Trajman A, Steffen R E, Menzies D
Gama Filho University, 20740-900 Rio de Janeiro, RJ, Brazil ; Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4.
Pulm Med. 2013;2013:601737. doi: 10.1155/2013/601737. Epub 2013 Feb 7.
A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals.
关于γ-干扰素释放试验的准确性及用途，已有大量文章发表。在此，我们综述结核菌素皮肤试验和γ-干扰素释放试验的临床应用、优点及局限性，并概述针对这些试验不同使用指征所进行的最新系统评价。我们得出结论，两种试验在检测潜伏性结核方面都是准确的，尽管在接种卡介苗的人群中，γ-干扰素释放试验比结核菌素皮肤试验具有更高的特异性，尤其是在婴儿期后接种卡介苗的情况下。然而，两种试验在预测进展为活动性结核的风险方面表现不佳。由于自发变异性以及缺乏关于转换和逆转的有效定义，γ-干扰素释放试验在系列检测中存在显著局限性，这使得临床医生难以解释类别变化（转换和逆转）。到目前为止，最重要的临床证据，即异烟肼预防性治疗可降低进展为疾病的风险，仅在结核菌素皮肤试验阳性个体中得到证实。
