免疫诊断技术在肺结核及肺外结核诊断中的价值

Value of immunodiagnostic techniques on diagnosis of pulmonary and extrapulmonary tuberculosis

目前结核病免疫学诊断技术的研究热点是血清学诊断技术和基于细胞免疫反应的干扰素-γ释放试验。血清学诊断方法具有简单快速的优点，易于推广应用，是研究比较多的结核病诊断方法之一，但现有血清学试验试剂在结核病诊断的特异性和敏感性方面还有待提高。基于细胞免疫反应的干扰素-γ 释放试验是结核免疫诊断技术的重要突破，在诊断结核潜伏感染中的价值已经得到广泛的认可，诊断的特异性可达89％，显著高于结核菌素试验。但基于外周血单个核细胞的干扰素-γ释放试验不能区分活动性肺结核、潜伏感染及以往感染，因此诊断活动性结核病的特异性差是其主要问题。基于结核病变局部免疫细胞的干扰素-γ释放试验在肺结核及肺外结核的诊断中具有更好的特异性和敏感性，值得进一步研究。

Serological diagnostic techniques and T-cell interferon gamma release assays （IGRAs） are main immunodiagnostic techniques for tuberculosis. Serological tests are simple and fast, however, they have low specificity and sensitivity in the diagnosis of tuberculosis. Based on cellular immune responses, IGRAs are important breakthrough of immunodiagnostic techniques for tuberculosis. The value of IGRAs in the diagnosis of latent tuberculosis infection has been widely recognized. The diagnostic specificity is 89~ in IGRAs, which is significantly higher than that in tuberculin test. However, peripheral blood mououclear ceil IGRAs could not be used to differentiate active tuberculosis, latent infection and previous infection, so the poor specificity of diagnosis of active tuberculosis is the main problem. Tuberculosis local immune cell IGRAs has better specificity and sensitivity in the diagnosis of pulmonary and extrapulmonary tuberculosis, so it is worth further study.