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href="//www.newsama.com/journals/trt/" aria-label="Tuberculosis Research and Treatment">结核病研究和治疗据/一种>/据一种Class="sc-htpNat bUhGXt link sc-nrwXf kCVAWK breadCrumb" href="//www.newsama.com/journals/trt/contents/year/2011/" aria-label="2011">2011年据/一种>/据span class="sc-eitiEO cWbOKB">文章据/span> </div> <div class="threeColumn__ThreeColumnWrapper-sc-1bf4078-0 comSpQ threeColumnWrapper"> <div class="threeColumn__LeftWrapper-sc-1bf4078-1 fkVFlF leftWrapper"> <button type="button" class="sc-likbZx iAOkZc section__button " id="sectionButton"><span class="sc-htoDjs diutvq icon__dots dots__detector icon-colored _3n-7Ho7DlfjMlZbrRr9Q4a icon-themeable" title="" font-size="22"></span>文章部分据/B.utton> <div class="sc-bGbJRg NxRXU static_contents__section_links links__hidden "> <div id="leftSectionMenu" class="sc-eLExRp jWsoil sc-jtRlXQ kkipbT left_section_menu"> <p>在本页据/p> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#abstract" aria-label="">摘要据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#introduction" aria-label="">介绍据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#methods" aria-label="">方法据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#results" aria-label="">结果据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#discussion" aria-label="">讨论据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#acknowledgments" aria-label="">致谢据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#references" aria-label="">参考据/一种></span> <span class="sc-ePZHVD dxfCqj grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-bEjcJn JKlRH" href="#copyright" aria-label="">版权据/一种></span> </div> </div> </div> <div class="threeColumn__ContentWrapper-sc-1bf4078-3 bbzREB contentWrapper"> <div class="threeColumn__Content-sc-1bf4078-4 jknsZc content"> <div class="articleContent__ArticleContentsWrapper-sc-2yl9jy-0 eSvjPB article_contents"> <div class="articleContent__ArticleContentsSectionsWrapper-sc-2yl9jy-1 jntdRu article_contents__sections_wrapper"> <div class="articleContent__ArticleWrapper-sc-2yl9jy-2 hAzjHP"> <div class="sc-hzNEM hNeCCc article_header_class"> <p class="sc-gmeYpB ctdkmR article_type">临床研究|据!-- -->开放访问据/p> <div class="sc-kZmsYB doGfnX article_citation"> 体积据!-- --> 2011年据!-- --> <span class="sc-iSDuPN ezntTT">|据/span>文章ID.据!-- --> 940642据!-- --> <span class="sc-iSDuPN ezntTT">|据/span> <a class="sc-htpNat bUhGXt link sc-fZwumE dqIsrA" href="https://doi.org/10.1155/2011/940642" aria-label="Doi-link">https://doi.org/10.1155/2011/940642据/一种> </div> <div class="sc-kaNhvL kwRfSr article_full_citation"> <div class="sc-iBEsjs ezuwCV isHide"> <p>阿里加春之，永井秀明，仓岛笃行，星野佳彦，正二正介，中岛裕树据!-- -->那据!-- --> “据span class="adjust-article-svg-size">Quantiferon测定的分层阈值诊断核心血栓抑制群中结核病感染据/span>“，据!-- --><i>结核病研究和治疗据/i>那据!-- --> 卷。据!-- -->2011年据!-- -->那据!-- --> 文章ID.据!-- -->940642据!-- -->那据!-- --> 9.据!-- -->   页面据!-- -->那据!-- --> 2011年据!-- -->．据!-- --> https://doi.org/10.1155/2011/940642据/p> </div> <button class="sc-hSdWYo etauus sc-LKuAh fxGnqr" color="">显示引文据/B.utton> </div> <h1 class="sc-iRbamj jZOxOO sc-RcBXQ goubQH article_title adjust-article-svg-size heading-title">Quantiferon测定的分层阈值诊断核心血栓抑制群中结核病感染据/h1> </div> <div class="sc-gPzReC fMlAsT article_authors"> <hr class="sc-fHxwqH kHliir hr__author"> <span class="">Haruyuki ariga.据!-- -->那据sup>1据/sup></span> <span class="">hideaki nagai.据!-- -->那据sup>1据/sup></span> <span class="">atsuyuki kurashima据!-- -->那据sup>1据/sup></span> <span class=""><b>财务大臣Hoshino据/B.><a class="sc-htpNat bUhGXt link" href="mailto:" aria-label="Mail Option"><span class="sc-htoDjs kNoiZu sc-jrIrqw eeUyzW icon-colored _2zt-1j0LmaF8UjTQAM413G icon-themeable" title="" font-size="16"></span></a>那据sup>2据/sup></span> <span class="">Syunsuke Shoji.据!-- -->那据sup>1据/sup> 和据/span> <span class="">Yutsuki Nakajima据sup>1据/sup></span> <div class="sc-iQtOjA llLcVY isHide"> <p><sup>1据/sup><span>日本东京东京国立医院国立医院组织呼吸医学中心，Kiyose Takeoka 3-1-1，东京204-8585据/span></p> <p><sup>2据/sup><span>西医国家传染病研究所皮杆菌科，东京都市，东京，日本东京189-0002据/span></p> </div> <button class="sc-hSdWYo etauus sc-iybRtq clzRlh" color="">展示更多据/B.utton> </div> <div class="articleContent__EditorWrapper-sc-2yl9jy-3 evMkvU"> <div class="articleContent__TextWrapper-sc-2yl9jy-8 fYrLtk"> <b>学术编辑器:据/B.>A. S. APT.