Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada.
Paediatr Respir Rev. 2011 Mar;12(1):9-15. doi: 10.1016/j.prrv.2010.09.009. Epub 2010 Oct 14.
Childhood TB is difficult to diagnose, since disease tends to be paucibacillary and sputum specimens are not easy to obtain in children. Thus, blood-based immune assays are an attractive option. Systematic reviews of serological assays suggest that these tests produce highly inconsistent estimates of sensitivity and specificity, but much of the serology literature is based on adults. In children, there is insufficient evidence to recommend the use of serological tests for active TB diagnosis. Interferon-gamma release assays (IGRA) do not offer substantial improvements in sensitivity over the TST for the diagnosis of active disease. For latent TB infection, the IGRA correlates well with the exposure gradient and seems to have utility in reducing the number of children who undergo preventive therapy due to false-positive TST. Although IGRAs can be used as evidence of TB infection in children, appropriate specimen collection and microbiological confirmation of TB disease should remain a priority.
儿童结核病难以诊断，因为儿童的疾病往往菌量较少，且难以获得痰液标本。因此，基于血液的免疫检测是一种很有吸引力的选择。对血清学检测的系统评价表明，这些检测对敏感性和特异性的评估结果高度不一致，但许多血清学文献都是基于成年人的。在儿童中，没有足够的证据推荐使用血清学检测来诊断活动性结核病。对于干扰素释放试验（IGRA），与 TST 相比，其在诊断活动性疾病方面的敏感性并没有显著提高。对于潜伏性结核感染，IGRA 与接触梯度相关性良好，似乎可以减少因 TST 假阳性而接受预防性治疗的儿童数量。尽管 IGRA 可作为儿童结核感染的证据，但仍应优先考虑适当的标本采集和结核疾病的微生物学确认。
