Nagai Hideaki, Kawabe Yoshiko, Ariga Haruyuki, Shigiyama Fumiko, Shimada Masahiro, Kunogi Makiko, Matsui Yoshinori, Kawashima Masahiro, Suzuki Junko, Ooshima Nobuharu, Masuda Kimihiko, Matsui Hirotoshi, Tamura Atsuhisa, Nagayama Naohiro, Akagawa Shinobu, Machida Kazuko, Kurashima Atsuyuki, Yotsumoto Hideki
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan.
Kekkaku. 2007 Aug;82(8):635-40.
New blood test (QuantiFERON-TB-2G: QFT-2G), based on detection of IFN-gamma released by T cells in response to M. tuberculosis specific antigens, has the high sensitivity and specificity for diagnosis of tuberculosis. However, it is essential to evaluate this T cell-based approach in individuals with HIV-associated impairment in T cell immunity.
We assessed the usefulness of QFT-2G on diagnosis of tuberculosis in 13 HIV-infected patients with tuberculosis and the performance of 25 HIV infected persons under highly active antiretroviral treatment (HAART). QFT-2G, CD4 counts, and tuberculosis skin test and so on were examined.
The sensitivity of QFT-2G in HIV-infected patients with tuberculosis was 76.9%, which was significantly higher compared with tuberculin skin test, 15.4%. There was one indeterminate case of which CD4 count was 16/microl, the lowest count among the all patients. CD4 counts of 25 HIV infected persons under HAART were between 100 and 1157/microl. There were 3 QFT-2G positive cases among them, who had past history of tuberculosis.
Although the very low CD4 counts in HIV-infected patients might adversely affect QFT-2G performance, the sensitivity of QFT-2G in the most of HIV-infected patients with tuberculosis was high, and it was thought that it was useful enough to diagnose tuberculosis infection. Careful observation is required in whether the recurrence of tuberculosis takes place among QFT-2G positive persons who have past history of tuberculosis.
新型血液检测（QuantiFERON-TB-2G：QFT-2G）基于检测T细胞对结核分枝杆菌特异性抗原反应释放的γ-干扰素，对结核病诊断具有高敏感性和特异性。然而，在T细胞免疫存在HIV相关损害的个体中评估这种基于T细胞的方法至关重要。
我们评估了QFT-2G在13例合并结核病的HIV感染患者中对结核病诊断的实用性，以及25例接受高效抗逆转录病毒治疗（HAART）的HIV感染者的检测表现。检测了QFT-2G、CD4细胞计数、结核菌素皮肤试验等。
QFT-2G在合并结核病的HIV感染患者中的敏感性为76.9%，与结核菌素皮肤试验的15.4%相比显著更高。有1例不确定病例，其CD4细胞计数为16/μl，是所有患者中最低的计数。25例接受HAART的HIV感染者的CD4细胞计数在100至1157/μl之间。其中有3例QFT-2G阳性病例，他们有结核病既往史。
尽管HIV感染患者中极低的CD4细胞计数可能对QFT-2G的表现产生不利影响，但QFT-2G在大多数合并结核病的HIV感染患者中的敏感性较高，并且认为其对结核病感染的诊断足够有用。对于有结核病既往史的QFT-2G阳性者是否会发生结核病复发需要仔细观察。