据/div> <div class="articleContent__PublicationTimeLineWrapper-sc-2yl9jy-4 fjviok"> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">收到了据/span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年2月7日据/span> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">公认据/span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年4月13日据/span> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC isPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">发表据/span> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2011年6月27日据/span> </div> </div> </div> <article class="sc-jeCdPy gaWrER article_body "> <div> <div class="xml-content"> <h4 class="header" id="abstract">摘要据/h4> <p><i>背景据/i>．潜在结核病（TB）的检测对于Tb对照至关重要，但T细胞测定可能受免疫抑制程度的影响。免疫功能性与干扰素（IFN）的关系 -据i>γ.据/i>Quantiferon-TB金（QFT）的反应是不确定的，特别是在HIV阴性群体中。据i>方法和结果据/i>．QFT已经为健康受试者和TB疑似患者进行。在3017例患者中，727例被培养被诊断为肺结核病。结核病患者血液淋巴细胞的绝对数量与QFT显着相关。根据淋巴细胞计数，将将结核病患者分为八组。对于每个子组，接收器操作特征曲线分析由357个健康对照受试者进行。发现具有足够淋巴细胞计数的患者组的最佳截止，但对淋巴细胞缺乏症降低了这一点。据i>结论据/i>．淋巴细胞计数与QFT呈正相关。阳性标准的校准应考虑到细胞介导的免疫能力和进展为活动性结核病的风险。据/p> <span class="end-abs"></span> <h4 id="introduction">1.介绍据/h4> <p>对潜在结核病感染（LTBI）的治疗对于预防活性结核病（TB）的发展是必不可少的。虽然TB疾病的风险最大，但传统上与最近的暴露有关，但免疫溢出的主体代表了一种设置，其中TB从更多远程暴露的重新激活是一个问题。美国疾病控制和预防中心（CDC）建议在特定的风险群体中对LTBI的靶向测试，包括免疫功能性患有HIV感染，接受免疫抑制治疗，慢性肾功能衰竭，固体器官移植，矽肺病，头部癌症或颈部和肺，营养不良和糖尿病[据一种href="#B1">1据/一种>］．针对这些人群的LTBI靶向治疗也是公共卫生层面结核病控制的核心[据一种href="#B1">1据/一种>那据一种href="#B2">2据/一种>］．据/p> <p>直到最近，结核菌素皮肤测试（TST）是唯一检测LTBI的测试，但现在在基于体外的T细胞的IFN-据i>γ.据/i>对结核分枝杆菌(Mtb)具有高度特异性的检测方法已被开发作为替代诊断试验[据一种href="#B3">3.据/一种>］．与TST相比，T细胞测定不受之前的BCG疫苗接种和感染的影响，具有大多数环境不泛骨分枝杆菌[据一种href="#B4">4.据/一种>］．QuantiFERON-TB Gold in tube (QFT-IT) (Cellestis, Carnegie, Australia)和T-SPOT。TB (Oxford Immunotec, Oxford, UK)是两种商业可用的t细胞试验。QuantiFERON-TB黄金(QFT;第二代)和QFT-IT(第三代)全血检测基于酶联免疫吸附试验，而T-SPOT。结核病在酶联免疫斑点试验中使用外周血单个核细胞进行抗原刺激。虽然没有诊断LTBI的金标准，但当使用最近暴露于结核分枝杆菌的替代标记物时，许多研究表明，t细胞检测在接触调查中即使不是比TST更好，也同样有效[据一种href="#B5">5.据/一种>那据一种href="#B6">6.据/一种>］．CDC指南建议在使用TST的所有情况下，单一使用QFT代替TST [据一种href="#B7">7.据/一种>］．据/p> <p>众所周知，TST在免疫功能性宿主的设置中具有减少的敏感性。TST的假阴性结果据报道，例如，老年人和营养不良[据一种href="#B8">8.据/一种>那据一种href="#B9">9.据/一种>］．最近的一项研究表明T细胞分析鉴定了LTBI比TST更多的免疫功能性血肿患者[据一种href="#B10">10.据/一种>］．由于这些新的t细胞试验依赖于测量特异性获得性细胞介导的免疫反应，任何影响细胞免疫的免疫调节因子都可能影响体外试验的性能[据一种href="#B11">11.据/一种>］．然而，免疫功能度与特定IFN之间的相关性据i>γ.据/i>答复尚不清楚。此外，大多数研究已经将来自T细胞测定的数据分析为使用单个截止值的二分法结果，并且考虑到免疫学多样性验证阈值时已经完成了很少的作用。存在流行病学证据来支持利用风险分层截止值，如在TST的解释中[据一种href="#B1">1据/一种>］．然而，目前没有存在用于T细胞测定的这些数据。我们假设用于诊断LTBI的QFT中适当的阳性截止值在免疫活性种群和免疫抑制宿主具有受损的细胞介导的免疫力。因此，本研究的目的是鉴定与抗原特异性IFN的程度相关的免疫相关临床指标据i>γ.据/i>生产使用具有明显Tb感染的大免疫未经用的人群。其次，根据这些发现，我们修改了临床实践中具有不同免疫状态的QFT的阈值。据/p> <h4 id="methods">2.方法据/h4> <h5 id="sec2.1">２.１.参与者据/h5> <p>2006年1月至2008年10月，经东京国立医院机构审查委员会(IRB)批准研究方案后，连续入组我院口头同意的新患者和健康受试者。目前，QFT检测已被日本国家医疗保险批准，并应在临床实践中用于诊断结核病感染。IRB批准QFT检测的口头知情同意。QFT由医院医生为任何病房的住院病人和门诊病人开出，不受调查者的任何影响。对于所有纳入研究的患者，在入组时收集了他们的既往病史、临床症状和体征以及放射学和微生物学数据。收集经纤维支气管镜获得的支气管灌洗液样本，并在必要时进行分枝杆菌培养。临床医生没有将QFT结果纳入最终诊断。同时进行了几项用于临床诊断的常规实验室检查。我们还在健康员工开始工作时定期进行QFT。我们收集了既往结核病史、曾在任何医疗机构工作或最近接触活动性结核病患者以及其他结核病风险因素(如服用免疫抑制药物)的信息。据/p> <h5 id="sec2.2">2.2。全血Quantiferon-TB金测定据/h5> <p>测试是根据制造商的指示进行的。对结果的解释是根据CDC提出的指导方针进行的[据一种href="#B7">7.据/一种>］．以前，我们评估了该试验在所有患者中具有74％的敏感性，包括HIV阴性免疫抑制患者（包括HIV阴性免疫抑制患者）[据一种href="#B12">12.据/一种>］．然而，患者患者患者增加到88％，患者≥1000个细胞/ mm据sup>3.据/sup>．我们医院的两名专业技术人员对个体的临床信息和最终诊断完全一无所知。据/p> <h5 id="sec2.3">2.3。统计分析据/h5> <p>抗原特异性IFN-之间的关联据i>γ.据/i>通过装配线性模型检查QFT测定中的生产和几种临床特征。回归诊断练习包括检测残余分布（定量定位和正常概率绘图，残差 - 与拟合图），与预测器（增强组件与剩余地块）的功能关系中的非线性，以及对共同性的检查（方差通货膨胀因素）。借助于段的涂抹估计，在原始度量中表达了由拟合模型制成的预测。测定结果对分类的群体进行最大似然逻辑回归。将逻辑回归系数的成对差异以0.05的I误码率进行比较，通过Bonferroni方法进行多次比较调整。对分类组的接收器操作特征（ROC）曲线（AUROC）的区域之间进行成对比较。使用Dunn-Sida'k方法进行多种比较调整。据svg height="12.4375" 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</svg>被认为是显着的。统计分析与Stata，第10.1和11份（Statacorp LLP，大学站，德州，U.S.A.）和GraphPad Prism 5（GraphPad Software，San Diego，California）进行。据/p> <h4 id="results">结果据/h4> <h5 id="sec3.1">3.1。患者的特征据/h5> <p>共有3762个受试者接受初始QFT测试。如图所示据一种href="//www.newsama.com/journals/trt/2011/940642/fig1/" target="_blank">1据/一种>，在3017 TB嫌疑人的中，最终诊断为727名患者，基于使用支气管基纤维复制获得的痰或支气管灌洗液的MTB的微生物检测具有明确的活性肺结核。我们排除了可能的结核病患者，其中没有获得细菌学证据，最近暴露于涂片阳性结核病患者的人，以及在测试时接受超过14天的抗骨性治疗的人。有源TB患者的特征如表所示据一种href="//www.newsama.com/journals/trt/2011/940642/tab1/" target="_blank">1据/一种>．比女性更多的男性参加了这项研究，大多数研究参与者都是日本人。大多数（98.9％）是艾滋病毒血清。