2005年广州市结核病现况抽样调查

目的了解广州市结核病的流行现状及危害程度，评价广州市结核病防治措施，为制定广州市2006至2010年结核病防治规划提供科学依据。方法采用整群随机和按人口比例抽样方法，抽样人口比例为1：158。广州市应有流行病学调查点为24个，平均每个调查点的应检人数为1656人。对调查点0～14岁儿童进行结核菌素纯蛋白衍生物试验，询问其卡介苗接种史并检查卡痕；对结核菌素反应≥10mm，或虽〈10mm但伴有水疱等强反应的儿童和≥15岁应检人口进行X线胸透；对疑有肺结核症状者、X线胸透有异常阴影及已知肺结核患者均拍摄胸部X线片；对X线胸透异常及疑有肺结核症状者进行痰涂片和痰培养检查，对培养阳性的标本进行菌种鉴定。结果广州市活动性肺结核患病率为201／10万，涂阳肺结核患病率为33／10万，菌阳肺结核患病率为43／10万；14岁以下儿童中未发现活动性肺结核患者，15～50岁组活动性肺结核患病率为72．5／10万～176．8／10万，80岁以上达高峰，以老年男性最高（2341／10万）；已知活动性肺结核、涂阳和菌阳肺结核分别为35．0％（28／80）、61．5％（8／13）和47．1％（8／17）；初治活动性肺结核、涂阳和菌阳肺结核分别为81．3％（65／80）、69．2％（9／13）和58．8％（10／17）；55岁以上组的复治活动性肺结核患者占80．0％。结论广州市的结核病患病率仍较高，老年菌阳肺结核仍较多。     

涂阳肺结核病人家庭密切接触者X线胸片筛检情况分析

目的了解涂阳肺结核病人家庭密切接触者中活动性肺结核检出情况。方法接受检查的家庭密切接触者771人,年龄＜15岁儿童进行结核菌素纯蛋白衍生物试验,对结核菌素反应≥10mm或虽＜10mm但伴有水泡等强反应的儿童,和≥15岁人群均摄X线胸片,对X线胸片提示肺部有异常阴影者进行痰涂片和痰培养检查。结果涂阳肺结核病人家庭密切接触者中活动性肺结核病人检出率为3.8%,涂阳肺结核检出率为0.8%。肺部病灶有空洞和排菌量大的病人其家庭密切接触者活动性肺结核检出率高。家庭密切接触者中年龄＞60岁组其活动性肺结核检出率高于其他组,经统计学处理,与15～60岁组比,差异有统计学意义。结论对涂阳肺结核病人家庭密切接触者摄X线胸片筛查,有助于提高肺结核病人发现率,是发现肺结核病例的一种有效手段。     

结核分枝杆菌特异性蛋白抗体检测在结核病诊断中的价值

目的研究结核分枝杆菌特异性蛋白（TB-SA）抗体检测在结核病诊断中的价值。方法对829例结核病患者（男471例，女358例）、278例非结核性肺部疾病患者（男172例，女106例）和125例健康志愿者（男51例，女74例）同时进行结核菌素纯蛋白衍生物（PPD）试验，结核分枝杆菌TB-SA抗体检测，并对全部肺结核和非结核性肺部疾病患者进行痰抗酸杆菌涂片和培养。采用EPl2000统计软件进行统计学分析，组间比较采用t检验，计数资料采用X^2检验。结果结核分枝杆菌TB-SA抗体检测诊断菌阳肺结核的敏感度为75．1％（272／362）；诊断菌阴肺结核的敏感度为68．9％（226／328）；诊断肺外结核病的敏感度为71，2％（99／139）；诊断结核病的总体敏感度为72．0％（597／829），特异度为82．1％（331／403）。TB-SA血清抗体检测值并不与PPD值呈线性关系，即结核分枝杆菌TB-SA抗体检测诊断结核病不受卡介苗接种反应的影响。结论结核分枝杆菌TB-SA抗体检测诊断结核病有较好的敏感度和特异度，是辅助诊断和鉴别诊断结核病的有效手段。     

