Evaluation of the clinical usefulness of mycobacterial skin test antigens in adults with pulmonary mycobacterioses.
Evaluation of the clinical usefulness of mycobacterial skin test antigens in adults with pulmonary mycobacterioses.
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评估成人肺分枝杆菌病分枝杆菌皮试抗原的临床有效性。
DOI：
10.1164/ajrccm/145.5.1160
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
R. O'brien
中科院分区：
文献类型：
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作者：
R. Huebner;Maybelle F. Schein;G. Cauthen;L. Geiter;Merle J. Selin;R. Good;R. O'brien
为评价分枝杆菌皮肤试验抗原对成人肺分枝杆菌病的特异性诊断的有效性，进行了一项双盲、多中心研究。皮试抗原为PPD-T(牛分枝杆菌)和PPD-B(细胞内分枝杆菌)，经人体生物测定，生物等效性为5TU PPD-S。在年龄大于或等于18岁的成人中，结核分枝杆菌引起的疾病患者对PPD-T的反应显著高于非结核分枝杆菌引起的疾病患者和培养结果阴性的患者(分别为13.41mmvs4.87mm2和4.96mmp<0.001)。NTM组对PPD-B的平均硬化度与MTB或NEG组无明显差异。PPD-T和PPD-B之间的“阳性”定义为硬结大于或等于10 mm，大小差异大于或等于3 mm，PPD-T诊断MTB与NTM的敏感度、特异度和阳性预测值(PPV)分别为29、90和75%。PPD-B和NTM病的对应值分别为70、61和%。双重检测在区分NEG中任何一种分枝杆菌引起的疾病方面用处较小。尽管PPD-B与PPD-S生物等效性较高，但特异性和PPV均较低。我们的结论是，这种PPD-B制剂在鉴别成人NTM引起的肺部疾病方面并不比单独使用PPD-T更有用。
A double-blind, multicenter study was conducted to evaluate the usefulness of mycobacterial skin test antigens for the specific diagnosis of adult pulmonary mycobacterial disease. The skin test antigens used were PPD-T (M. bovis) and PPD-B (M. intracellulare), made bioequivalent to 5 TU PPD-S through bioassay in human subjects. Of the 192 adults (18 yr of age or older), those with disease caused by M. tuberculosis (MTB) had significantly larger reactions to PPD-T than did those with disease caused by nontuberculous mycobacteria (NTM) or those with negative culture results (NEG)(13.41 mm versus 4.87 and 4.96 mm, respectively, p less than 0.001). The mean induration to PPD-B in NTM was not different from that in MTB or NEG. Defining a "positive" to be greater than or equal to 10 mm induration and a size difference of greater than or equal to 3 mm between PPD-T and PPD-B, the sensitivity, specificity, and positive predictive value (PPV) for PPD-T in diagnosing MTB versus NTM was 29, 90, and 75%. Corresponding values for PPD-B and NTM disease were 70, 61, and 64%. Dual testing was less useful in distinguishing disease caused by any of the mycobacteria from NEG. Although the sensitivity of PPD-B, made bioequivalent to PPD-S, was high, the specificity and PPV were low. We conclude that this preparation of PPD-B is no more useful in distinguishing adult pulmonary disease caused by NTM than is PPD-T alone.