在727名患者的552名（75.9％）中发现了阳性痰涂片。表中也显示在表达中的临床免疫调节因子据一种href="//www.newsama.com/journals/trt/2011/940642/tab1/" target="_blank">1据/一种>．患者同时可以有多种因素。据/p> <div class="floats-partial-section partial-other-wrapper" data-section="tab1"> <div class="floats-partial-content fig-content-tab1"> <table class="table-group" id="tab1"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="4"> <hr></td> </tr> <tr> <td align="left">全部的，据i>N.据/i></td> <td align="center"></td> <td align="center">727.据/T.d> <td align="center"></td> </tr> <tr> <td align="left">年龄、中值、范围据/T.d> <td align="center"></td> <td align="center">63.据/T.d> <td align="center">15-97据/T.d> </tr> <tr> <td align="left">女,据i>N.据/i>， %据/T.d> <td align="center"></td> <td align="center">208据/T.d> <td align="center">28.8据/T.d> </tr> <tr> <td align="left">国籍(日语除外)据i>N.据/i>， %据/T.d> <td align="center"></td> <td align="center">9.据/T.d> <td align="center">1．2据/T.d> </tr> <tr> <td align="left" rowspan="5">痰涂片状态据sup>一种据/sup>那据i>N.据/i>， %据/T.d> <td align="center">0.据/T.d> <td align="center">167.据/T.d> <td align="center">23.0据/T.d> </tr> <tr> <td align="center">1+据/T.d> <td align="center">187.据/T.d> <td align="center">25.7据/T.d> </tr> <tr> <td align="center">2+据/T.d> <td align="center">113.据/T.d> <td align="center">15.5据/T.d> </tr> <tr> <td align="center">3+据/T.d> <td align="center">252.据/T.d> <td align="center">34.7据/T.d> </tr> <tr> <td align="center">未知的据/T.d> <td align="center">7.据/T.d> <td align="center">1．0据/T.d> </tr> <tr> <td align="left">肺空洞病灶,据i>N.据/i>（％）据/T.d> <td align="center"></td> <td align="center">276.据/T.d> <td align="center">38.0据/T.d> </tr> <tr> <td align="left">潜在的预先存在的条件据sup>B.据/sup>那据i>N.据/i>， %据/T.d> <td align="center"></td> <td align="center"></td> <td align="center"></td> </tr> <tr> <td align="left">在结核病之前施用免疫抑制剂据sup>C据/sup></td> <td align="center"></td> <td align="center">39.据/T.d> <td align="center">5.4据/T.d> </tr> <tr> <td align="left"> Malignant diseases据/T.d> <td align="center"></td> <td align="center">44.据/T.d> <td align="center">6.1据/T.d> </tr> <tr> <td align="left">血清白蛋白小于3.0g / dl据/T.d> <td align="center"></td> <td align="center">248.据/T.d> <td align="center">34.1.据/T.d> </tr> <tr> <td align="left"> Bedridden据/T.d> <td align="center"></td> <td align="center">78.据/T.d> <td align="center">10.7据/T.d> </tr> <tr> <td align="left"> Diabetes mellitus据/T.d> <td align="center"></td> <td align="center">69.据/T.d> <td align="center">9.5据/T.d> </tr> <tr> <td align="left"> HIV positive据/T.d> <td align="center"></td> <td align="center">8.据/T.d> <td align="center">1．1据/T.d> </tr> <tr> <td align="left">肝硬化据/T.d> <td align="center"></td> <td align="center">5.据/T.d> <td align="center">0.7据/T.d> </tr> <tr> <td align="left"> Renal failure据/T.d> <td align="center"></td> <td align="center">5.据/T.d> <td align="center">0.7据/T.d> </tr> <tr> <td align="left">脑梗死病史据/T.d> <td align="center"></td> <td align="center">17.据/T.d> <td align="center">2．3据/T.d> </tr> <tr> <td align="left">矽肺病据/T.d> <td align="center"></td> <td align="center">3.据/T.d> <td align="center">0.4据/T.d> </tr> <tr> <td align="left"> Dementia据/T.d> <td align="center"></td> <td align="center">45.据/T.d> <td align="center">6.2据/T.d> </tr> <tr> <td align="left"> Alcoholism据/T.d> <td align="center"></td> <td align="center">15.据/T.d> <td align="center">2．1据/T.d> </tr> <tr> <td align="left">无家可归的人据/T.d> <td align="center"></td> <td align="center">34.据/T.d> <td align="center">4.7据/T.d> </tr> <tr> <td align="left"> Drug abuser据/T.d> <td align="center"></td> <td align="center">0.据/T.d> <td align="center">0.0据/T.d> </tr> <tr class="table-tr"> <td colspan="4"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>请注意。据sup>一种据/sup>痰显微镜涂抹：0（涂抹酸酸快速杆菌（AFB）），1+（每100个田间1-99个AFB），2+（每场1-10小时）和3+（每次超过10个）场地）。据B.r><sup>B.据/sup>不止一个条件可以在同一患者共存。据B.r><sup>C据/sup>包括慢性全身类固醇，抗肿瘤坏死α剂和免疫抑制剂。据B.r></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表格1据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/tab1/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 肺结核患者的人口统计学和基线临床特征。据/div> </div> </div> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig1"> <div class="floats-partial-content fig-content-fig1"> <div class="partial-carousel--single-image"> <img alt="" name="940642.fig.001" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.001.