涂阳肺结核病人家庭密切接触者筛查情况分析

目的了解涂阳肺结核病人家庭密切接触者中活动性肺结核检出情况。方法接受检查的家庭密切接触者771人,年龄〈15岁儿童进行结核菌素纯蛋白衍生物实验,对结核菌素强阳性反应（硬结≥20 mm或局部伴有水泡等）的儿童,和≥15岁人群均拍摄X线胸片,对X线胸片提示肺部有异常阴影者进行痰涂片和痰培养检查。结果涂阳肺结核病人家庭密切接触者中活动性肺结核病人检出率为3.8%,涂阳肺结核检出率为0.8%。肺部病灶有空洞和排菌量大的病人其家庭密切接触者活动性肺结核检出率高。家庭密切接触者中年龄〉60岁组其活动性肺结核检出率高于其他组,经统计学处理,与15~60岁组比,差异有统计学意义（P〈0.05）。结论对涂阳肺结核病人家庭密切接触者摄X线胸片筛查,有助于提高肺结核病人发现率,是发现肺结核病例的一种有效手段。     

结核分枝杆菌效应T细胞检测在诊断活动性结核病中的价值

目的分析结核分枝杆菌效应T细胞检测法在诊断活动性结核病中的价值。方法选取2015年1-12月来自上海市公共卫生临床中心、上海市肺科医院和沈阳市胸科医院的708例活动性结核病患者、289例非结核肺部疾病患者和55名健康志愿者作为研究对象。将55名健康志愿者和289例非结核肺部疾病患者作为非活动性结核组。活动性结核组包括68例肺外结核患者和640例肺结核患者,肺结核并发肺外结核者归属为肺结核患者;在肺结核患者中有230例患者痰标本的细菌学检查呈阳性,410例痰标本细菌学检查阴性。分离研究对象外周血单核细胞,应用结核分枝杆菌效应T细胞检测试剂盒进行检测,评价该检测方法的诊断效能。结果结核分枝杆菌效应T细胞检测试剂盒检测活动性结核组的敏感度为81．78％（579／708）;检测非活动性结核组的特异度为79．36％（273／344）;检测健康志愿者的特异度为89．09％（49／55）。在经检测结果为阳性的650例研究对象中,正确检出阳性579例,阳性预测值为89．08％;在所有检查结果为阴性的402例研究对象中,正确检出阴性273例,阴性预测值为67．91％（273／402）;阳性似然比、阴性似然比和正确诊断效率依次为3．96、0．23和80．99％（852／1052）。检测痰检阳性患者的阳性检出率相对更高,为84．78％（195／230）;检测肺结核并发肺外结核患者的阳性检出率为91．49％（43／47）。结论结核分枝杆菌效应T细胞检测试剂盒对于活动性结核病的诊断具有较高的敏感度和特异度,尤其在肺结核并发肺外结核的患者以及痰检阳性的肺结核患者中效果较好,可用于辅助诊断活动性结核病。     

四川省平原与丘陵地区菌阳肺结核比较分析

目的了解四川省平原与丘陵地区菌阳肺结核的发病差异、菌型及耐药性概况,为不同地区采用不同结核病控制策略提供科学依据。方法选择四川省结核病耐药监测点中平原地区的双流县和丘陵地区的隆昌县,收集2009年菌阳肺结核病例,对分离培养阳性的菌株进行耐药性测定和菌种初步鉴定。结果双流县2009年发现菌阳肺结核患者246例（培养阳性172例）,菌阳发病率27／10万,检出1例非结核分枝杆菌,总耐药率34．88％（60／172）,其中耐单药49例,耐2药9例,耐多药2例;隆昌县2009年发现菌阳肺结核患者374例（培养阳性99例）,菌阳发病率为53／10万,检出11例非结核分枝杆菌,总耐药率为32．32％（32／99）,其中耐单药18例、耐2药2例、耐多药12例。隆昌县肺结核菌阳发病率高于双流县,差异有统计学意义（x2=8．45,P〈0．01）;2县总耐药率比较无统计学意义（x2=0．12,P〉0．05）,隆昌县耐多药肺结核患者明显多于双流县,差异有统计学意义（x2=16．7,P〈0．01）。结论四川省丘陵地区结核病菌阳患病率及结核菌耐多药率相对高于平原地区,应采取相应措施。     

