胸内结节病患者的结核菌素试验

目的为临床诊断胸内结节病减少误诊误治提供依据。方法收集１９９１年至１９９６年住院治疗的３５例胸内结节病病例,按我国规定的测试方法对所有病例进行了结核菌素试验测定,并严格按判断标准进行结果判定。同时与国内外已报道病例结核菌素试验结果进行比较。结果３５例胸内结节病,１７例结核菌素试验为阳性,４例强阳性,阳性及强阳性率为６０％,明显高于国内外已报道的结节病结核菌素试验阳性发生率。结论结果提示,胸内结节病患者结核菌素试验可呈现阳性乃至强阳性,阳性或强阳性发生率的高低与国家／地区及其结核病发病率、患者年龄和患者外周血Ｔ淋巴细胞（ＴＬＣ）γ／δ表型差异相关。将结核菌素试验阴性或弱阳性作为诊断结节病的重要参考指标应慎重,尽可能减少误诊误治。     

结核菌素试验的应用进展

结核菌纯蛋白衍生物（purified protein derivative,PPD）即结核菌素是由结核分枝杆菌培养物经过加热灭活和过滤浓缩制得的一种物质。利用结核菌素在人体皮肤上进行试验,可以判断受试者是否受到结核菌的感染,由于结核菌纯蛋白衍生物不含任何非特异性物质,使其试验更稳定,反应更准确,还不易产生非特异性反应。     

结核菌素试验复强反应发生率及机理的探讨

对１９７３名健康人群进行结素复强反应观察及发生机理探讨。结果：第２次复强阳性率１１．０％，第３次阳性率４．７％。复强阳性率随年龄增长而增高。复强阳性人群血Ｔ淋巴细胞亚群Ｔ_３、Ｔ_４、Ｔ_８可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）的水平高于其它组，证明第２次结素试验使免疫活性细胞激活，增强回忆反应，使免疫反应再现。同时，本文抗体及补体水平检测结果说明，结素反应中有体液免疫参与，且抗体及补体水平与年龄有关，而复强作用并不增强机体免疫反应。     

结核菌素试验对过敏反应的复强作用

Baldwin(1911,1921)、Roemer(1909)、Krause(1916)和 Willia(1928)等人曾报导,经过无毒性结核菌感染的动物,其过敏反应随着感染的痊愈而减弱或完全消失;但重复感染后,过敏反应立即恢复到原来的高水平。     

结核菌素反应与结核病的危险综述

背景:尽管各种研究已经检验了结核菌素反应与结核病危险之间的联系,但确定在多项研究中这种联系的强度和一致性尚未得到核实和检验。 目的:对支持结核菌素反应与结核病危险之间存在联系的证据进行综述。 设计:前瞻性研究,包括根据用电子搜寻的方法查到的三个或更多的结素阳性类别的结核发病的原始资料。这些研究结果按需要重新校正并进行了比较。 结果:11项确定的研究都表明结素皮肤试验反应的增加与结核病危险性增加有联系,有几项研究发现弱结素反应与保护性作用有关。结素反应与结核病危险性之间关系的大小有很大不同。在报告最小的结素阳性反应类别里结核病发病率低的研究中,结素反应和结核病危险性的联系加大。 结论:这些研究综述结果都支持结素反应与结核病危险性之间呈正相关。但该综述发现发病危险增加程度与增大结素反应之间的联系有很大程度的不同。     

结核菌素超敏反应1例

病人女 17岁注射结核菌素48小时后,自觉全身不适、心慌。注射局部红肿、皮肤呈紫褐色,继之水泡、溃烂,两手背皮肤多处大小不等溃烂及紫斑;溃烂面积最大约2.5×2cm;双足背部及一、二趾间出现多处紫褐色斑片,右耳轮有一蚕豆大小溃疡灶,右胸部锁骨中线2～3肋间处及右大腿内侧各有片状紫斑出现。病人及家属即往无皮肤病史和过敏史。其姊曾患淋巴结核2年,已手术切除。病人在此次结素试验前,未感不适。查体:体温36.5℃,心、肺、腹部     