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图1据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/fig1/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <table> 学习参与者招聘概况。TB：结核病。据/T.一种B.le> </div> </div> </div> <h5 id="sec3.2">3.2。与特定IFN相关的临床预测因子据i>γ.据/i>结核病患者的反应据/h5> <p>特定IFN-之间的关联据i>γ.据/i>通过适合线性模型检查未选择的TB患者的生产和几种患者特征。为此，响应变量是最大IFN-据i>γ.据/i>在用ESAT-6和CFP-10刺激后，对数转换为使模型残留的分布更接近正常和同性恋。以下患者特征用作抗原刺激的IFN-的预测因子据i>γ.据/i>生产：年龄，淋巴细胞，单核细胞，中性粒细胞和嗜酸性粒细胞的绝对计数，促丝瘤刺激的IFN-据i>γ.据/i>生产（阳性控制）和零（背景）负控制IFN-据i>γ.据/i>以及各种临床实验室测试结果可能涉及免疫功能和一般条件（血清白蛋白和血液血红蛋白浓度），炎症状态（C反应蛋白质水平; CRP），血清肌酐浓度和血清肝酶活性水平。没有任何预测因素被转化。某些临床实验室测试结果的值根据需要进行缩放，以使它们进入相似的数值域;在实践中，这意味着以数千个形成的元素单元/ mm为单位给出了与Leukakic相关的回归系数据sup>3.据/sup>．白蛋白缺失3个值，CRP缺失3个值。因此，可用于回归的总观测值为721。回归系数，标准误差，据svg height="11.175" id="M2" style="vertical-align:-0.0pt;width:10.9375px;" version="1.1" viewbox="0 0 10.9375 11.175" width="10.9375" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,11.113)"> <use xlink:href="#x1D443"></use> </g> </svg>值和95％的置信区间呈现在表格中据一种href="//www.newsama.com/journals/trt/2011/940642/tab2/" target="_blank">2据/一种>．背景和丝裂原 - 背景控制条件与抗原特异性IFN呈正相关据i>γ.据/i>生产（据svg height="11.375" id="M3" style="vertical-align:-0.1638pt;width:66.875px;" version="1.1" viewbox="0 0 66.875 11.375" width="66.875" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,11.112)"> <use xlink:href="#x1D443"></use> </g> <g transform="matrix(.017,-0,0,-.017,15.582,11.112)"> <use xlink:href="#x3C"></use> </g> <g transform="matrix(.017,-0,0,-.017,30.286,11.112)"> <use xlink:href="#x2E"></use> </g> <g transform="matrix(.017,-0,0,-.017,34.162,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,42.321,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,50.481,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,58.64,11.112)"> <use xlink:href="#x35"></use> </g> </svg>和据svg height="11.375" id="M4" style="vertical-align:-0.1638pt;width:58.712502px;" version="1.1" viewbox="0 0 58.712502 11.375" width="58.712502" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,11.112)"> <use xlink:href="#x1D443"></use> </g> <g transform="matrix(.017,-0,0,-.017,15.582,11.112)"> <path d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" id="x3D"></path> </g> <g transform="matrix(.017,-0,0,-.017,30.286,11.112)"> <use xlink:href="#x2E"></use> </g> <g transform="matrix(.017,-0,0,-.017,34.162,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,42.321,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,50.481,11.112)"> <path d="M137 343l67 33q37 17 63 17q79 0 129.5 -53t50.5 -131q0 -92 -58 -156.5t-147 -64.5t-147 68t-58 182q0 63 17 119t43 95.5t61.5 72t69 52t67.5 31.5q62 22 128 33l6 -32q-56 -11 -108 -35q-149 -71 -184 -231zM227 337q-47 0 -95 -27q-6 -23 -6 -70q0 -93 36 -155.5 t96 -62.5q53 0 78 45.5t25 105.5q0 68 -35 116t-99 48z" id="x36"></path> </g> </svg>，resp。）。淋巴细胞计数同样与测试试剂盒反应呈正相关（据svg height="11.375" id="M5" style="vertical-align:-0.1638pt;width:66.875px;" version="1.1" viewbox="0 0 66.875 11.375" width="66.875" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,11.112)"> <use xlink:href="#x1D443"></use> </g> <g transform="matrix(.017,-0,0,-.017,15.582,11.112)"> <use xlink:href="#x3C"></use> </g> <g transform="matrix(.017,-0,0,-.017,30.286,11.112)"> <use xlink:href="#x2E"></use> </g> <g transform="matrix(.017,-0,0,-.017,34.162,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,42.321,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,50.481,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,58.64,11.112)"> <use xlink:href="#x35"></use> </g> </svg>）.中性粒细胞计数与特定反应产生负面相关（据svg height="11.375" id="M6" style="vertical-align:-0.1638pt;width:66.875px;" version="1.1" viewbox="0 0 66.875 11.375" width="66.875" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,11.112)"> <use xlink:href="#x1D443"></use> </g> <g transform="matrix(.017,-0,0,-.017,15.582,11.112)"> <use xlink:href="#x3C"></use> </g> <g transform="matrix(.017,-0,0,-.017,30.286,11.112)"> <use xlink:href="#x2E"></use> </g> <g transform="matrix(.017,-0,0,-.017,34.162,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,42.321,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,50.481,11.112)"> <use xlink:href="#x30"></use> </g> <g transform="matrix(.017,-0,0,-.017,58.64,11.112)"> <use xlink:href="#x35"></use> </g> </svg>）.