McMurray D N, Echeverri A
Am Rev Respir Dis. 1978 Nov;118(5):827-34. doi: 10.1164/arrd.1978.118.5.827.
Twelve adults with confirmed pulmonary tuberculosis who failed to respond to repeated skin tests with 250 TU of second-strength purified protein derivative of tuberculin were studied using in vivo and in vitro tests of cell-mediated immunity. All but 2 of the patients failed to respond to skin tests with candidin and histoplasmin, and only one could be sensitized with topical applications of dinitrochlorobenzene. The blastogenic response of peripheral blood lymphocytes from these anergic patients, when cultured in the presence of phytohemagglutinin, pokeweed mitogen, and purified protein derivative, was significantly less than that of lymphocytes from tuberculin-positive control patients. During the course of therapy with isoniazid and streptomycin, 6 of the anergic patients converted spontaneously and reacted positively to purified protein derivative. This skin-test conversion was accompanied by a significant increase in the blastogenic response of lymphocytes from the converted patients when cultured with purified protein derivate. Tuberculin anergy in these 12 patients was not associated with progessive, disseminated disease. All patients responded successfully to the primary chemotherapeutic regimen.
对12例确诊为肺结核且对250单位中等强度结核菌素纯蛋白衍生物反复皮肤试验无反应的成年人，采用细胞介导免疫的体内和体外试验进行研究。除2例患者外，其余患者对念珠菌素和组织胞浆菌素皮肤试验均无反应，只有1例患者通过局部应用二硝基氯苯可被致敏。这些无反应性患者的外周血淋巴细胞在植物血凝素、商陆有丝分裂原和结核菌素纯蛋白衍生物存在的情况下培养时，其增殖反应明显低于结核菌素阳性对照患者的淋巴细胞。在异烟肼和链霉素治疗过程中，6例无反应性患者自发转变，对结核菌素纯蛋白衍生物反应呈阳性。这种皮肤试验转变伴随着转变患者的淋巴细胞在与结核菌素纯蛋白衍生物一起培养时增殖反应的显著增加。这12例患者的结核菌素无反应性与进行性播散性疾病无关。所有患者对初始化疗方案反应良好。
