Skraba Cissiara Manetti, de Mello Tatiane França Perles, Pedroso Raíssa Bocchi, Ferreira Érika Cristina, Demarchi Izabel Galhardo, Aristides Sandra Mara Alessi, Lonardoni Maria Valdrinez Campana, Silveira Thaís Gomes Verzignassi
Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, BR.
Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, BR.
Rev Soc Bras Med Trop. 2015 Jul-Aug;48(4):437-44. doi: 10.1590/0037-8682-0067-2015.
The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.
The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles.
The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm.
Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.
黑山皮肤试验（MST）在美洲皮肤利什曼病（ATL）的诊断中具有良好的临床适用性且成本低廉。然而，尚无研究验证通常用于区分阳性和阴性结果的参考值（5毫米）。我们调查了MST结果，并使用不同的截断点评估其性能。
分析了4256例疑似ATL患者的实验室检测结果，发现1182人符合既定标准。形成了两组。阳性皮肤利什曼病（PCL）组包括有皮肤病变且寄生虫直接检测（DS）结果为阳性的患者。阴性皮肤利什曼病（NCL）组包括皮肤病变发展至2个月、DS结果为阴性且间接免疫荧光试验结果为阴性的患者，这些患者居住在据报告可能是住所和周边地区感染地点的城市地区。
PCL组和NCL组分别包括769人和413人。PCL组的平均±标准差MST为12.62±5.91毫米[95%置信区间（CI）：12.20 - 13.04]，NCL组为1.43±2.17毫米（95%CI：1.23 - 1.63）。受试者工作特征曲线分析表明，截断值为5毫米时灵敏度为97.4%，特异性为93.9%；截断值为6毫米时灵敏度为95.8%，特异性为97.1%。
5毫米或6毫米均可作为诊断ATL的截断值，因为这两个值均具有高灵敏度和特异性。
