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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 117 -120. doi: 10.3877/cma.j.issn.1674-1358.2017.02.003

综述

γ-干扰素释放试验在免疫功能抑制人群中诊断结核分枝杆菌感染的应用
边赛男1, 刘晓清1,()   
  1. 1. 100730 北京,中国医学科学院 北京协和医学院 北京协和医院感染内科
  • 收稿日期:2016-01-21 出版日期:2017-04-15
  • 通信作者: 刘晓清
  • 基金资助:
    国家"十二五"科技重大专项(No. 2014ZX10003003); 国家卫生和计划生育委员会行业公益基金(No. 201402001)

Interferon-γ release assays (IGRAs) on the diagnosis of Mycobacterium tuberculosis infection in immunocompromised population

Sainan Bian1, Xiaoqing Liu1,()   

  1. 1. Internal Medicine of Infectious Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2016-01-21 Published:2017-04-15
  • Corresponding author: Xiaoqing Liu
引用本文:

边赛男, 刘晓清. γ-干扰素释放试验在免疫功能抑制人群中诊断结核分枝杆菌感染的应用[J]. 中华实验和临床感染病杂志(电子版), 2017, 11(02): 117-120.

Sainan Bian, Xiaoqing Liu. Interferon-γ release assays (IGRAs) on the diagnosis of Mycobacterium tuberculosis infection in immunocompromised population[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(02): 117-120.

结核病仍是严重危害人类健康的全球性疾病,近年随着获得性免疫缺陷综合征、肿瘤以及风湿免疫病等免疫功能抑制人群的增多,该类人群有较高的潜伏结核分枝杆菌感染(LTBI)再活动风险,其结核分枝杆菌感染应受到更多关注。早期发现、诊断和治疗LTBI可大大降低其再活动风险,而传统的结核菌素皮肤试验(TST)在上述人群中的应用存在一定的局限性,现总结γ-干扰素释放试验(IGRAs)在免疫功能抑制人群中诊断结核分枝杆菌感染的应用,以指导临床应用。

Tuberculosis (TB) is a major global health problem and remains one of the world’s deadliest communicable diseases. In recent years, patients with immunocompromised conditions such as human immunodeficiency virus (HIV) infection, tumors and rheumatic diseases have increased, and these patients have a higher risk of latent tuberculosis infection (LTBI) reactivation, so Mycobacterium tuberculosis (MTB) infection in this group of patients should be paid more attention to. Early diagnosis and treatment of LTBI could decrease the risk of LTBI developing to active TB. However, traditional tuberculin skin test (TST) has some limitations in these patients, therefore studies about the interferon-γ release assays (IGRAs) for the diagnosis of TB infection in immunocompromised patients were reviewed to summarize the instructions for its clinical application.

表1 免疫缺陷患者中使用TST和IGRAs诊断LTBI(现有的指南及建议方法)
患者人群 CDC指南a 评论 建议方法
HIV感染者 高危患者考虑TST和IGRAs连续检测b任何阳性结果应该被认为LTBI的证据 CD4+细胞计数<200个/μl,TST受限IGRAs和LTBI临床危险因素间的关系:强证据两种不确定结果的IGRAs增加可能性T-SPOT.TB更少受低CD4+淋巴细胞计数影响 CD4+细胞计数> 200个/μl的患者考虑TST;低CD4+淋巴细胞计数患者考虑T-SPOT.TB;不应用QFT-GIT作为常规筛查
接受TNF-α抑制剂治疗的患者和免疫介导的炎症性疾病(RA、SLE和其他自身免疫病) 高危患者考虑TST和IGRAs连续检测b任何阳性结果应该被认为LTBI的证据 TST在免疫介导的炎症性疾病患者中受限IGRAs和LTBI临床危险因素间的关系:强证据T-SPOT.TB较少受使用免疫抑制药物如糖皮质激素影响TST受限 拟接受TNF-α抑制剂治疗的患者在治疗前检查LTBI;高危患者考虑同时或连续检测TST和IGRAs(拟接受TNF-α抑制剂患者);接受糖皮质激素患者考虑T-SPOT.TB
透析患者 高危患者考虑TST和IGRAs连续检测b任何阳性结果应该被认为LTBI的证据 QFT-GIT和LTBI临床危险因素之间的关系:强证据T-SPOT.TB不具特征性TST受限 考虑QFT-GIT作为检测的选择;不推荐使用TST
血液系统恶性肿瘤患者,包括HSCT者 高危患者考虑TST和IGRAs连续检测b任何阳性结果应该被认为LTBI的证据 IGRAs和LTBI临床危险因素间的关系:弱证据T-SPOT.TB较少受中性粒细胞减少和(或)淋巴细胞减少影响,优先选择若移植前获得,TST有价值 考虑TST作为检测的选择不推荐IGRAs作为常规检查
实体器官移植者 高危患者考虑TST和IGRAs连续检测b任何阳性结果应该被认为LTBI的证据 IGRAs和LTBI临床危险因素间的关系:弱证据肝脏移植患者潜在的肝脏疾病可能增加IGRAs不确定结果的可能性 实体器官移植前检测LTBI;考虑TST作为检测的选择不推荐使用IGRAs作为常规筛查
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