TB or not TB: The role of immunodiagnosis

The evaluation of delayed‐type hypersensitivity immune responses by the tuberculin skin test and, more recently, by ex vivo IFN‐γ release assays (IGRAs) form the basis for the risk assessment for the development of tuberculosis (TB) in close contacts of infective index patients and in immunocompromised hosts. In contrast, immunodiagnosis has little value for the diagnosis of active TB so far. A report in this issue of the European Journal of Immunology [ Eur J Immunol 2012. 42: 2844–2850 ] provides new insight into the phenotypic characteristics and selective recruitment of Ag‐specific T cells to the site of the infection, as analyzed by flow cytometry, which may provide new opportunities for the immune‐based diagnosis of TB in the future.     

结核感染T细胞斑点试验在结核诊断与筛查中的价值

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)在结核诊断与筛查中的价值.方法 对2013年1月至2016年12月在南通市第一人民医院就诊的266个患者分为结核组、非结核组及生物制剂组,抽取静脉血应用结核感染T细胞斑点试验进行检测,同时部分患者进行了结核菌素检测.结果 T-SPOT.TB法诊断TB患者的敏感度为87.9％,阳性预测价值和阴性预测价值分别是43.2％和88.5％,TB组T-SPOT.TB检测阳性率明显高于非TB组(P ＜0.001)和生物制剂组(P＜0.001)的阳性率.而TST试验结果中,TB组阳性率与非TB组、非TB组阳性率与生物制剂组差异均没有统计学意义(P＞0.05),而TB组阳性率与生物制剂组差异有统计学意义(P＜0.05).在所有受试者T-SPOT.TB检测和TST试验的一致性为70.3％(K =0.397),生物制剂组中两者一致性为59.5％ (K=0.313).在TB组和非TB组中,两种方法一致性更高,分别为83.7％(K=0.486)和77.1％ (K=0.437).T-SPOT.TB法中TB组的斑点数显著高于非TB组(P ＜0.001)和生物制剂组(P＜0.001),而非TB组和生物制剂组的斑点数差异没有统计学意义(P＞0.05).结论 T-SPOT.TB检测比结核菌素试验有更高的灵敏度及阴性预测价值,并且不受环境分枝杆菌和BCG接种的影响,使得T-SPOT.TB在结核感染的诊断与筛查中具有较好的临床应用价值.