Adams Lisa V, Waddell Richard D, Von Reyn C Fordham
Section of Infectious Disease and International Health, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03765, USA.
Scand J Infect Dis. 2008;40(3):196-203. doi: 10.1080/00365540701642179.
The tuberculin skin test is limited by its inability to distinguish between infection with Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM). Newer interferon-gamma release assays using ESAT-6 and CFP-10 antigens should have a higher specificity for tuberculosis but have not been widely tested in adults with pulmonary disease due to NTM. In this study, we tested the T-SPOT.TB Test in patients with pulmonary disease due to Mycobacterium avium complex (MAC), the most common disease-causing NTM. Fourteen patients with prior culture-confirmed pulmonary disease due to MAC, 10 patients with prior culture-confirmed tuberculosis and 4 healthy controls were interviewed and tested with the T-SPOT.TB Test. 13 patients with MAC disease and 4 healthy subjects (negative controls) had non-reactive T-SPOT.TB results and 10 patients with prior tuberculosis (positive controls) had reactive results. One patient with MAC disease had a minimally reactive result on initial testing and a non-reactive result on re-testing. The T-SPOT.TB Test had a specificity of 94% for distinguishing between patients with prior MAC disease and prior tuberculosis disease, and will be useful in low tuberculosis prevalence settings where most mycobacterial infections are due to MAC. Reactions to the T-SPOT.TB Test may persist months to years after treatment of tuberculosis.
结核菌素皮肤试验的局限性在于无法区分结核分枝杆菌感染和非结核分枝杆菌（NTM）感染。使用ESAT-6和CFP-10抗原的新型干扰素-γ释放试验对结核病应具有更高的特异性，但尚未在患有NTM所致肺部疾病的成人中广泛测试。在本研究中，我们对患有鸟分枝杆菌复合群（MAC）所致肺部疾病的患者进行了T-SPOT.TB检测，MAC是最常见的致病性NTM。对14例先前经培养确诊为MAC所致肺部疾病的患者、10例先前经培养确诊为结核病的患者和4名健康对照者进行了访谈，并采用T-SPOT.TB检测进行检测。13例MAC疾病患者和4名健康受试者（阴性对照）的T-SPOT.TB检测结果为阴性，10例先前患有结核病的患者（阳性对照）检测结果为阳性。1例MAC疾病患者初次检测结果为轻度阳性，再次检测结果为阴性。T-SPOT.TB检测在区分先前患有MAC疾病和先前患有结核病的患者方面特异性为94%，在结核病患病率较低、大多数分枝杆菌感染由MAC引起的情况下将很有用。结核病治疗后，对T-SPOT.TB检测的反应可能会持续数月至数年。