结核菌素试验复强反应与血清IgE含量关系的研究

报告一处农村全人口结核菌素试验复强反应现象调查。复强反应阳性率为１１．０％。采用ＥＬＩＳＡ测定ＰＰＤ试验的后５组人群血清ＩｇＥ含量，结果：人群血清ＩｇＥ含量随着ＰＰＤ试验次数的增加呈现逐渐升高的趋势。提示结核菌抗原刺激机体，可使其产生大量的ＩｇＥ，Ⅰ型变态反应可能也参与了被结核菌感染机体的感染发病过程。各组ＰＰＤ反应强度与血清ＩｇＥ含量无相关，支持结核菌进入机体，机体免疫呈现细胞免疫与体液免疫发生分离现象的观点。     

结核菌素试验复强反应与血清IgE含量关系的研究

报告一处农村全人口结核菌素试验复强反应现象调查。复强反应阳性率为１１．０％，采用ＥＬＩＳＡ测定ＰＰＤ试验前后５组人群血清ＩｇＥ含量，结果：人群血清ＩｇＥ含量随着ＰＰＤ试验次数的增加呈现逐渐升高的趋势。     

结核菌素皮肤试验的应用及其优化

中国是结核病和结核分枝杆菌感染高负担国家,针对感染和发病的高危人群开展预防干预是结核病防控工作的重要内容。结核菌素皮肤试验作为一种成熟的结核分枝杆菌感染的免疫学检测方法,尽管其结果受卡介苗接种、环境非结核分枝杆菌感染、宿主免疫状态等多种因素的影响,但在高危人群筛查、结核病辅助诊断、重点人群监测等工作中发挥着重要作用。结合中国国情及结核分枝杆菌感染的流行特征,通过优化应用策略可以在有效控制影响因素的基础上发挥结核菌素皮肤试验作为感染筛查手段的优势;同时,在科学数据支撑下,针对不同目标人群细化应用和结果解读也将为其更好地服务中国结核病防控工作提供质量保证。     

The prevalence and predictors of tuberculin positivity in subjects screened for reasons other than contact investigation

BACKGROUND:

No previous studies have estimated the rates of tuberculin positivity (TP) in noncontact populations within the same community, which is important for prioritizing and implementing preventive measures.

OBJECTIVES:

To estimate the prevalence and predictors of TP in noncontact populations.

METHODS:

A retrospective analysis of tuberculin results of non-contact populations screened in British Columbia from 1990 to 2002 was conducted.

RESULTS:

The period prevalence of TP in 59,791 screened subjects was 12.7% (95% CI 12.4% to 13.0%), 30.4% (95% CI 28.2% to 32.7%) and 60.9% (95% CI 60.3% to 61.6%) for Canadian-born non-Aboriginals (CBNAs), Canadian-born Aboriginals (CBAs) and foreign born (FB), respectively. After controlling for age and sex, independent predictors of TP included Bacille Calmette-Guérin (BCG) vaccination (OR 19.6, 95% CI 17.9 to 21.5), country of birth (CBA: OR 2.87, 95% CI 2.44 to 3.37; FB: OR 3.67, 95% CI 3.34 to 4.03) and the following populations: correctional centre residents (OR 4.14, 95% CI 1.87 to 9.15), residents of long-term care and community care facilities (OR 1.79, 95% CI 1.44 to 2.23), immigrants (OR 1.75, 95 % CI 1.50 to 2.04), health centre employees (OR 1.71, 95 % CI 1.56 to 1.88), volunteers (OR 1.38, 95% CI 1.14 to 1.68), self-referred healthy subjects (OR 1.30, 95% CI 1.15 to 1.48) and students (OR 1.27, 95% CI 1.19 to 1.35). CBAs, FB and male subjects were less likely to react to tuberculin than CBNAs and female subjects among those vaccinated with Bacille Calmette-Guérin (P<0.05).

