Department of Infectious Diseases Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Am J Transplant. 2011 Sep;11(9):1927-35. doi: 10.1111/j.1600-6143.2011.03625.x. Epub 2011 Jul 12.
We evaluated whether ELISPOT assay can predict tuberculosis (TB) development in kidney-transplantation (KT) recipients with a negative tuberculin skin test (TST). All adult patients admitted to a KT institute between June 2008 and December 2009 were enrolled; TB development after KT was observed between June 2008 and December 2010. Isoniazid (INH) was given to those patients with positive TST or clinical risk factors for latent TB infection (LTBI). ELISPOT assay was performed on all patients, and TB development after KT was observed by a researcher blinded to the results of ELISPOT. A total of 312 KT recipients including 242 (78%) living-donor KT were enrolled. Of the 312 patients, 40 (13%) had positive TST or clinical risk factors for LTBI and received INH; none developed TB after KT. Of the remaining 272 patients, 4 (6%) of 71 with positive ELISPOT assay developed TB after KT, whereas none of the 201 patients with negative (n = 171) or indeterminate ELISPOTs (n = 30) developed TB after KT (rate difference between positive and negative/indeterminate ELISPOT, 3.3 per 100 person-years [95% CI 1.4-5.1, p<0.001]). Positive ELISPOT results predict subsequent development of TB in KT recipients in whom LTBI cannot be detected by TST or who lack clinical risk factors for LTBI.
我们评估了 ELISPOT 检测是否可以预测结核菌素皮肤试验（TST）阴性的肾移植（KT）受者中结核病（TB）的发生。纳入 2008 年 6 月至 2009 年 12 月期间收治于 KT 研究所的所有成年患者；观察 KT 后至 2010 年 12 月期间的 TB 发病情况。TST 阳性或有 LTBI 临床危险因素的患者给予异烟肼（INH）治疗。对所有患者进行 ELISPOT 检测，由对 ELISPOT 结果不知情的研究人员观察 KT 后 TB 的发病情况。共纳入 312 例 KT 受者，包括 242 例（78%）活体供者 KT。312 例患者中，40 例（13%）TST 阳性或有 LTBI 临床危险因素，接受 INH 治疗；他们在 KT 后均未发生 TB。在其余 272 例患者中，4 例（6%）ELISPOT 阳性患者在 KT 后发生 TB，而 171 例 ELISPOT 阴性（n=171）或不确定（n=30）患者在 KT 后均未发生 TB（ELISPOT 阳性和阴性/不确定的发病率差异，每 100 人年 3.3 例[95%CI 1.4-5.1，p<0.001]）。ELISPOT 阳性结果预测了 TST 无法检测 LTBI 或缺乏 LTBI 临床危险因素的 KT 受者中随后发生 TB 的风险。