据/p> <div class="floats-partial-section partial-other-wrapper" data-section="tab2"> <div class="floats-partial-content fig-content-tab2"> <table class="table-group" id="tab2"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="7"> <hr></td> </tr> <tr> <td align="left" rowspan="2">预测因子据/T.d> <td align="center" rowspan="2">系数据/T.d> <td align="center" rowspan="2">SE据/T.d> <td align="center" rowspan="2"><i> t据/i></td> <td align="center" rowspan="2"><i> P据/i></td> <td align="center" colspan="2">95％CI.据/T.d> </tr> <tr> <td align="center">降低据/T.d> <td align="center">上据/T.d> </tr> <tr> <td align="center" colspan="7"> <hr></td> </tr> <tr> <td align="left">年龄（Y）据/T.d> <td align="center">-0.0030据/T.d> <td align="center">0.0027据/T.d> <td align="center">-1.12据/T.d> <td align="center">.26据/T.d> <td align="center">-0.0083据/T.d> <td align="center">0.0023据/T.d> </tr> <tr> <td align="left">背景(国际单位/毫升)据/T.d> <td align="center">0.57据/T.d> <td align="center">0.089据/T.d> <td align="center">6.46据/T.d> <td align="center"><.0005据/T.d> <td align="center">0.40据/T.d> <td align="center">０.７５据/T.d> </tr> <tr> <td align="left">mitogen背景（IU / ml）据/T.d> <td align="center">0.016据/T.d> <td align="center">0.0056.据/T.d> <td align="center">2.78据/T.d> <td align="center">.006据/T.d> <td align="center">0.0046据/T.d> <td align="center">0.027据/T.d> </tr> <tr> <td align="left">白蛋白（G / DL）据/T.d> <td align="center">0.0055据/T.d> <td align="center">0.11据/T.d> <td align="center">0.05据/T.d> <td align="center">.96据/T.d> <td align="center">-0.21据/T.d> <td align="center">0.22据/T.d> </tr> <tr> <td align="left">血红蛋白(g / dL)据/T.d> <td align="center">-0.023据/T.d> <td align="center">0.029据/T.d> <td align="center">-0.79据/T.d> <td align="center">点据/T.d> <td align="center">-0.080据/T.d> <td align="center">0.034据/T.d> </tr> <tr> <td align="left">中性粒细胞（1000 / mm据sup>3.据/sup>）据/T.d> <td align="center">−0.14据/T.d> <td align="center">0.021据/T.d> <td align="center">-6.51据/T.d> <td align="center"><.0005据/T.d> <td align="center">−0.18据/T.d> <td align="center">-0.095据/T.d> </tr> <tr> <td align="left">单核细胞（1000 / mm据sup>3.据/sup>）据/T.d> <td align="center">0.26据/T.d> <td align="center">0.23据/T.d> <td align="center">1.13据/T.d> <td align="center">.26据/T.d> <td align="center">−0.19据/T.d> <td align="center">0.72据/T.d> </tr> <tr> <td align="left">淋巴细胞（1000 / mm据sup>3.据/sup>）据/T.d> <td align="center">0.61据/T.d> <td align="center">0.13据/T.d> <td align="center">4.65据/T.d> <td align="center"><.0005据/T.d> <td align="center">0.35据/T.d> <td align="center">0.87据/T.d> </tr> <tr> <td align="left">嗜酸性粒细胞(1000 /毫米据sup>3.据/sup>）据/T.d> <td align="center">-0.63据/T.d> <td align="center">0.44据/T.d> <td align="center">-1.43据/T.d> <td align="center">.15据/T.d> <td align="center">-1.5据/T.d> <td align="center">0.23据/T.d> </tr> <tr> <td align="left">CRP (mg / dL)据/T.d> <td align="center">-0.015据/T.d> <td align="center">0.012据/T.d> <td align="center">-1.27据/T.d> <td align="center">.21据/T.d> <td align="center">−0.038据/T.d> <td align="center">0.0081据/T.d> </tr> <tr> <td align="left">AST（IU / L）据/T.d> <td align="center">−0.0023据/T.d> <td align="center">0.0030.据/T.d> <td align="center">-0.76据/T.d> <td align="center">。45据/T.d> <td align="center">-0.0082据/T.d> <td align="center">0.0036.据/T.d> </tr> <tr> <td align="left">alt（iu / l）据/T.d> <td align="center">0.0047据/T.d> <td align="center">0.0032据/T.d> <td align="center">1.48据/T.d> <td align="center">.14据/T.d> <td align="center">-0.0015据/T.d> <td align="center">0.011据/T.d> </tr> <tr> <td align="left">肌酐（mg / dl）据/T.d> <td align="center">0.18据/T.d> <td align="center">0.12据/T.d> <td align="center">1.48据/T.d> <td align="center">.14据/T.d> <td align="center">-0.058据/T.d> <td align="center">0.41据/T.d> </tr> <tr> <td align="left">有丝分裂原据svg height="8.7875004" id="M7" style="vertical-align:-0.3135pt" version="1.1" viewbox="0 0 20.549999 8.7875004" width="20.549999" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,8.7875)"> <g transform="translate(72,-64.97)"> <text transform="matrix(1,0,0,-1,-67.78,65.34)"> <tspan style="font-size: 12.50px; " x="0" y="0"> ×据/T.span> </text> </g> </g> </svg>淋巴细胞据/T.d> <td align="center">-0.0073据/T.d> <td align="center">0.0034据/T.d> <td align="center">-2.16据/T.d> <td align="center">.031据/T.d> <td align="center">-0.014据/T.d> <td align="center">−0.00067据/T.d> </tr> <tr> <td align="left">拦截（ln iu / ml）据/T.d> <td align="center">0.22据/T.d> <td align="center">0.47据/T.d> <td align="center"></td> <td align="center"></td> <td align="center"></td> <td align="center"></td> </tr> <tr class="table-tr"> <td colspan="7"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>请注意。