CONCLUSIONS:

Rates of TP correlate with disease rates by sex and origin. The continuation of tuberculin screening programs is warranted in noncontact populations with high TP rates, where unknown exposure to active cases is more likely to occur. Further research is needed to determine the reasons why a higher response to tuberculin occurs in BCG-vaccinated women and CBNAs.     

γ干扰素释放试验与结核菌素皮肤试验辅助检测肺外结核病的比较

目的 比较γ干扰素释放试验与结核菌素皮肤试验在肺外结核病辅助诊断中的差异。 方法 对上海市肺科医院2012年1月至2012年6月住院治疗的100例肺外结核病患者（简称“结核病组”）及81名体检者（简称“对照组”）分别进行γ干扰素释放试验及结核菌素皮肤试验检测,统计两种检测方法的检出率,并对检出率进行比较,以P〈0.05为差异具有统计学意义。 结果 100例结核病组患者γ干扰素释放试验和结核菌素皮肤试验检测的检出率分别为80.00%（80/100）,46.00%（46/100）;对两者检出率进行统计学处理,差异有统计学意义（χ^224.80,P〈0.05）。100例结核病组患者γ干扰素释放试验检测的检出率为80.00%（80/100）,81名对照组γ干扰素释放试验检测的检出率为25.93%（21/81）;对两者检出率进行统计学处理,差异有统计学意义（χ^251.76,P〈0.05）。 结论 γ干扰素释放试验较结核菌素皮肤试验检测对于肺外结核病的辅助诊断有更高的敏感度及特异度。     

菏泽市单县中学新生结核菌素试验结果分析

目的 分析菏泽市单县2020年中学新生结核菌素纯蛋白衍生物(purified protein derivative,PPD)试验结果,了解入学新生结核分枝杆菌感染情况。方法 以单县辖区内3所寄宿制高中和37所寄宿制初中新生为研究对象,于2020年10月—2021年1月对其开展PPD试验,分析并比较不同年级、不同性别、不同区域学生的阳性率、强阳性率差异。结果 共有15 994名学生接受PPD试验,PPD试验阳性率为5.11%,强阳性率为0.43%,未发现活动性肺结核患者。高一新生阳性率和强阳性率分别为7.58%(547/7 219)和0.82%(59/7 219),初一新生阳性率和强阳性率分别为3.08%(270/8 775)和0.10%(9/8 775),不同年级学生的阳性率和强阳性率差异均有统计学意义(χ²=165.484、47.791,P均<0.05)。高一男生阳性率和强阳性率分别为7.47%(315/4 215)和0.66%(28/4 215),女生阳性率和强阳性率分别为7.72%(232/3 004)和1.03%(31/3 004),高一不同性别学生...     

Positive tuberculin skin tests in nursing home residents in Southern Taiwan

In Taiwan, the tuberculin skin test (TST) is not recommended as a screening test for Mycobacterium tuberculosis (TB) infections. The aim of this study is to determine the prevalence and predictors of positive tuberculin reactivity and its association with TB infections among nursing home residents in Taiwan. A cross-sectional study and review of medical records were conducted at four nursing homes in Tainan City. A one-stage TST was performed by study nurses using two tuberculin units of purified protein derivative (PPD) of the RT23 strain. An induration ≥10 mm at 72 h was considered to be a positive reaction. Chest radiographs, acid-fast stains and mycobacterial cultures of three sputum samples were performed for those with a positive TST result. Of 115 residents (66.5% participation, mean age 73.1 years) who underwent a TST, 26 (22.6%) had a positive reaction. One woman was microbiologically diagnosed to have pulmonary TB. On multivariate analysis, a Bacille Calmette-Guérin (BCG) scar and a history of myocardial infarction were significantly associated with a positive TST. In conclusions, this study shows a considerable rate of positive TST among nursing home residents in southern Taiwan. A BCG scar and a history of myocardial infarction were associated with a positive TST.     

