Enarson Donald A
International Union Against Tuberculosis and Lung Disease, Paris, France.
Paediatr Respir Rev. 2004;5 Suppl A:S135-7. doi: 10.1016/s1526-0542(04)90025-5.
The tuberculin skin test, originally developed by Koch over a century ago as a means to treat tuberculosis, has emerged as the definitive means to identify infection with Mycobacterium tuberculosis. Its value was first demonstrated in studies of student nurses in Norway where it correctly identified uninfected students at greatest risk of dying of tuberculosis during the course of their training. The test was used to investigate contacts of active cases of tuberculosis, especially children. Cohort studies of such children undertaken in the 1950s and early 1960s showed that those who developed an induration in response to the tuberculin test of 10mm or greater were most likely to go on to develop tuberculosis in the future and that, if they were treated with isoniazid for a prolonged period (with maximal effect after 12 months of treatment), they were substantially less likely to develop tuberculosis. Since that time, the tuberculin skin test has been used extensively to identify individuals who have been infected with Mycobacterium tuberculosis and who would most likely benefit from treatment of latent tuberculous infection. Subsequently, international experts recommend that all children under five years of age who are in contact especially with sputum smear positive cases of tuberculosis should all be tested with tuberculin if it is available. Those found to have a significant reaction should be treated with isoniazid if they do not have active tuberculosis. Moreover, the tuberculin skin test has been used as a reliable means to monitor the progress of tuberculosis in the community through the means of surveys of school children to determine prevalence (and estimate incidence) of tuberculous infection in the community. The tuberculin skin test is not easy to administer or to interpret and requires careful application and interpretation. Tuberculin consists of a mixture of material produced by Mycobacterium tuberculosis as it is growing. It is prepared in a form termed 'purified protein derivative (PPD)' but is neither pure nor consists entirely of protein. Reference material has been developed to standardise it. The reading of the result of tuberculin testing requires experience and care. Inexperience leads to error (terminal digit preference). Tuberculin also detects the presence of antigens from other Mycobacteria species the most important of which is environmental Mycobacteria. Previous vaccination with BCG has less effect on the results of the test. The tuberculin test is useful to detect infection in children.
结核菌素皮肤试验最初是由科赫在一个多世纪前作为治疗结核病的一种方法而开发的，现在已成为识别结核分枝杆菌感染的决定性方法。其价值首先在挪威对实习护士的研究中得到证明，该研究正确地识别出在培训过程中死于结核病风险最高的未感染学生。该试验被用于调查结核病现症病例的接触者，尤其是儿童。20世纪50年代和60年代初对这类儿童进行的队列研究表明，那些对结核菌素试验出现10毫米或更大硬结反应的儿童未来最有可能患上结核病，而且，如果他们长期接受异烟肼治疗（治疗12个月后效果最佳），患结核病的可能性会大幅降低。从那时起，结核菌素皮肤试验就被广泛用于识别感染了结核分枝杆菌且最有可能从潜伏性结核感染治疗中受益的个体。随后，国际专家建议，如果有结核菌素，所有与痰涂片阳性结核病病例有接触的五岁以下儿童都应进行结核菌素检测。那些被发现有明显反应且无活动性结核病的儿童应接受异烟肼治疗。此外，通过对学童进行调查以确定社区结核感染的患病率（并估计发病率），结核菌素皮肤试验已被用作监测社区结核病进展情况的可靠方法。结核菌素皮肤试验不容易实施或解读，需要仔细操作和判断。结核菌素是结核分枝杆菌生长过程中产生的物质混合物。它以“纯化蛋白衍生物（PPD）”的形式制备，但既不纯也不完全由蛋白质组成。已开发出参考物质来对其进行标准化。结核菌素检测结果的判读需要经验和细心。缺乏经验会导致错误（尾数偏好）。结核菌素还能检测到其他分枝杆菌属细菌的抗原，其中最重要的是环境分枝杆菌。以前接种卡介苗对试验结果的影响较小。结核菌素试验对于检测儿童感染很有用。
