Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
School of Public Health and Family Medicine, University of Cape Town, South Africa.
AIDS. 2009 May 15;23(8):961-969. doi: 10.1097/QAD.0b013e32832956ad.
To evaluate an enzyme-linked immunospot assay (ELISPOT) for the diagnosis of tuberculosis (TB) in HIV-infected children with suspected TB and to compare the performance of ELISPOT with the tuberculin skin test (TST).
Interferon-gamma responses to Mycobacterium tuberculosis-specific antigens were measured by ELISPOT in HIV-infected children with suspected TB. HIV-infected and HIV-uninfected children without TB were taken for comparison.
Results were available for 188 children, of whom 139 (74%) were HIV-infected. Of these, 22 were classified as having definite TB: 24 probable TB, 14 possible TB and 128 not having TB. The median (range) age of patients was 20 (10-54.1) months. Median interferon-gamma responses to early-secreted antigenic target-6 and culture filtrate protein-10 were higher in children with definite or probable TB compared with children without TB (P < 0.002). In HIV-infected children with an interpretable ELISPOT result, the ELISPOT was positive in 14/21 (66%) with definite TB. A significantly higher proportion of HIV-infected children with definite or probable TB had a positive ELISPOT compared with a positive TST [25/39 (64%) vs. 10/34 (29%), P = 0.005]. In contrast to TST, results from ELISPOT were not affected by young age or severe immunosuppression. In HIV-infected children without active TB disease, 27% had a positive ELISPOT, suggesting latent TB infection.
ELISPOT is more sensitive than TST for the detection of active TB in HIV-infected children. However, the sensitivity of current ELISPOT assays is not sufficiently high to be used as a rule out test for TB.
评估酶联免疫斑点（ELISPOT）技术在疑似结核病（TB）的 HIV 感染儿童中的诊断价值，并与结核菌素皮肤试验（TST）进行比较。
对疑似结核病的 HIV 感染儿童进行 ELISPOT 检测，以检测结核分枝杆菌特异性抗原的干扰素 -γ反应。同时，选取 HIV 感染且无结核病的儿童和 HIV 未感染且无结核病的儿童作为对照。
共纳入 188 例儿童，其中 139 例（74%）为 HIV 感染者。22 例患儿被诊断为明确结核病：24 例可能结核病，14 例可能结核病，128 例无结核病。患儿的中位（范围）年龄为 20（10-54.1）个月。与无结核病的患儿相比，明确或可能结核病患儿的早期分泌抗原靶-6 和培养滤液蛋白-10 的干扰素 -γ反应的中位数（范围）更高（P<0.002）。在可进行 ELISPOT 结果判读的 HIV 感染儿童中，21 例明确结核病患儿中 14 例（66%）ELISPOT 阳性。与 TST 相比，明确或可能结核病的 HIV 感染儿童中，ELISPOT 阳性的比例明显更高[25/39（64%）与 10/34（29%），P=0.005]。与 TST 不同，ELISPOT 结果不受年龄较小或严重免疫抑制的影响。在无活动性结核病的 HIV 感染儿童中，27%的患儿 ELISPOT 阳性，提示潜伏性结核病感染。
与 TST 相比，ELISPOT 技术在 HIV 感染儿童中检测活动性结核病的敏感性更高。然而，目前的 ELISPOT 检测方法的敏感性还不够高，无法作为结核病的排除性检测。