对数转化的抗原刺激IFN的线性回归的回归系数据i>γ.据/i>由Quantiferon-TB Gold生产。沃尔德（据i>T.据/i>）测试统计数据基于698度的自由度。据svg height="10.325" id="M8" style="vertical-align:-0.0pt" version="1.1" viewbox="0 0 11.75 10.325" width="11.75" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,10.325)"> <g transform="translate(72,-63.74)"> <text transform="matrix(1,0,0,-1,-71.95,63.79)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> </text> </g> </g> </svg>不调整值以进行多重性。诊断图并不意味着在预测中分布残差或非线性的正常性的大量偏离。最大方差流量因子（<4）在可接受的范围内。CRP：C-反应蛋白;AST：天冬氨酸氨基转移酶;ALT：丙氨酸氨基转移酶;SE:标准误差;CI：信心互动。据B.r></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表2.据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/tab2/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 回归系数及相关统计量。据/div> </div> </div> <h5 id="sec3.3">3.3。QFT导致淋巴细胞分层TB种群据/h5> <p>接下来，基于外周血淋巴细胞的绝对数量，将TB患者群分为八个亚组。选择类别的范围为0-299,300-499,500-699,700-999,1000-1199,1200-1499,1500-1799和> 1800个细胞/ mm据sup>3.据/sup>（数字据一种href="//www.newsama.com/journals/trt/2011/940642/fig2/" target="_blank">2（a）据/一种>）.数字据一种href="//www.newsama.com/journals/trt/2011/940642/fig2/" target="_blank">2（b）据/一种>根据这八类淋巴细胞计数显示患者的QFT结果。阳性测定结果的比例（在0.35 IU / ml的截止值）和促丝溶解的IFN-据i>γ.据/i>发现反应与淋巴细胞计数正相关（图据一种href="//www.newsama.com/journals/trt/2011/940642/fig2/" target="_blank">2（b）据/一种>和据一种href="//www.newsama.com/journals/trt/2011/940642/fig2/" target="_blank">2（c）据/一种>）.相反，不确定的检测结果显示与淋巴细胞计数呈负相关(图)据一种href="//www.newsama.com/journals/trt/2011/940642/fig2/" target="_blank">2（b）据/一种>）.在细胞数小于700个/mm的类别中，不确定结果率显著增加据sup>3.据/sup>．最明显的是，在严重的淋巴细胞减少症，少于300个细胞/ mm据sup>3.据/sup>，结果不确定的百分率为37.8%。据/p> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig2"> <div class="floats-partial-content fig-content-fig2"> <div class="partial-carousel--single-image"> <img alt="（一种）“N.一种me="940642.fig.002a" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002a.jpg"> <br> <strong>（一种）据/strong> </div> <div class="partial-carousel--single-image"> <img alt="（b）“N.一种me="940642.fig.002b" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002b.jpg"> <br> <strong>（b）据/strong> </div> <div class="partial-carousel--single-image"> <img alt="（C）“N.一种me="940642.fig.002c" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002c.jpg"> <br> <strong>（C）据/strong> </div> </div> <div class="floats-partial-middle"> <div class="floats-partial-middle--thumbs fig-thumbs-fig2"> <button class="partial-carousel-dot" aria-label="(a)"><img alt="（一种）“N.一种me="940642.fig.002a" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002a.jpg"><br><strong>（一种）据/strong></button> <button class="partial-carousel-dot" aria-label="(b)"><img alt="（b）“N.一种me="940642.fig.002b" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002b.jpg"><br><strong>（b）据/strong></button> <button class="partial-carousel-dot" aria-label="(c)"><img alt="（C）“N.一种me="940642.fig.002c" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.002c.jpg"><br><strong>（C）据/strong></button> </div> <div class="partial-carousel-next-prev fig-nav-fig2"> <button class="carousel-prev" aria-label="Previous"></button> <button class="carousel-next" aria-label="Next"></button> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图2据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/fig2/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <svg height="11.25" id="M9" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <sup>＆据/sup> <svg height="11.25" id="M10" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M11" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M12" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <sup>＃据/sup> <svg height="11.25" id="M13" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M14" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M15" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M16" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <sup>$据/sup> <svg height="11.25" id="M17" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M18" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M19" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M20" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M21" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <i>γ.