Gordin F M, Perez-Stable E J, Flaherty D, Reid M E, Schecter G, Joe L, Slutkin G, Hopewell P C
Department of Medicine, Veterans Administration Medical Center, Washington, D.C. 20422.
Am Rev Respir Dis. 1988 Jan;137(1):153-7. doi: 10.1164/ajrccm/137.1.153.
To evaluate factors that might influence the accuracy of tuberculin tests in identifying elderly persons recently infected with Mycobacterium tuberculosis, we performed as many as 3 sequential administrations of 5 tuberculin units of purified protein derivative in 1,726 persons residing in chronic care facilities. Significant reactions (greater than or equal to 10 mm of induration) to 1 of 3 tests were found in 702 (40.7%) persons. Of these, 68% were found with Test 1, 22.5% with Test 2, and 9.5% with Test 3. Of 1,146 persons with nonsignificant reactions to Test 1, 13.8% had significant reactions on Test 2, and of 769 persons with nonsignificant reactions to Tests 1 and 2, 8.7% had significant reactions on Test 3. Males, nonwhites, and persons between 50 and 79 yr of age had a greater proportion of significant reactions for each of the first 2 tests but not for the third test. These data indicate that continued boosting of the tuberculin reaction occurs in a substantial number of persons who receive a third sequential test. Marked increases in the size of reactions caused by boosting may explain high apparent conversion rates found in facilities where the third test is delayed for one year.
为评估可能影响结核菌素试验在识别近期感染结核分枝杆菌的老年人中准确性的因素，我们对1726名居住在长期护理机构的人员进行了多达3次5结核菌素单位纯化蛋白衍生物的连续接种。在702名（40.7%）人员中发现对3次试验中的1次有显著反应（硬结大于或等于10毫米）。其中，68%在试验1中发现，22.5%在试验2中发现，9.5%在试验3中发现。在对试验1无显著反应的1146名人员中，13.8%在试验2中有显著反应；在对试验1和2无显著反应的769名人员中，8.7%在试验3中有显著反应。男性、非白种人以及50至79岁的人员在前2次试验中的每次试验中显著反应的比例都更高，但在第三次试验中并非如此。这些数据表明，在接受第三次连续试验的相当一部分人员中会出现结核菌素反应的持续增强。增强导致的反应大小的显著增加可能解释了在第三次试验推迟一年的机构中发现的高表观转化率。