对广州市涂阳肺结核患者家庭密切接触者筛查的情况分析

目的 了解广州市涂阳肺结核患者(以下称“指示患者”)家庭密切接触者中活动性肺结核检出情况及有关影响因素.方法 采用整群分层随机抽样方法抽取广州市6个区的2011年1月至2011年12月在广州市结核病防治所登记的涂阳肺结核患者家庭密切接触者5664名进行结核病筛查现况调查,接受结核病筛查的家庭密切接触者5206名,对＜15岁的家庭密切接触者629名进行结核菌素纯蛋白衍生物(BCG-PPD)皮肤试验,其中结核菌素反应硬结平均直径≥15 mm或伴有水泡或溃破等强阳性反应的儿童144名;对≥15岁人群4577名拍摄胸片,胸片提示肺部有异常阴影者进行痰涂片和痰培养检查,用SPSS 16.0软件统计分析,计数资料及率的比较采取x2检验,P＜0.05为差异有统计学意义.结果 指示患者家庭密切接触者中活动性肺结核患者检出率为3.6％(187/5206),痰涂片阳性患者检出率为0.7％(36/5206),痰菌阳性患者检出率为1.3％(66/5206).629例15岁以下儿童BCG-PPD皮肤试验一般阳性和中度阳性的485名,强阳性144名,BCG-PPD皮肤试验强阳性儿童活动性肺结核检出率5.6％(8/144).指示患者家庭密切接触者中,男、女性活动性肺结核患者检出率分别为3.7％(86/2348)和3.5％(101/2858),差异无统计学意义(x2=0.062,P＞0.05).与指示患者是夫妻、父母或兄弟姐妹关系的密切接触者检出率分别为4.4％(74/1675)、4.3％(34/794)和5.7％(29/507),与指示患者是儿女或其他关系的检出率分别为2.4％(40/1682)和1.8％(10/548),不同关系组比较差异有统计学意义(x2=23.119,P＜0.01).初治指示患者家庭密切接触者检出率3.9％(160/4131),比复治指示患者家庭密切接触者检出率2.5％(27/1075)高,两组比较差异有统计学意义(x2=4.566,P＜0.05).结论 涂阳肺结核患者家庭密切接触者筛查是主动发现肺结核患者的有效手段,特别是初治指示患者的家庭密切接触者需更加注意,与指示患者是夫妻、父母或兄弟姐妹关系者是结核病筛查的重点.     

2009--2013年广州市普通高考招生体格检查检出结核病情况分析

目的了解广州市普通高考招生体格检查结核病检出特征并进行分析。方法采用回顾性调查研究方法,收集2009--2013年广州市普通高考招生体格检查病案资料和全国结核病信息管理系统的疫情资料,共有316386名考生参加体格检查,采用描述性统计分析方法对检出的238例活动性肺结核患者进行分析,组间比较用7。检验,P〈0．05为差异有统计学意义。结果2009--2013年广州市普通高考招生体格检查活动性肺结核患者检出率为75．2／10万,2010年和2011年检出率较高,分别为115．0／10万、102．0／10万,2012年检出率最低,为46．5／10万。其中男性为55．9％（133／238）,女性为44．1％（105／238）。根据学校生源地区检出例数从高至低排列前5位为番禺区54例、越秀区37例、荔湾区29例、增城区25例、天河区22例、白云区22例。5年间检出患者均为初治类型,涂阳肺结核患者占18．I％（43／238）,涂阴肺结核患者占81．9％（195／238）,肺部病灶以1～2个肺野为主,占90．7％（216／238）。结论广州市普通高考招生体格检查活动性肺结核检出率较高,应加强广州市在校高中学生,尤其是老城区和流动人口密集区域高中学生的结核病控制工作。     

