来自作者:
我们确实感谢M. Tebruegge和同事对我们最近出版的手稿的评论European Respiratory Journal1。the aim of this reply is to clarify some points in order to interpret better the results of the study, given that we think there were some misunderstandings.
我n vitro测量干扰素(IFN)-γ在特定后T细胞释放的测定mycobacterium tuberculosis刺激表明成人和儿童诊断结核病(TB)感染的刺激表现出了令人鼓舞的结果2,,,,3。但是,基于IFN-γ的测定与结核蛋白皮肤测试(TST)之间存在不一致的结果,这些结果需要澄清以评估实际效用in vitro在患者管理中的测试2,,,,4。
我n our study we determined the potential role of non-tuberculous mycobacteria (NTM) sensitisation in children as a factor of discordant results between TST and anin vitrot-cell based assay (T.SPOT.TB;Oxford Immunotec, Oxford, UK). We enrolled 21 non-bacille Calmette–Guérin vaccinated paediatric patients for suspicion of latent TB infection (LTBI). These patients yielded a positive TST and a negative T.SPOT.TB。刺激细胞mycobacterium avium灵敏素(MAS)和反应性T细胞的存在由离体酶联免疫疗法测定。从16例有效结果的患者中,在10例中,我们在用MAS刺激后获得了阳性ELISPOT结果。
我们与Tebruegge M. Tebruegge和同事的论点的主要分歧是我们没有使用MAS来区分的事实m。tuberculosis来自NTM感染。对于这个目标,我们使用了特定的m。tuberculosisrD1 antigens included in the T.SPOT.TB测试,并且由于没有对RD1抗原的反应,我们评估了T细胞对MAS抗原的敏感性,以研究NTM敏化是否可能导致TST阳性。确实,莱因等。5,,,,also referred to in the letter by M. Tebruegge and co-workers, obtained significant immune responses to ESAT-6 from 59% of pulmonarym。tuberculosis疾病患者被诊断出,但没有从患者中获得m。aviumcomplex pulmonary disease.
但是,我们同意Tebruegge M.和同事的观点,在某些情况下,也可以进行替代解释。鉴于MAS并不是完全具体的,并且已经描述了与其他分枝杆菌物种的交叉反应,我们不能完全排除在某些情况下发现特定T细胞对某些的反应的可能性m。tuberculosisantigens different from ESAT-6 and CFP-10; or a false-negative result of the T.SPOT.TB。
On the one hand, M. Tebruegge and co-workers have shown some concerns about our group of children with positive TST and positive T.SPOT.TB50%的儿童对MAS做出了回应。结果与MAS和其他分枝杆菌之间已知的交叉反应一致。然而,我们不能完全拒绝同时感染m。tuberculosis和NTM。此外,这些结果与Lein获得的结果完全一致等。5,他们在27分中发现24个对MAS的反应m。tuberculosis疾病患者。
另一方面,我们要指出的是,在LTBI筛查期间,TST硬化> 5 mm和<10 mm的LTBI筛查期间,MAS的主要结果是获得的。在所有这些孩子中,进行了完整的医学探索,包括临床和放射学研究,并排除了主动结核。在随后的接触跟踪研究中,没有发现指数案例。基于Nyboe进行的经典研究6,这种儿童人口的主要准则认为m。tuberculosisinfection a TST induration ≥10 mm, in order to avoid false-positive TST results induced by NTM immunisation7。然而,笔记> 15毫米8and 20 mm9have been reported in children with NTM infections. Therefore, our results reinforce, in part, the guidelines in that unnecessary chemoprophylaxis treatment in this unexposed population could be avoided, and that IFN-γ based assays could help to confirm a positive TST result.
Children from contact-tracing studies truly exposed to an active TB case merit special consideration as they can develop the disease very quickly after primary infection, with the most severe forms prevailing in younger children10。对于这个儿童人群,我们不建议扣留化学预防性;但是我们指出,根据我们的结果,基于IFN-γ的测定可以减少非不必要的化学预防症m。tuberculosisinfected children. In fact, Bakir等。11最近的一项研究得出的结论是,基于IFN-γ的阳性测定结果预测了活性结核和TST的发展,从而使更为专注的预防疗法降低了接触。
我n conclusion, we believe our results provide enough evidence that previous NTM sensitisation induces false-positive results in the TST for diagnosing LTBI; but, we also strongly agree with Tebruegge等。为了阐明与不和谐IFN-γ的测定结果相关的不同问题,还需要进行其他研究,并评估儿童人口管理和利益的真正效用。
Footnotes
利益声明
一个statement of interest for J. Domínguez can be found atwww.www.qdcxjkg.com/misc/statements.dtl
- ©ERS 2010