Rooney J J, Crocco J A, Kramer S, Lyons H A
Am J Med. 1976 Apr;60(4):517-22. doi: 10.1016/0002-9343(76)90718-x.
One hundred patients with active tuberculosis were tested for tuberculin reactivity within 24 hours of their admission to the hospital. Commercial intermediate tuberculin, Tween stabilized intermediate tuberculin and the Tine test as well as a mumps antigen were applied simultaneously. False negative reactions were obtained in 28 per cent with Tine testing and in 21 per cent with Tween stabilized as well as plain tuberculin. These nonreactors were clinically identifiable as seriously ill with manifestations primarily attributable to protein depletion as a result of their illness. This is not specifically related to the effects of tuberculosis itself, but can be demonstrated in patients suffering the same sequelae of other debilitating illness. After two weeks of protein supplementation via a high calorie, high protein, hospital diet, skin reactivity was restored in the vast majority of these nonreactors. It is concluded that the lack of tuberculin reactivity on hospital admission probably results from impaired lymphocyte function in patients suffering serious protein depletion as a result of their illness; it is not attributable to deficiencies in the tuberculin test itself.
100例活动性肺结核患者在入院后24小时内接受结核菌素反应性检测。同时应用市售的中等强度结核菌素、吐温稳定化中等强度结核菌素、划痕试验以及腮腺炎抗原。划痕试验有28%出现假阴性反应，吐温稳定化结核菌素和平板结核菌素均有21%出现假阴性反应。这些无反应者在临床上可被认定为重症患者，其表现主要归因于疾病导致的蛋白质消耗。这并非与结核病本身的影响有特定关联，而是在患有其他消耗性疾病相同后遗症的患者中也能得到证实。通过高热量、高蛋白的医院饮食补充蛋白质两周后，这些无反应者中的绝大多数恢复了皮肤反应性。得出的结论是，入院时缺乏结核菌素反应性可能是由于患者因疾病导致严重蛋白质消耗而使淋巴细胞功能受损所致；并非是结核菌素试验本身存在缺陷。
