Gordin F M, Perez-Stable E J, Reid M, Schecter G, Cosgriff L, Flaherty D, Hopewell P C
Department of Medicine, Veterans Affairs Medical Center, Washington, DC 20422.
Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):560-3. doi: 10.1164/ajrccm/144.3_Pt_1.560.
To determine the stability and presumed significance of tuberculin skin tests, we followed a cohort of 380 tuberculin-positive patients living in chronic care facilities. Each patient had a positive reaction (greater than or equal to 10 mm induration to 5 tuberculin units of purified protein derivative) to one of three sequential baseline tuberculin tests. One year after the initial series, each patient had a single repeat skin test. Reversion to a negative test occurred in 98 (26%) of the 380 patients. Decreases in induration of 6 mm or more occurred in 88 (90%) of the reverters. Initially positive tests were more likely (p less than 0.001) to remain stable than tests that were "boosted" to positive reactions on the second or third initial administration. Stable responses were found in 96% of those whose tests had greater than or equal to 15 mm induration compared with 61% of those with reactions of 10 to 14 mm induration. Increasing age also was associated with a high rate of reversion. The instability of boosted tuberculin reactions brings into question the clinical significance of these tests. We propose limiting tuberculin testing to two sequential tests.
为了确定结核菌素皮肤试验的稳定性及可能的意义，我们对380名居住在慢性病护理机构中的结核菌素阳性患者进行了队列研究。每位患者对连续三次基线结核菌素试验中的一次呈阳性反应（对5个结核菌素单位的纯化蛋白衍生物硬结直径大于或等于10毫米）。在初始系列试验一年后，每位患者进行了一次重复皮肤试验。380名患者中有98名（26%）试验结果转为阴性。在转为阴性的患者中，88名（90%）硬结直径减少了6毫米或更多。与在第二次或第三次初始给药时“增强”为阳性反应的试验相比，最初呈阳性的试验更有可能（p<0.001）保持稳定。硬结直径大于或等于15毫米的患者中，96%的试验反应稳定，而硬结直径为10至14毫米的患者中这一比例为61%。年龄增长也与较高的转阴率相关。增强后的结核菌素反应不稳定，使得这些试验的临床意义受到质疑。我们建议将结核菌素试验限制为连续两次试验。