据/i> <sup>一种据/sup> <i>γ.据/i> <sup>B.据/sup> <i>γ.据/i> <i>γ.据/i> <sup>C据/sup> <i>γ.据/i> <i>γ.据/i> <table> Quantiferon-TB Gold结果在培养验证的肺结核亚组中，通过绝对数量的外周血淋巴细胞分层。（a）基于外周淋巴细胞的八个亚组分为八个亚组的数量和年龄。（b）QFT结果的比例八个亚组。*：与< 300 /毫米类别。：与< 300 /毫米类别，与300-500 / mm类别，和与500-700 / mm类别。：与< 300 /毫米类别，与300-500 / mm类别，与500-700 / mm类别，和与700-1000 / mm类别。：与< 300 /毫米类别，与300-500 / mm类别，与500-700 / mm类别，与700-1000 / mm类别，和与1000-1200 / mm类别。（c）抗原刺激和促丝裂解的IFN-对淋巴细胞计数（IU / mL）的反应。：nil（背景）IFN-专注。：更高的IFN -抗原肽ESAT-6或CFP-10和无(背景)IFN-刺激后的浓度专注。：确定的IFN之间的差异有丝裂原刺激后的浓度和无(背景)IFN-专注。据/T.一种B.le> </div> </div> </div> <h5 id="sec3.4">3.4。淋巴细胞分层TB种群的最佳阈值据/h5> <p>在我们院长的745名员工中，357名免疫活性人没有TB疾病的历史或与活性结核病患者接触，并且没有在任何医疗保健环境中工作的现有历史记录（图据一种href="//www.newsama.com/journals/trt/2011/940642/fig1/" target="_blank">1据/一种>）.中位年龄为25岁（21-28的范围）。比男性更多的女性（79.3％）。这些受试者都没有任何免疫抑制条件。所有健康的受试者至少接受了一次BCG疫苗接种。仅在3名参与者（0.8％）中观察到阳性QFT结果，并且没有不确定的结果。中位抗原特异性IFN-据i>γ.据/i>响应为0.01 IU / mL（末端范围为0-0.02）。使用来自357个健康受试者的这些QFT数据，对于如上所述的淋巴细胞计数分层的8组TB患者，进行ROC曲线分析以确定最佳截止值（表据一种href="//www.newsama.com/journals/trt/2011/940642/tab3/" target="_blank">3.据/一种>）.在亚组中，淋巴细胞计数为1800个细胞/ mm据sup>3.据/sup>并结束，菌射曲线为0.996，并确定适当的截止值为0.19 iu / ml（敏感性96％和特异性98％）（表据一种href="//www.newsama.com/journals/trt/2011/940642/tab3/" target="_blank">3.据/一种>和图据一种href="//www.newsama.com/journals/trt/2011/940642/fig3/" target="_blank">3.据/一种>）.观察到具有降低淋巴细胞计数的Auroc曲线的负趋势。值得注意的是，在淋巴细胞病患者（小于700个细胞/ mm）的患者中发现了菌热曲线的突然减少据sup>3.据/sup>）.适当的截止适合适度的淋巴细胞蛋白（700-1500个细胞/ mm据sup>3.据/sup>）确定为0.1IU / ml。虽然严重的淋巴细胞病组（<700个细胞/ mm）的测试性能显着降低据sup>3.据/sup>），发现最佳截止值为0.040 iu / ml。据/p> <div class="floats-partial-section partial-other-wrapper" data-section="tab3"> <div class="floats-partial-content fig-content-tab3"> <table class="table-group" id="tab3"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="10"> <hr></td> </tr> <tr> <td align="left">淋巴细胞计数/ mm据sup>3.据/sup></td> <td align="center"><i>N.据/i></td> <td align="center">AUROC曲线据/T.d> <td align="center">95％CI.据/T.d> <td align="center">SE.据/T.d> <td align="center">截止值IU / ml据/T.d> <td align="center">灵敏度％据/T.d> <td align="center">95％CI.据/T.d> <td align="center">特异性％据/T.d> <td align="center">95％CI.据/T.d> </tr> <tr> <td align="center" colspan="10"> <hr></td> </tr> <tr> <td align="left"><300.据/T.d> <td align="center">45.据/T.d> <td align="center">0.86据/T.d> <td align="center">0.777-0.943.据/T.d> <td align="center">0.04据/T.d> <td align="center">0.04据/T.d> <td align="center">80据/T.d> <td align="center">65.4-90.4据/T.d> <td align="center">86.据/T.d> <td align="center">81.7 - -89.2据/T.d> </tr> <tr> <td align="left">300-500.据/T.d> <td align="center">57.据/T.d> <td align="center">0.82据/T.d> <td align="center">0.806-0.938.据/T.d> <td align="center">0.03据/T.d> <td align="center">0.04据/T.d> <td align="center">79.据/T.d> <td align="center">66.1 - -88.6据/T.d> <td align="center">86.据/T.d> <td align="center">81.7 - -89.2据/T.d> </tr> <tr> <td align="left">500 - 700据/T.d> <td align="center">79.据/T.d> <td align="center">0.93据sup>一种据/sup></td> <td align="center">0.883-0.973.据/T.d> <td align="center">0.02据/T.d> <td align="center">0.05据/T.d> <td align="center">89.据/T.d> <td align="center">81.0-95.5.据/T.d> <td align="center">89.据/T.d> <td align="center">85.7-92.4据/T.d> </tr> <tr> <td align="left">700-1000.据/T.d> <td align="center">145.据/T.d> <td align="center">0.97据sup>B.据/sup></td> <td align="center">0.962-0.987.据/T.d> <td align="center">0.01据/T.d> <td align="center">0.1据/T.d> <td align="center">87.据/T.d> <td align="center">80.3 - -91.9据/T.d> <td align="center">94.据/T.d> <td align="center">91.2-96.3.据/T.d> </tr> <tr> <td align="left">1000-1200据/T.d> <td align="center">98.据/T.d> <td align="center">０．９８据sup>B.据/sup></td> <td align="center">0.957-0.994.据/T.d> <td align="center">0.01据/T.d> <td align="center">0.1据/T.d> <td align="center">91.据/T.d> <td align="center">83.3 - -95.7据/T.d> <td align="center">94.据/T.d> <td align="center">91.2-96.3.据/T.d> </tr> <tr> <td align="left">1200-1500.据/T.d> <td align="center">121.据/T.d> <td align="center">0.97据sup>B.