总结与结核菌素皮肤试验相比，抗原特异性干扰素-γ测定在标准化方案中使用时（使用两种抗原的组合的过夜孵育测定）用于诊断LTBI，在BCG接种的个体中具有更高的特异性，显示出与暴露更强的相关性，并且较少受到环境分枝杆菌如鸟分枝杆菌的影响。然而，需要进行前瞻性研究，以证实治疗LTBI（如干扰素-γ测定法所定义）将减少低流行率国家的结核病负担，以及干扰素-γ反应是否可预测进展为活动性结核病的高风险患者。需要进一步的研究，以解决干扰素-γ测定在发展中国家的特殊亚组患者中的效用，并作为疾病活动的标志物。
Purpose of review The tuberculin skin test, now over a century old, is prone to reader variability, and outcomes are influenced by cross-reactivity with environmental mycobacteria, previous bacillus Calmette-Guerin (BCG) vaccination, and anergy in immunosuppressed individuals. More recently, T-cell-based interferon-gamma responses to Mycobacterium tuberculosis specific antigens have been investigated for their role in diagnosing latent tuberculosis infection.Recent finding We review the evidence supporting the utility of the inferferon-gamma assay for the diagnosis of latent tuberculosis infection (LTBI) in low-prevalence countries. We discuss the principle of the test technical factor related to performance, and its utility in active tuberculosis, in specialised subgroup such as immunocompromised patients, and its applicability in developing countries.Summary Compared with the tuberculin skin test the antigen-specific interferon-gamma assay, when used in a standardised protocol (overnight incubation assay using a combination of two antigens) for the diagnosis of LTBI, has greater specificity in BCG-vaccinated individuals, displays a stronger associated with exposure, and is less biased by environmental mycobacteria such as Mycobacterium avium. Prospective studies are required, however, to confirm that treating LTBI, as defined by the interferon-gamma assay, will reduce the tuberculosis burden in low-prevalence countries and whether interferon-gamma responses are predictive of those who have a high risk of progression to active tuberculosis. Further studies are required to address the utility of the interferon-gamma assay in specialised subgroups of patients, in developing countries, and as a marker of disease activity.