Alifano M, Sofia M, Mormile M, Micco A, Mormile A F, Del Pezzo M, Carratù L
Institute of Respiratory Disease, University of Naples Federico II, Italy.
Respiration. 1996;63(5):292-7. doi: 10.1159/000196563.
Searching for IgG and IgM against the mycobacterial antigen A60 has been recognized as a potential diagnostic tool for pulmonary tuberculosis. The role of detection of anti-A60 IgA in improving diagnostic accuracy of serology is not well known. In this study we measured with ELISA serum levels of both anti-A60 IgG and IgA in 216 subjects. 88 healthy volunteers (44 PPD- and 44 PPD+), 44 patients suffering from nontuberculous lung disease and 15 subjects with healed pulmonary tuberculosis constituted the control population; 69 patients with active pulmonary tuberculosis (35 cavitary forms, 26 productive forms and 8 miliary forms) were examined. The sensitivity of IgG test was 73.9% in pulmonary tuberculosis (77.1% in cavitary forms, 65.4% in productive forms, 87.5% in miliary forms); the specificity of the test was 95.9%. For the IgA test we observed a sensitivity of 72.5% (74.3 in cavitary forms, 69.2% in productive forms, 75.0 in miliary forms) and a specificity of 93.9%. Combination of the two tests increased the sensitivity to 84.0% (+10.1% compared to IgG test, +11.5% compared to IgA test); the specificity decreased to 92.5% (-3.4% vs. IgG test; -1.4 vs. IgA test). In conclusion, the combined use of evaluation of anti-A60 IgG and IgA increases the accuracy of serological diagnosis of pulmonary tuberculosis.
检测抗分枝杆菌抗原A60的IgG和IgM已被认为是肺结核的一种潜在诊断工具。抗A60 IgA检测在提高血清学诊断准确性方面的作用尚不明确。在本研究中，我们采用酶联免疫吸附测定法（ELISA）检测了216名受试者血清中抗A60 IgG和IgA的水平。88名健康志愿者（44名结核菌素纯蛋白衍生物阴性和44名结核菌素纯蛋白衍生物阳性）、44名非结核性肺病患者和15名肺结核已愈患者构成对照组；对69名活动性肺结核患者（35例空洞型、26例增殖型和8例粟粒型）进行了检查。IgG检测在肺结核中的敏感性为73.9%（空洞型为77.1%，增殖型为65.4%，粟粒型为87.5%）；该检测的特异性为95.9%。对于IgA检测，我们观察到敏感性为72.5%（空洞型为74.3%，增殖型为69.2%，粟粒型为75.0%），特异性为93.9%。两种检测方法联合使用可将敏感性提高到84.0%（与IgG检测相比提高了10.1%，与IgA检测相比提高了11.5%）；特异性降至92.5%（与IgG检测相比降低了3.4%；与IgA检测相比降低了1.4%）。总之，联合检测抗A60 IgG和IgA可提高肺结核血清学诊断的准确性。
