Arend S M, Ottenhoff T H, Andersen P, van Dissel J T
Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
Int J Tuberc Lung Dis. 2001 Jul;5(7):680-6.
Leiden University Medical Center, Leiden, the Netherlands.
To illustrate the potential value of a recently developed diagnostic assay for detection of tuberculosis (TB), based on T cell responses to the early secreted antigenic target 6 kDa protein (ESAT-6) and culture filtrate protein 10 (CFP-10). These antigens are Mycobacterium tuberculosis specific because they are expressed by M. tuberculosis but absent from M. bovis bacille Calmette-Guérin (BCG) and most environmental mycobacteria. In recent studies, the assay had a high sensitivity and specificity for detection of active TB.
We describe five patients with uncommon presentations of tuberculosis, in whom the diagnosis was delayed by negative or conflicting results of diagnostic procedures aimed at detection of M. tuberculosis and an uninformative tuberculin skin test. IFN-gamma production in response to ESAT-6 and CFP-10 by peripheral blood mononuclear cells from these patients was evaluated before and during anti-tuberculosis treatment.
In all five patients, IFN-gamma responses to ESAT-6 and/or CFP-10 were above the cut-off level defined in a previous study. During treatment, IFN-gamma responses generally increased.
These results indicate that T cell responses to M. tuberculosis-specific antigens have potential diagnostic value when TB is suspected and the results of other diagnostic tests are inconclusive, especially in BCG-vaccinated individuals.
荷兰莱顿大学医学中心。
阐述一种基于T细胞对早期分泌抗原靶6 kDa蛋白（ESAT-6）和培养滤液蛋白10（CFP-10）的反应而新近开发的结核病诊断检测方法的潜在价值。这些抗原是结核分枝杆菌特异性的，因为它们由结核分枝杆菌表达，但在卡介苗（BCG）和大多数环境分枝杆菌中不存在。在最近的研究中，该检测方法对活动性结核病的检测具有高灵敏度和特异性。
我们描述了5例结核病表现不常见的患者，其诊断因旨在检测结核分枝杆菌的诊断程序结果为阴性或相互矛盾以及结核菌素皮肤试验无信息而延迟。在抗结核治疗前和治疗期间，评估了这些患者外周血单个核细胞对ESAT-6和CFP-10的γ干扰素产生情况。
所有5例患者对ESAT-6和/或CFP-10的γ干扰素反应均高于先前研究中定义的临界水平。在治疗期间，γ干扰素反应通常增加。
这些结果表明，当怀疑患有结核病且其他诊断试验结果不确定时，尤其是在接种卡介苗的个体中，T细胞对结核分枝杆菌特异性抗原的反应具有潜在诊断价值。
