Shigeto E, Tasaka H, Yamamoto M, Kataoka T, Haga S, Nagao S, Tajima H, Kurashima A, Aoyagi A, Wada R
National Hiroshima Hospital, Higashihiroshima City, Japan.
Kekkaku. 1993 May;68(5):351-60.
Purified protein derivatives (PPDs) prepared from M. intracellulare (PPD-B), M. kansasii (PPD-Y), M. fortuitum (PPD-F), M. chelonei subsp. abscessus (PPD-C) and M. tuberculosis (PPDs) were simultaneously used in skin tests on patients diagnosed as having tuberculosis or atypical mycobacteriosis to reveal their specificity, clinical usefulness and immunological status of the patients. The mean diameter of reaction (redness) for patients with M. tuberculosis positive sputum (TB group, n = 71; age, 20-90 yrs) was PPDs, 20.4 mm; PPD-B, 7.9 mm; PPD-Y, 11.7 mm; PPD-F, 0.8 mm; and PPD-C, 0.3 mm. For M. avium complex positive patients (MAC group, n = 100; age, 31-89 yrs), the results were PPDs, 10.9; PPD-B, 16.9 mm; PPD-Y, 10.7 mm; PPD-F, 1.6 mm; and PPD-C, 0.3 mm. The M. kansasii positive patients (K group; n = 8) showed results of PPDs, 12.6 mm; PPD-B, 10.7 mm; PPD-Y, 20.8 mm; PPD-F, 0.5 mm; PPD-C, 0.0 mm. The M. fortuitum positive patients (F group; n = 5) had measurements of PPDs, 5.8 mm; PPD-B, 4.4 mm; PPD-Y, 9.8 mm; PPD-F, 17.8 mm; and PPD-C, 16.0 mm. The patients who were previously M. tbc. positive but presently negative patients (pre. TB group; n = 50) showed the following results: PPDs, 16.6 mm; PPD-B, 7.4 mm; and PPD-Y, 10.9 mm. For the patients who were previously M. avium complex positive (previous MAC group; n = 19), the results were PPDs, 10.4 mm; PPD-B, 9.9 mm; and PPD-Y, 7.7 mm. Also considering their frequency distribution curve, with exception of the previous MAC group, the patient groups showed specificity to the PPD of the bacilli detected. The previous MAC group recorded no significant difference in response to PPDs and PPD-B. Strong cross reactions were observed between PPD-F and PPD-C, and moderate reactions between PPDs, PPD-B and PPD-Y. Cross reactions were scarce between PPDs, PPD-B or PPD-Y and PPD-F or PPD-C. Though it is difficult to distinguish cross-reaction and multiple infections, majority of the patients (72-85%) showed greatest response to the PPD that corresponds with the species of bacilli detected. In conclusion, two or more PPDs applied simultaneously can be of aid in diagnosing mycobacteriosis especially in the early stages of the disease. Also, cross-reactions between atypical mycobacteria and PPDs should be taken into consideration when diagnosing infection caused by M. tuberculosis.
从胞内分枝杆菌（PPD-B）、堪萨斯分枝杆菌（PPD-Y）、偶然分枝杆菌（PPD-F）、龟分枝杆菌脓肿亚种（PPD-C）和结核分枝杆菌（PPDs）制备的纯化蛋白衍生物（PPDs）同时用于对诊断为患有结核病或非典型分枝杆菌病的患者进行皮肤试验，以揭示其特异性、临床实用性和患者的免疫状态。痰结核分枝杆菌阳性患者（结核病组，n = 71；年龄，20 - 90岁）的反应（发红）平均直径为：PPDs为20.4毫米；PPD-B为7.9毫米；PPD-Y为11.7毫米；PPD-F为0.8毫米；PPD-C为0.3毫米。鸟分枝杆菌复合群阳性患者（MAC组，n = 100；年龄，31 - 89岁）的结果为：PPDs为10.9；PPD-B为16.9毫米；PPD-Y为10.7毫米；PPD-F为1.6毫米；PPD-C为0.3毫米。堪萨斯分枝杆菌阳性患者（K组；n = 8）的结果为：PPDs为12.6毫米；PPD-B为10.7毫米；PPD-Y为20.8毫米；PPD-F为0.5毫米；PPD-C为0.0毫米。偶然分枝杆菌阳性患者（F组；n = 5）的测量值为：PPDs为5.8毫米；PPD-B为4.4毫米；PPD-Y为9.8毫米；PPD-F为17.8毫米；PPD-C为16.0毫米。既往结核分枝杆菌阳性但目前为阴性的患者（既往结核病组；n = 50）显示出以下结果：PPDs为16.6毫米；PPD-B为7.4毫米；PPD-Y为10.9毫米。对于既往鸟分枝杆菌复合群阳性的患者（既往MAC组；n = 19），结果为：PPDs为10.4毫米；PPD-B为9.9毫米；PPD-Y为7.7毫米。此外，考虑到它们的频率分布曲线，除既往MAC组外，各患者组对检测到的杆菌的PPD显示出特异性。既往MAC组对PPDs和PPD-B的反应无显著差异。在PPD-F和PPD-C之间观察到强烈的交叉反应，在PPDs、PPD-B和PPD-Y之间观察到中度反应。在PPDs、PPD-B或PPD-Y与PPD-F或PPD-C之间交叉反应较少。虽然很难区分交叉反应和多重感染，但大多数患者（72 - 85%）对与检测到的杆菌种类相对应的PPD反应最大。总之，同时应用两种或更多种PPDs有助于诊断分枝杆菌病，尤其是在疾病的早期阶段。此外，在诊断结核分枝杆菌引起的感染时，应考虑非典型分枝杆菌与PPDs之间的交叉反应。
