Welty C, Burstin S, Muspratt S, Tager I B
Am Rev Respir Dis. 1985 Jul;132(1):133-6. doi: 10.1164/arrd.1985.132.1.133.
A prospective study of serial tuberculin skin testing was performed on 642 patients from the chronic care wards of a Veterans Administration Hospital. Five hundred eighty-eight patients without a documented history of tuberculosis or a positive tuberculin skin test received an initial 5 TU PPD, and results in 139 were positive (23.6%). Of those initially tuberculin negative, 398 received a second 5 TU PPD 2 to 4 wk later; 45 (11.3%) showed a booster effect. Of the initial 642 patients, 64 had documented negative tuberculin skin tests within the year preceding the survey. Eight (12.5%) of the 64 patients were positive at the initial survey. There were 213 patients with 2 negative tuberculin tests within the first 4 wk of the study who were followed for the year of the study, and 10 converted their tuberculin skin test for a converter rate of 4.7%. The decrease in the converter rate from 12.5 to 4.7% suggests that the initial converter rate was falsely elevated by the booster effect. The high rate of conversion during the year of the study (4.7%) suggests that there may have been inapparent spread of tuberculous infection among patients in this chronic care facility.
对一家退伍军人管理局医院慢性病护理病房的642名患者进行了系列结核菌素皮肤试验的前瞻性研究。588名无结核病记录史或结核菌素皮肤试验阴性的患者接受了初始5 TU PPD检测，其中139名结果呈阳性（23.6%）。在那些初始结核菌素试验阴性的患者中，398名在2至4周后接受了第二次5 TU PPD检测；45名（11.3%）显示出增强效应。在最初的642名患者中，64名在调查前一年有结核菌素皮肤试验阴性的记录。64名患者中有8名（12.5%）在初始调查时呈阳性。在研究的前4周内有2次结核菌素试验阴性的213名患者在研究年度内接受了随访，其中10名结核菌素皮肤试验发生了转化，转化率为4.7%。转化率从12.5%降至4.7%表明初始转化率因增强效应而被错误抬高。研究年度内较高的转化率（4.7%）表明，在这个慢性病护理机构的患者中可能存在结核感染的隐匿传播。
