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[结核反应]

[Tuberculous reactions].

作者信息

Kermarec J, Bussy E, Hiltenbrand C

出版信息

Rev Pneumol Clin. 1994;50(5):280-7.

PMID:7899763
Abstract

Intradermoreaction made with reliable tuberculin is the reference test: it is the only one that allows a therapeutic decision. The other tests can only be used as pre or post vaccinal tests, or as a technical approach for new born. In France, the reading of the IDR is difficult because BCG is almost always applied during small childhood. However it is possible to admit tuberculosis infection for vaccinated person with clear increase of the IDR positivity compared to a measured reference IDR, or when the IDR is superior to 14 mm for persons vaccinated a long time ago. For immunocompetent persons, a tuberculosis infection admitted on an isolated IDR (not associated with tuberculosis disease) does not need chimiprophylaxy for children under five, or in case of clear and recent increase of IDR, or in a context of contamination. For a HIV positive person, a tuberculosis infection admitted on an isolated IDR implies a systematic chimioprophylaxy, but the IDR looses its signification as the immunodepression progresses. An attempt to study the prevalence of tuberculosis infection at twenty in France for vaccinated persons has been realized. In 1984 the admitted rate is over 8%, superior to the calculated rate from Styblo and Sutherland tables. That seems to mean that tuberculosis infection is under evaluated in France.

摘要

使用可靠结核菌素进行的皮内反应是参考检测

它是唯一能用于做出治疗决策的检测。其他检测仅可作为疫苗接种前或接种后的检测,或作为针对新生儿的技术手段。在法国,由于卡介苗几乎总是在幼儿期接种,因此皮内反应的判读很困难。然而,对于接种过疫苗的人,如果皮内反应阳性率相较于测量的参考皮内反应明显增加,或者对于很久以前接种过疫苗的人皮内反应大于14毫米,则可以判定为结核感染。对于免疫功能正常的人,仅基于皮内反应判定的结核感染(与结核病无关),对于五岁以下儿童、皮内反应近期明显增加或存在感染情况时,不需要进行化学预防。对于HIV阳性者,仅基于皮内反应判定的结核感染意味着需要进行系统性化学预防,但随着免疫抑制的进展,皮内反应失去其意义。已尝试对法国20岁接种过疫苗人群的结核感染患病率进行研究。1984年,判定率超过8%,高于根据斯泰布洛和萨瑟兰表格计算出的比率。这似乎意味着法国的结核感染情况被低估了。

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