北京市昌平区高校新入学学生结核菌素反应强度及患病调查

目的了解北京市昌平区高校大学新生结核菌素反应及患病状况，以便采取相应的措施。方法对2004年9月-2006年9月昌平辖区范围内高校的每年入学新生进行连续3年的结核菌素（PPD）试验；对结核菌素试验强阳性者摄X线胸片及查痰，掌握活动性病例及菌阳病例。结果3年来在昌平辖区内共计给21所高校的大学新生做PPD试验139136人次，查出活动性肺结核患者226例，结核性胸膜炎44例，陈旧性肺结核患者46例，其中痰涂片阳性患者16例，痰培养仅阳性患者3例。通过连续3年的观察表明，每年高校入学新生PPD≥15mm者分别占受调查总数的16．5％、17．6％、17．7％，提示新大学生受结核菌感染及患病情况较严重。结论应把大学生列为结核病防治重点对象之一。加强入学时的检查，及时发现病人彻底治疗，预防传染。     

湖北省两所监狱结核病现况调查研究

目的 了解示范区监狱结核病疫情和防治工作现状。方法 对示范区2所监狱3516名在押人员进行肺结核普查和结核病知晓率问卷调查,对有肺结核可疑症状者和X线胸片异常者进行痰涂片、培养、菌型鉴定和药敏试验检查。利用结核分枝杆菌散在分布数目可变串联重复序列分析方法(MIRU-VNTR)对痰菌阳性患者进行传染源同源性分析。计算监区肺结核患病率,并与普通人群患病率进行比较。结果 共确诊肺结核患者40例,其中涂片阳性1例,涂片阳性培养阳性1例(涂片阳性1例与涂片阳性培养阳性1例为同一例患者),涂片阴性培养阳性5例,涂片阴性培养阴性34例。6例培养阳性菌株药敏试验结果显示,共有3例患者耐药,其中1例耐链霉素,1例同时耐异烟肼、利福平和乙胺丁醇,1例同时耐异烟肼、利福平、乙胺丁醇和氧氟沙星。肺结核患病率、涂阳患病率、菌阳患病率分别为1156.4/10万（40/3459）、28.9/10万（1/3459）、173.5/10万（6/3459）。其中肺结核患病率高于当地普通人群患病率338.4/10万（χ²=17.858,P＜0.01）。在押人员对3条核心信息总知晓率为61.6%（6384/10 359）,其中乙监狱67.4%（4737/7026）,甲监狱49.4%（1647/3333）,差异有统计学意义（χ²=309.1,P＜0.01）。同一监狱5例痰菌阳性患者其传染源来源不同。结论 监狱结核病疫情严重,应探索有效的监狱结核病防控模式。     

Contribution of Interferon gamma release assays testing to the diagnosis of latent tuberculosis infection in HIV-infected patients: A comparison of QuantiFERON-TB gold in tube, T-SPOT.TB and tuberculin skin test

ABSTRACT: BACKGROUND: Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most effective strategy to control tuberculosis (TB) among patients with HIV infection. The tuberculin skin test (TST) was the only available method to identify LTBI. The aim of the present work was to evaluate the usefulness of the interferon-gamma release assays (IGRAs): QuantiFERONtuberculosis (TB) Gold-In-Tube test (QFG) and T-SPOT.TB for the diagnosis of LTBI in a diverse cohort of HIV-infected patients. METHODS: A prospective study was carried out in consecutive patients cared for in a single institution in Spain from January 2009 to October 2010. IGRAS and tuberculin skin test (TST) were performed simultaneously. TST induration [greater than or equal to] 5 mm was considered positive. RESULTS: QFG, T-SPOT.TB and TST were performed in 373 subjects. Median CD4 cell count was 470/mul with a median nadir of 150/mul. TST, QFG and T-SPOT.TB were positive in 13.3%, 7.5% and 18.5% cases respectively. Among 277 patients with neither past or current TB nor previous treatment for LTBI and who had TST results, a positive TST result was obtained in 20 (7.2%) cases. When adding QFG results to TST, there were a total of 26 (8.6%) diagnoses of LTBI. When the results of both IGRAs were added, the number of diagnoses increased to 54 (17.9%) (incremental difference: 10.7% [95% confidence interval [CI]:5.3-16.2%] [p <0.001]), and when both IGRAs were added, the number of diagnoses reached 56 (18.5%) (incremental difference: 11.3% [95% CI:5.7%-16.9%] [p < 0.001]). Patients with a CD4 cell count greater than 500 cells/mul and prior stay in prison were more likely to have a diagnosis of LTBI by TST and/or QFG and/or T-SPOT.TB (adjusted odds ratio [aOR]: 3.76; 95% CI, 1.4 - 9.89; and aOR: 3.3; 95% CI, 1.3 - 8.3, respectively). CONCLUSIONS: IGRAs were more sensitive than TST for diagnosis of M. tuberculosis infection in HIVinfected patients. Dual sequential testing with TST and IGRAs may be the optimal approach for LTBI screening in this population.     

