Ninet B, Roux-Lombard P, Schrenzel J, Janssens J-P
Laboratoire de bactériologie, service de médecine de laboratoire, hôpital cantonal universitaire, 1211 Genève 4, Suisse.
Rev Mal Respir. 2011 Jun;28(6):823-33. doi: 10.1016/j.rmr.2010.12.012. Epub 2011 May 25.
Over the last decade, molecular biology techniques for identifying mycobacteria in pulmonary secretions have become more and more sensitive and rapid, even in smear negative samples. Nuclear amplification techniques also allow the rapid detection of resistance to first or second line anti-tuberculous drugs. The sensitivity of these techniques for non respiratory samples is yet to be determined. The diagnosis of latent tuberculous infection (LTBI) has also increased in sensitivity, specificity and positive predictive value through the use of interferon-γ release assays (IGRAs), which are tending to replace the tuberculin skin test, except for children aged under five. These tests, however, do have limitations which are important for the clinician; especially their inability to distinguish active from latent tuberculosis and their inability, in most circumstances, to exclude a diagnosis of active TB.
在过去十年中，用于鉴定肺部分泌物中分枝杆菌的分子生物学技术变得越来越灵敏和快速，即使在涂片阴性样本中也是如此。核酸扩增技术还能够快速检测对一线或二线抗结核药物的耐药性。这些技术对非呼吸道样本的敏感性尚待确定。通过使用干扰素-γ释放试验（IGRAs），潜伏性结核感染（LTBI）的诊断在敏感性、特异性和阳性预测值方面也有所提高，除五岁以下儿童外，IGRAs正逐渐取代结核菌素皮肤试验。然而，这些检测确实存在一些对临床医生来说很重要的局限性；特别是它们无法区分活动性结核和潜伏性结核，并且在大多数情况下无法排除活动性结核病的诊断。
