Habesoğlu M A, Torun D, Demiroglu Y Z, Karatasli M, Sen N, Ermis H, Ozdemir Nurhan, Eyuboglu F O
Department of Pulmonary Disease, Faculty of Medicine, Baskent University, Ankara, Turkey.
Transplant Proc. 2007 May;39(4):883-6. doi: 10.1016/j.transproceed.2007.02.035.
Hemodialysis patients are at high risk for tuberculosis, and a tuberculin skin test (TST) is not usually helpful in detecting tuberculosis infection because of anergic reactions. Prophylactic therapy against tuberculosis in dialysis patients is important to enhance transplantation success. Herein we evaluated the value of TST in screening for tuberculosis and analyzed any compounding factors that might affect the results of the test in hemodialysis patients in an endemic area of Turkey.
A total of 187 (96 female, 91 male) patients were screened using a 2-step TST. Test results were compared with clinical, radiologic, and laboratory data.
None of the patients had active tuberculosis during the study and 55% had been vaccinated against tuberculosis. After the first purified protein derivative (PPD) test, 55.1% of the patients showed a positive reaction, ultimately reaching a total of 68.4% following the second test. Cumulative positive TST results were significantly correlated with male gender (P=.001, r=.352), previous tuberculosis history (P=.013, r=.183) positively, whereas with the ferritin level (P=.001, r=-.233) negatively; but there were no significant relationships between TST results and other data.
Impairment of delayed-type hypersensitivity reaction is frequent in dialysis patients, but we observed high rates of positivity with the two-step TST which could be attributed to tuberculosis being endemic in Turkey. Further comparative studies with more specific diagnostic methods will be helpful to evaluate the importance of TST positivity in identifying tuberculosis-infected HD patients.
血液透析患者患结核病的风险很高，由于存在无反应性，结核菌素皮肤试验（TST）通常无助于检测结核感染。对透析患者进行结核病预防性治疗对于提高移植成功率很重要。在此，我们评估了TST在筛查结核病中的价值，并分析了土耳其一个流行地区可能影响血液透析患者试验结果的任何复合因素。
共对187例患者（96例女性，91例男性）进行了两步TST筛查。将试验结果与临床、放射学和实验室数据进行比较。
研究期间无患者患有活动性结核病，55%的患者接种过结核病疫苗。首次纯化蛋白衍生物（PPD）试验后，55.1%的患者呈阳性反应，第二次试验后最终阳性率达到68.4%。TST累积阳性结果与男性性别显著正相关（P = 0.001，r = 0.352）、既往结核病史显著正相关（P = 0.013，r = 0.183），而与铁蛋白水平显著负相关（P = 0.001，r = -0.233）；但TST结果与其他数据之间无显著关系。
透析患者中迟发型超敏反应受损很常见，但我们观察到两步TST的阳性率很高，这可能归因于土耳其结核病流行。采用更特异诊断方法进行进一步的比较研究将有助于评估TST阳性在识别结核感染血液透析患者中的重要性。
