γ干扰素释放试验与结核菌素皮肤试验在肺结核患者密切接触者随访中的应用比较  

Evaluation of interferon-gamma release assays and tuberculin skin test in screening active tuberculosis and latent tuber- culosis infection in close contacts of pulmonary tuberculosis patients

作　　者：李晋[1] 杨倩婷[1] 岳建荣[2] 林玲[1] 张明霞[1] 顾美红[1] 邓群益[2] 邓国防[2] 邓永聪[2] 陈心春[1] 

机构地区：[1]广东医学院附属深圳市第三人民医院深圳市感染免疫重点实验室广东省新发传染病诊治重点实验室,5180202 [2]广东医学院附属深圳市第三人民医院深圳市感染免疫重点实验室广东省新发传染病诊治内科,5180202

出　　处：《中国防痨杂志》2015年第7期748-752,共5页Chinese Journal of Antituberculosis

基　　金：“十二五”国家科技重大专项（2013ZXl0003004002006）;广东省医学科研基金（132014354）;深圳市科技计划项目（JCYJ20130329171031741）

摘　　要：目的比较γ干扰素释放试验（IGRAs）和结核菌素皮肤试验（TST）在筛查肺结核密切接触者是否发生结核感染中的效能。方法对138名肺结核患者的密切接触者[分别为家属（60名）和同事（78名）]每6个月进行酶联免疫斑点试验（ELISPOT）和TST平行检测，同时了解结核病的发生情况，共随访24个月；统计分析ELISPOT和TST检测结果与疾病发生和结核分枝杆菌暴露的关系。结果在2年的随访中，累计发现11例新发活动性肺结核。与127名完成2年共5次随访的未发病密切接触者相比，新发活动性肺结核发病人群第一次ELISPOT检测的阳性率为72．7％（8／11），显著高于未发病人群的阳性率33．1％（42／127），χ^2=6．8905，P=0．0087；而TsT检测的阳性率分别是63．6％（7／11）、66．9％（85／127），χ^2=0．0494，p=0．8241，差异无统计学意义。ELISPOT阳性率与结核分枝杆菌暴露程度有关，暴露程度较高的密切接触者（家属）的阳性率为45．0％（27／60），显著高于暴露程度较低的同事[28．2％（22／78）]，χ^2=4．1773，P=0．0410；而TST检测的阳性率分别为55．0％（33／60）和75．6％（59／78），与结核分枝杆菌暴露程度不一致。结论ELISPOT筛查肺结核密切接触者中高危人群的特异度显著高于TsT，能更准确地反映结核分枝杆菌暴露后的感染情况。Objective To evaluate the efficiency of interferon release assays （IGRAs） and tuberculin skin test （TST） in screening active tuberculosis （TB） and latent tuberculosis infection （LTBI） in close contacts of pulmonary TB patients. Methods Samples of 138 close contacts of TB patients from family members （60 cases） and col leagues （78 cases） were collected. ELISPOT test （ELISPOT） and TST parallel detection were done every six months during the whole process of 24 months. Statistical analysis of the relationship between the results and disease occurrence and Mycobacterium tuberculosis exposure was performed. Results Among 138 close contacts who completed 5 times of follow-up detection in a period of 24 month, 11 cases developed to active PTB. of the 11 patients, the positive rate of first ELISPOT was 72.7%（8/11）, which was significantly higher than that of the unaffected （33.1%, 42/127） χ^2=6. 8905, P= 0. 0087）. While the positive rates of first TST were 63.6 % （TB） and 66.9 % （unaffected） respectively, and the difference was not statistically significant （χ^2 =0. 0494, P=0. 8241）. ELISPOT positive rate was correlated to the degree of exposure to Mycobacterium tuberculosis. In high level exposure close contacts （families）, ELISPOT positive rate was 45.0% （27/60）, which was significantly higher than the low level exposure colleagues （28.2%, 22/78） （χ^2=4. 1773, P=0. 0410）. While TST positive rates among the high and low level exposure group were 55.0% （33/60） and 75.6% （59/78） respectively, which was inconsistent with Mycobacterium tuberculosis exposure level. Conclusion Compared to TST, IGRAs ELISPOT has higher specificity in high risk population in close contacts of PTB cases, and is more accurate in the detection of active TB and LTBI in close contact of PTB patients.

关 键 词：结核 肺/诊断 接触者追踪 干扰素丫释放试验 结核菌素试验 酶联免疫斑点测定 随访研究 

分 类 号：R521.04[医药卫生—内科学]