Division of Infectious Disease, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon 97239, USA.
Curr Opin Pediatr. 2010 Feb;22(1):71-6. doi: 10.1097/MOP.0b013e3283350301.
The testing and treatment of children at risk for Mycobacterium tuberculosis infection represents an important public health priority in the United States. Until recently, diagnosis has relied upon the tuberculin skin test (TST). New interferon-gamma release assays (IGRAs) offer improvements over TST, but these tests have not been studied in children until recently.
Evidence regarding IGRA performance in children is accumulating rapidly. Overall, the findings demonstrate performance of IGRAs equivalent or superior to that of the TST. However, IGRAs have biological limitations similar to TST and some technical problems of their own, and critical gaps in our knowledge remain.
Current evidence supports usage of IGRAs in children aged 5 years or older. IGRAs are preferred over TST when specificity is paramount or wherein patients might fail to return for TST reading. Evidence for use in children aged less than 5 years is insufficient at this time: the sensitivity is poorly defined, and TST is preferred for testing these children. Future IGRA research should focus on children aged less than 5 years for informing expanded usage in this vulnerable population.
在美国，检测和治疗有结核分枝杆菌感染风险的儿童是一项重要的公共卫生重点。直到最近，诊断一直依赖于结核菌素皮肤试验（TST）。新型干扰素 - γ释放试验（IGRA）在 TST 基础上有所改进，但直到最近才在儿童中进行了这些测试。
关于 IGRA 在儿童中的表现的证据正在迅速积累。总的来说，这些发现表明 IGRA 的性能与 TST 相当或优于 TST。然而，IGRA 具有与 TST 相似的生物学局限性和自身的一些技术问题，我们的知识仍存在关键空白。
目前的证据支持将 IGRA 用于 5 岁或以上的儿童。在特异性至关重要或患者可能无法返回进行 TST 读数的情况下，IGRA 优于 TST。目前，在 5 岁以下儿童中使用的证据不足：敏感性定义不明确，TST 更适合用于检测这些儿童。未来的 IGRA 研究应集中在 5 岁以下的儿童，以告知在这一脆弱人群中扩大使用。