四所中学初中生结核菌素反应性调查

目的了解当地初中生结核菌素反应状况。方法选医院驻地怀来县4所中学5153名初一年级学生进行标准化PPD试验调查，并对学生年龄、性别、居住来源及结核病流行特点进行调查分析。结果80.2%的学生集中在13～14岁组，来源于农村者占57.6%，≥5mm总阳性反应率23.1%，≥15mm为7.4%。2219名无卡痕学生PPD反应在≥5mm，≥10mm，≥15mm和≥20mm分别为16.0%、10.9%、5.9%和2.9%，有卡痕学生结素反应性明显高于无卡痕者；有结核接触史和既往史学生的结素反应均高于无结核接触史和既往史者。结论把初中新入学学生作为当地结素试验对象，建议将≥15mm结素反应者列为预防性治疗对象,以减少结核病发生。     

结核菌素试验和T细胞斑点试验在肠结核中的诊断价值

本文介绍了结核菌素试验和T细胞斑点试验在诊断肠结核中的研究进展。结核菌素试验在肠结核诊断中的灵敏度在50～60%,特异度可到达70%,阴性预测值在60～70%。T细胞斑点试验诊断肠结核的灵敏度超过70%,特异度超过80%,阴性预测值可超过80%。两者联合在肠结核的诊断中灵敏度可超过80%,特异度超过60%,阴性预测值可超过85%,对肠结核的诊断和鉴别诊断有较高的临床意义。因此可根据临床情况联合应用。     

Percentage of reactor animals to single comparative cervical intradermal tuberculin (SCCIT) in small ruminants in Punjab Pakistan

To investigate the percentage reactor animals to SCCIT in sheep and goat the present study was carried out by using bovine and avian PPDs at 7 Livestock Experiment Stations of Punjab and villages around two cities. The overall percentage of reactor animals to SCCIT at farms in sheep and goat was 0.9% and 2.4%, while it was 0.4% and 0.0% around two cities, respectively. Hundred percent of goat and 86% of sheep farms under study had positive reactor animals. The reactor animals to SCCIT around two cities were 0% in goat and 0.4% in sheep. Goats (P < 0.05) and sheep (P < 0.001) kept with large ruminants at farms had higher percentage of reactor animals. Age showed significant (P < 0.01) association with tuberculosis in sheep and goat. In goats of more than 6 years of age, the reactor animals to SCCIT were 5, 8 and 11 times higher than goats of 4.1-6, 3-4 and <3 years of age. The reactor animals were significantly (P < 0.05) higher in goats of <30 kg (3.5%) and > 40 kg (3.5%) body weights, while these were less in goats weighing between 30 and 40 kg (1.5%). Sheep and goat breeds showed significant (P < 0.001; P < 0.05) difference in percentage of reactor animals to SCCIT. Beetal (3.9%) and Teddy breeds (2.9%) had 3.3 and 2.4 times higher percentages of reactor animals to SCCIT as compared to Pak-Angora (1.2%) breed. However, no animal of Nachhi and Dera Din Pinah breeds showed positive reaction to PPDs.     

血清结核抗体检测及结核菌素试验对肺结核病诊断的价值

目的 评价血清抗ＰＰＤ－ＩｇＧ检测及ＰＰＤ皮试在肺结核病诊断中的价值。方法 对１６２例肺结核病患者，４０例非结核病患者的ＰＰＤ皮试结果及血清抗ＰＰＤ－ＩｇＧ检测结果进行相关回归分析及ｘ＾２检验。结果 ＰＰＤ皮试敏感度为７２．８％，特异度为６０％；血清抗ＰＰＤ－ＩｇＧ检测敏感度为７９％，特异度为５５％，两者联合检测敏感度８９．５％；双阳性的特异度８５％；双阴性排除肺结核的特异度９７％。有无空洞对两者