Klein R S, Flanigan T, Schuman P, Smith D, Vlahov D
Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA. Disease, Department of Medicine,
J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):93-8. doi: 10.1016/s0091-6749(99)70531-2.
Controversy exists about both the clinical utility of anergy testing and the optimal criteria for defining anergy.
We sought to assess various definitions of cutaneous anergy for ability to distinguish HIV status, level of immunodeficiency, and ability to mount a tuberculin reaction among women with or at risk for HIV infection.
HIV-seropositive (n = 721) and HIV-seronegative (n = 358) at-risk women at academic medical centers in Baltimore, Detroit, New York, and Providence had cutaneous testing with mumps, Candida, tetanus toxoid, and tuberculin antigens. Associations with HIV status and CD4+ lymphocyte levels were analyzed.
Candida, mumps, and tetanus antigens alone or in combination elicited reactions significantly less often in HIV-seropositive than in HIV-seronegative women and less often in seropositive women with lower CD4+ counts, regardless of induration cutpoint chosen to define a positive reaction. The best antigen combinations for distinguishing groups included tetanus and mumps. Some women nonreactive to the 3 antigens ("anergic") had positive tuberculin reactions among both seropositive subjects (range, 1.1% to 2.9% depending on induration cutpoint for defining anergy) and seronegative subjects (range, 8.9% to 14%).
Absence of reactions to Candida, mumps, and tetanus antigens alone or in combination and at any induration cutpoint is associated with HIV status and with CD4+ level. Combinations, including tetanus and mumps antigens with an induration cutpoint of less than 2 mm, may be the best for defining anergy.
关于无反应性检测的临床效用以及定义无反应性的最佳标准均存在争议。
我们试图评估皮肤无反应性的各种定义在区分感染HIV的状态、免疫缺陷水平以及HIV感染女性或有感染风险女性中引发结核菌素反应能力方面的作用。
在巴尔的摩、底特律、纽约和普罗维登斯的学术医疗中心，对721名HIV血清阳性和358名HIV血清阴性的有感染风险女性进行了腮腺炎、念珠菌、破伤风类毒素和结核菌素抗原的皮肤检测。分析了与HIV状态和CD4+淋巴细胞水平的相关性。
无论选择何种硬结切点来定义阳性反应，单独或联合使用念珠菌、腮腺炎和破伤风抗原引发的反应在HIV血清阳性女性中显著少于HIV血清阴性女性，且在CD4+计数较低的血清阳性女性中也较少见。区分不同组别的最佳抗原组合包括破伤风和腮腺炎。一些对这3种抗原无反应（“无反应性”）的女性在血清阳性受试者（根据定义无反应性的硬结切点，范围为1.1%至2.9%）和血清阴性受试者（范围为8.9%至14%）中结核菌素反应均为阳性。
单独或联合使用念珠菌、腮腺炎和破伤风抗原且在任何硬结切点均无反应与HIV状态和CD4+水平相关。硬结切点小于2 mm的包括破伤风和腮腺炎抗原的组合可能是定义无反应性的最佳组合。