武汉市青山区2005-2012年肺结核控制情况分析

目的 了解武汉市青山区2005-2012年结核病控制工作情况,为全区2011-2015年结核病防治规划的实施提供依据。 方法 统计分析武汉市青山区8年的结核病资料、手工季度和年度报表及《中国结核病控制信息系统》数据资料,率的比较采用χ²检验。 结果 2005-2012年青山区登记活动性肺结核患者2848例,其中男2100例,女748例。男性活动性肺结核、新涂阳肺结核、复治涂阳肺结核和涂阴肺结核患者分别为女性患者的2.8倍（2100/748）、3.3倍（949/289）、5.3倍（159/30）和2.3倍（992/429）。初治涂阳和复治涂阳患者均以65～岁组老人为主,共计263例和52例,初治涂阳前三位从高到低依次为65～岁（263例）、45～岁（239例）、55～岁（159例）;而涂阴则由高到低前三位依次为25～岁（268例）、15～岁（259例）、35～岁（242例）;活动性肺结核职业分布上,离退休人员最多（711例),工人和家政家务及待业人员居第二位(647例)和第三位(489例)。年平均登记率分别为：活动性肺结核78.6/10万,初治涂阳34.2/10万,复治涂阳5.2/10万,涂阴39.2/10万;962例涂阳患者治愈,2008年及以后治愈率达90%及以上。因症就诊患者1073例,结核病防治机构因症就诊的活动性肺结核和涂阳肺结核患者由2005年的41.0%(133/324)和52.6%(70/133）下降到2012年的11.9%（40/336）和47.5%（19/40）;非结核病专科医院查出1477例活动性肺结核和722例涂阳肺结核患者。 结论 武汉市青山区登记活动性肺结核患者男性多于女性,老年离退休患者居多,肺结核患者登记率不高,结核病防治机构因症就诊率下降。     

Interferon-gamma release assays are a better tuberculosis screening test for hemodialysis patients: A study and review of the literature

Diagnosing latent tuberculosis (TB) infection (LTBI) in dialysis patients is complicated by poor response to tuberculin skin testing (TST), but the role of interferon-gamma release assays (IGRAs) in the dialysis population remains uncertain. Seventy-nine patients were recruited to compare conventional diagnosis (CD) with the results of two IGRA tests in a dialysis unit. Combining TST, chest x-ray and screening questionnaire results (ie, CD) identified 24 patients as possible LTBI. IGRA testing identified 22 (QuantiFERON Gold IT, Cellestis, USA) and 23 (T-spot.TB, Oxford Immunotec, United Kingdom) LTBI patients. IGRA and CD correlated moderately (κ=0.59). IGRA results correlated with history of TB, TB contact and birth in an endemic country. TST was not helpful in identifying LTBI patients in this population. The tendency for IGRAs to correlate with risk factors for TB, active TB infection and history of TB argues for their superiority over TST in dialysis patients. There was no superiority of one IGRA test over another.     

Rapid diagnosis of Mycobacterium tuberculosis infection in children using interferon-gamma release assays (IGRAs)

