内科学课件：肺结核 Pulmonary Tuberculosis英文.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ? Test for M. tuberculosis infection Currently, there are two methods available for the detection of MTB infection: Mantoux tuberculin skin test (TST，结核菌素实验); Interferon-gamma release assays (IGRAs, γ-干扰素释放试验) In the TST test, a substance called purified protein derivative (PPD，纯蛋白衍生物), which is derived from tuberculin, is injected under the skin. Typically PPD produces a T-cell mediated delayed-type hypersensitivity reaction if the person has been infected with MTB. It takes 2 to 8 weeks for the host to establish delayed cell-mediated hypersensitivity after initial infection with MTB and detected by the TST. ? Administering the TST The TST is performed by intradermal (皮内) injection of 0.1 ml of PPD containing 5 tuberculin units into the volar surface of the forearm. ? Reading the TST The reaction to the TST should be assessed 48 to 72 hours after the injection, by measuring the diameter of?induration (硬结)(palpable raised, hardened area) across the forearm (perpendicular to the long axis) in millimeters. If there is no induration, the result should be recorded as 0 mm.?Erythema ?(redness) should not be measured ? ? judgement of the TST PPD Negative - 0-4mm Positive + ≧ 5 mm Mild positive positive ++ ≧ 10 mm Moderate positive Positive +++ ≧ 20 mm (or bleb,水疱) Significant positive TST is a valuable tool, but not perfect. Several factors can lead to false-positive or falsenegative skin test reactions TST False-Positive Reactions: Infection with nontuberculous mycobacteria BCG vaccination TST False-Negative Reactions: Concurrent viral infection (e.g., measles 麻疹, mumps 腮腺炎, chicken pox 水痘, HIV); overwhelming TB disease Chronic renal failure Immunosuppressive therapy (corticosteroid) improper testing technique interpretation of the TST it may overcome TST’s false-positi