抗原诱发的γ干扰素测定在结核诊断中的应用

目的 探讨结核分枝杆菌特异性抗原早期分泌抗原靶6000(ESAT-6)体外诱发的γ干扰素反应在结核感染和结核病诊断中的价值.方法 外周全血中加入ESAT-6抗原,诱导产生γ干扰素,以酶联免疫吸附法测定γ干扰素浓度,以增加的百分率为ESAT-6抗原诱发的γ干扰素反应值.进行下列研究:对比结核密切接触者(60例)、痰培养证实的结核患者(46例)以及健康人(55例);追踪调查儿童(68例)、青少年(52例)、老年(45例);治疗过程中动态观察20例结核患者;比较HIV(+)TB(+)者(78例)和HIV(+)TB(-)者(60例).结果 结核密切接触者与痰培养证实的结核患者ESAT-6反应具有很高的敏感性;儿童与青少年ESAT-6反应与临床诊断和预后具有很高的一致性;65%的结核患者在治疗过程中ESAT-6反应呈下降趋势;ESAT-6反应在HIV(+)TB(+)的诊断中敏感度为87.2%.结论 体外ESAT-6诱发的γ干扰素测定对活动性结核病尤其是儿童和青少年结核病的诊断有一定意义,也可用于鉴别HIV阳性者合并结核.

Application of antigen-induced interferon-gamma assay in diagnosis of tuberculosis

Objective To evaluate the value of early secreted antigen terget 6000(ESAT-6)-induced interferon-gamma(IFN-γ)response in vitro in diagnosis of tuberculosis and mycobacterium tuberculosis infections.Methods ESAT-6 was added into peripheral whole blood to induce IFN-γ,and concentration of IFN-γ was detected by ELISA.Comparing with saline control,the percentage of increase was regarded as the value of ESAT-6 induced IFN-γ response.ESAT-6-induced IFN-γ response was analysed in the following four aspects:to compare with the people intimate contact to tuberculosis(60 cases),the sputum culture confirmed active tuberculosis patients(46 eases)and healthy people(55 cases);to compare with children(68 cases),adolescents(52 cases)and elder people(45 cases)by follow up;dynamically observe 20 tuberculosis patients during long-time treatment;to compare HIV(+)and TB(+)people(78 cases)with HIV(+)and TB(-)people(60 cases).Results Between people intimate contacts to tuberculosis and active tuberculosis patients,ESAT-6 response has high sensitivity;ESAT-6 response in children and adolescents was completely consistent with the following clinical diagnosis and prognosis;ESAT-6 response decreased during treatment duration in 65%tuberculosis patients;in HIV(+)and TB(+)cases,the sensitivity of tuberculosis diagnosis by ESAT-6 response was 87.2%.Conclusion In vitro IFN-γ response induced by ESAT-6 is helpful in diagnosis of tuberculosis,especially for children and adolescents.And it is also available for differential diagnosis of HIV(+)patients with tuberculosis.