Diagnosis of tuberculosis (TB) in children by the tuberculin skin test (TST) poses a diagnostic challenge for physicians due to its low specificity and cross-reactivity with nontuberculous mycobacteria and bacille Calmette-Guerin (BCG). Although interferon-gamma release assays (IGRAs) have been shown as novel TST alternatives for diagnosis of latent TB infection (LTBI) in adults, their effectiveness is less clear in children. The present study examined QuantiFERON-TB Gold (QFT-G) responses and IFN-gamma production capacity of TST-positive children, younger children ≤5 years. A total of 517 children of whom 434 were TST positive ranging in age from 1 month to 18 years were evaluated by the QFT-G. Of the 517 children, 434 (84%) were TST positive, 25 (5.8%) of whom were found to be QFT-G positive and 25 (5.4%) with an indeterminate response. Of the 517 children, 355 (68.7%) were previously BCG immunized and 310/355 (87.3%) were TST positive including 18/27 (66.7%) QFT-positive children. Adequate IFN-gamma production by purified TB peptides or mitogen was observed in 92.8% of children, 29.6% of whom were <5 years. This study shows that the QFT-G assay is useful for diagnosis of LTBI. The finding of 5.8% positive QFT-G in 434 TST-positive children underscores the superior specificity of the QFT-G than the TST and its greater cost effectiveness in preventing unnecessary and potentially toxic treatment in children. The study suggests that the majority of positive TST in children represent false-positive reactions and supports the use of IGRAs for diagnosis of LTBI in children, including those <5 years of age.     

Treatment of latent TB infection for close contacts as a complementary TB control strategy in Singapore.

OBJECTIVE: To describe our initial experience with treatment of latent tuberculosis infection (LTBI) for close contacts of infectious TB cases in Singapore, an intermediate TB burden country with mass BCG (re)vaccination since the 1950s. METHODS: Screening of 5699 contacts of 1374 index cases notified in 1998 was carried out at the TB Control Unit. RESULTS: Seventy-five per cent (4239) completed tuberculin skin testing (TST). Fifty-three cases of TB disease were detected (0.9% yield). Twenty-one per cent (895/4239) of the TST-screened contacts were started on LTBI treatment, comprising 92% (810/883) of contacts with TST > or = 15 mm, 5% (64/1195) of those with TST 10-14 mm and 1% (21/2161) of those with TST < 10 mm. The regimen utilized was isoniazid for 6 months in adults and 9 months in children. Eighty-one per cent completed treatment. The incidence of isoniazid-induced hepatitis was 0.45%. Over the ensuing 4 years, one case of active TB was reported among those treated for LTBI, and 10 cases (five without TST readings) were notified among contacts who did not receive treatment. CONCLUSIONS: Where good case-finding and treatment of TB disease exist, and where resources permit, LTBI treatment for close contacts is feasible as a complementary TB control strategy in an intermediate TB burden country with a BCG-vaccinated population.     

Tuberculosis infection in drug users: interferon-gamma release assay performance.

SETTING: An inner city neighborhood in Houston, Texas, known for a high rate of drug use. OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) using the QuantiFERON-TB Gold (QFT-G) test, the TSPOT.TB test and the tuberculin skin test (TST) in drug users and to evaluate the performance of the QFT-G and TSPOT.TB tests vs. the TST. DESIGN: Cross-sectional study. Bivariate and multivariate logistic regression analyses were used to determine risks associated with each test outcome. RESULTS: The prevalence of LTBI in 119 drug users studied was 28% by TST and 34% by QFT-G and T-SPOT.TB. Kappa statistics indicated fair to moderate concordance between QFT-G and TSPOT.TB vs. TST. About one-fifth of the population that tested negative with TST was positive with either QFT-G or T-SPOT.TB. On multivariate analysis, the likelihood of testing QFT-positive or T-SPOT.TB-positive increased by 8% and 6%, respectively, for every year of age; TST positivity was associated with smoking crack at home; being Caucasian or having a history of alcohol use was positively associated with a positive T-SPOT.TB test. CONCLUSION: Interferon-gamma release assays (IGRAs) are superior to the TST in drug users with a higher prevalence of LTBI. Future studies need to assess the predictive value of IGRAs on the progression from LTBI to active TB in high-risk populations.     

风湿性疾病的T细胞γ干扰素释放分析诊断潜伏性结核分枝杆菌感染

风湿性疾病患者的机体处于免疫抑制状态,而其中接受肿瘤坏死因子α(tumor necrosis factor α,TNF-α)拮抗剂治疗的患者更可能存在结核(tuberculosis,TB)复燃的风险.T细胞γ干扰素释放试验(interferon-γ release assays,IGRA)对于潜伏性结核感染(laten...     

