Utility of quantitative T-cell responses versus unstimulated interferon-gamma for the diagnosis of pleural tuberculosis

作者：Dheda K^*; van Zyl Smit R N; Sechi L A; Badri M; Meldau R; Meldau S; Symons G; Semple P L; Maredza A; Dawson R; Wainwright H; Whitelaw A; Vallie Y; Raubenheimer P; Bateman E D; Zumla A

来源：European Respiratory Journal, 2009, 34(5): 1118-1126.

DOI：10.1183/09031936.00005309

• Diagnosis
• diagnostic accuracy
• human
• interferon-gamma
• pleural effusion
• tuberculosis

The clinical utility of antigen-specific interferon (IFN)-gamma release assays (IGRAs) using pleural mononuclear cells, for the diagnosis of tuberculosis (TB), requires clarification.
We compared the diagnostic utility of unstimulated pleural IFN-gamma levels with several pleural antigen-specific T-cell IGRAs (early secretory antigenic target-6 and culture filtrate protein-10 (T-SPOT.(R) TB, QuantiFERON (R)-TB Gold In-tube), purified protein derivative (PPD) and heparin-binding haemagglutinin (HBHA)) in 78 South African TB suspects. Test results were compared against a clinical score and a reference standard.
Out of 74 evaluable subjects 48, seven and 19 had definite, probable and no TB, respectively. 11 (15%) out of 74 pleural samples (nine (19%) out of 48 of the definite TB cases) had total cell counts that were inadequate for T-cell processing. In the remaining 63 samples, the sensitivity, specificity, positive predictive value and negative predictive value of different diagnostic methods were as follows. Maximal bioclinical score: 54, 89, 92 and 43%, respectively; T-SPOT.(R) TB: 86, 60, 84 and 64%, respectively; QuantiFERON (R)-TB Gold In-tube: 57, 80, 87 and 44%, respectively; HBHA-specific IGRA: 59, 31, 64 and 27%, respectively; PPD-specific IGRA: 81, 40, 76 and 46%, respectively; and pleural fluid unstimulated IFN-gamma: 979 100, 100 and 94%, respectively.
Unstimulated IFN-gamma was the most accurate test for distinguishing TB from non-TB effusions in a high-burden setting. The antigen-specific T-cell IGRAs were limited by suboptimal accuracy and the inability to isolate sufficient mononuclear cells to perform the assay.

• 出版日期2009-11