结核病临床诊治进展年度报告（2013年）（第一部分 结核病临床诊断）

近一年来,结核病的诊断方面继续深入进行相关方面的研究,取得了不少进步.在细菌学诊断方面,使用新技术如新型移动数字化荧光显微镜痰检涂片技术可清晰显示并保存图像,发光二极管（LED）性能的荧光显微镜（FM）检查能够明显缩短常规涂片的染色时间,明显提高检出率.影像学诊断在结核病诊断的难点方面进行了详细的研究,如肺癌合并肺结核的临床分期、耐多药结核病与非结核分枝杆菌病的鉴别等.γ干扰素释放试验诊断结核分枝杆菌感染具有很大优势,今年对其诊断价值进行再评价.分子生物学诊断发展迅速,继续对XpertMtb/RIF诊断系统进行深入研究,超支化滚环扩增（hyperbranched rolling circle amplification,HRCA）技术简单、经济、省时,在贫困地区具有广泛的应用前景.介入诊断方面,将气管镜、腔镜技术与分子生物学、超声引导技术、细菌学、病理学检测技术相结合,使得结核病的诊断效率得到显著的提高,如气管镜下支气管冲洗液进行XpertMtb/RIF的检测等.病理学诊断方面以分子病理技术的发展较引人注目,使用活检标本行基因检测提高了结核病的检出率.     

山东省某监狱劳教人员结核病筛查结果分析

目的掌握山东省某监狱某监区劳教人员结核病的传播流行以及潜伏结核感染情况。方法对某监区314名劳教人员进行了结核病筛查,筛查者同时作胸透、HIV试验、结核菌素试验、ELISPOT试验,并对每个人进行了有关资料调查,对筛查人群中有咳嗽咳痰症状者以及已确诊的结核病患者,进行分枝杆菌培养,培养阳性的分枝杆菌进行菌种鉴定和药物敏感试验,结核分枝杆菌进行基因分型。结果314名筛查者HIV结果全部为阴性;3例分枝杆菌培养阳性都是结核分枝杆菌,A患者分离的结核杆菌是非北京家族,B患者和C筛查者分离的结核杆菌是北京家族,菌株成簇,312人同时有2种试验T-SPOT.TB试验阳性率为27.9%,PPD反应硬结平均直径≥10mm,阳性率为81.7%,2种试验结果的符合率为42.3%（95%CI,36.8%～47.8%）。结论以T-SPOT.TB试验结果阳性为结核感染的参考标准,该监区潜伏结核感染率为27.6%（86/312）;结核病患病率为0.93%;结核病人部分是内源性复燃引起,部分是在狱内由于新近感染结核菌而引起,监狱内结核病存在局部范围内的传播,该监区在结核病治疗、预防和控制工作方面需要进一步采取措施。     

Is the T-cell-based interferon-gamma releasing assay feasible for diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country?

The diagnosis of active and latent tuberculosis infection (LTBI) remains a challenge, especially in light of the fact that the tuberculin skin test (TST), which has been used to diagnose LTBI for over a century, has many well-known drawbacks. This study aimed to compare the diagnostic performance of the T-cell-based interferon-gamma releasing assay (IGRA) T-SPOT.TB with the TST for the diagnosis of LTBI in an intermediate tuberculosis (TB)-burden country with high BCG coverage. For this purpose, a total of 91 participants, including culture-confirmed TB patients, healthy contacts known to have been exposed to Mycobacterium tuberculosis, and healthy volunteers, selected from a BCG-vaccinated population were recruited. The sensitivities of the T-SPOT.TB and TST were 79.3 and 25.8%, and the specificities were 75.9 and 56.7%, respectively. The negative- and positive-predictive values for T-SPOT.TB and TST were 78.6 and 76.7% and 42.5 and 38.1%, respectively. The diagnostic performance of the TST in LTBI diagnosis is therefore severely diminished in BCG-vaccinated populations, with the sensitivity and specificity of the T-SPOT.TB assay being markedly higher. IGRAs have been reported to have higher diagnostic sensitivity and specificity in low TB-incidence settings than those seen here. Further larger scale studies in high and intermediate TB-incidence settings are therefore warranted.