据/sup></td> <td align="center">0.954 - -0.993据/T.d> <td align="center">0.01据/T.d> <td align="center">0.1据/T.d> <td align="center">93.据/T.d> <td align="center">87.4-97.1.据/T.d> <td align="center">95.据/T.d> <td align="center">91.8-96.8.据/T.d> </tr> <tr> <td align="left">1500-1800.据/T.d> <td align="center">78.据/T.d> <td align="center">0.97据sup>B.据/sup></td> <td align="center">0.949 - -0.989据/T.d> <td align="center">0.01据/T.d> <td align="center">0.15据/T.d> <td align="center">91.据/T.d> <td align="center">82.4-96.3.据/T.d> <td align="center">96.据/T.d> <td align="center">93.2-97.6.据/T.d> </tr> <tr> <td align="left">> 1800.据/T.d> <td align="center">104.据/T.d> <td align="center">0.99据sup>B.据/sup></td> <td align="center">0.992 - -0.9997据/T.d> <td align="center">0．002据/T.d> <td align="center">0.19据/T.d> <td align="center">96.据/T.d> <td align="center">90.4 - -98.9据/T.d> <td align="center">98.据/T.d> <td align="center">96.0-99.2据/T.d> </tr> <tr class="table-tr"> <td colspan="10"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>请注意。AUROC:接收机工作特性下的面积;SE:标准误差;CI:淋巴细胞计数的置信区间类别排除了范围的上端显示的值。据B.r><sup>一种据/sup>：据svg height="11.25" id="M22" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg>与< 300 /毫米据sup>3.据/sup>类别和据svg height="11.25" id="M23" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg>与300-500 / mm据sup>3.据/sup>类别。据B.r><sup>B.据/sup>：据svg height="11.25" id="M24" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg>与< 300 /毫米据sup>3.据/sup>类别，据svg height="11.25" id="M25" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg>与300-500 / mm据sup>3.据/sup>类别，和据svg height="11.25" id="M26" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg>与500-700 / mm据sup>3.据/sup>类别。据B.r></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表3据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/tab3/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 淋巴细胞分层患者组接收器操作特征曲线下面积分析。据/div> </div> </div> <div class="floats-partial-section partial-carousel-wrapper" data-section="fig3"> <div class="floats-partial-content fig-content-fig3"> <div class="partial-carousel--single-image"> <img alt="" name="940642.fig.003" src="https://static-01.hindawi.com/articles/trt/volume-2011/940642/figures/940642.fig.003.jpg"> <br> <strong></strong> </div> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">图3.据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/fig3/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> <svg height="11.25" id="M27" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M28" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <sup>＃据/sup> <svg height="11.25" id="M29" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M30" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <svg height="11.25" id="M31" style="vertical-align:-0.30096pt" version="1.1" viewbox="0 0 48.337502 11.25" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.25)"> <g transform="translate(72,-63)"> <text transform="matrix(1,0,0,-1,-71.95,63.35)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 据/T.span> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> 据据/T.span> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> ．据/T.span> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0.据/T.span> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 5.据/T.span> </text> </g> </g> </svg> <sup>3.据/sup> <table> 淋巴细胞分层患者组接收器操作特征曲线下面积分析。Auroc：接收器下的区域操作特征。错误栏;标准错误。*：与< 300 /毫米类别和与300-500 / mm类别。：与< 300 /毫米类别，与300-500 / mm类别，和与500-700 / mm类别。据/T.一种B.le> </div> </div> </div> <h4 id="discussion">4。讨论据/h4> <p>不同的相互关联的免疫调节因子通常可能在体内影响淋巴细胞状况。营养不良倾向于临床上表观感染的发生率更大，并且由于感染而增加发病率和死亡率。在仅7天的速度下，已经观察到循环淋巴细胞和白细胞介素-2在丝裂原刺激后产生的抑制[据一种href="#B13">13.据/一种>］．施用全身皮质类固醇可以抑制淋巴细胞增殖和功能[据一种href="#B14">14.据/一种>］．来自年龄的动物和人类的T细胞始终显示对线粒体的抑郁反应性[据一种href="#B15">15.据/一种>］．各种固体瘤的存在与损伤延迟型超敏反应和体外T细胞增殖降低有关，对丝率损失有关[据一种href="#B16">16.据/一种>］．接受血液透析的患者显示在体外，减少抗体生产和抑制中性粒细胞和树突细胞功能的降低的T细胞功能[据一种href="#B17">17.据/一种>］．最近的一项研究表明，艾滋病毒感染的QFT结果下降了CD4的艾滋病毒感染的个体据sup>+据/sup>T细胞计数[据一种href="#B18">18.据/一种>那据一种href="#B19">19.据/一种>］．如果这些临床免疫抑制条件下的人可能具有高可能性，如果它们感染MTB，则可能具有发育活性TB疾病。因此，淋巴细胞病或淋巴细胞功能障碍与受损宿主中活性TB疾病的风险密切相关。本研究表明，在具有Tb感染的免疫外未选择的人群中，绝对淋巴细胞计数和丝分裂型IFN-据i>γ.据/i>响应与抗原特异性IFN的水平正相关据i>γ.据/i>全血T细胞测定中的反应。因为CD4.据sup>+据/sup>T细胞是IFN-的主要来源据i>γ.据/i>在T细胞测定中，这种发现不是出乎意料的（尽管使用细胞内细胞因子染色方法的未发表的数据表明CD8据sup>+据/sup>T细胞也产生IFN-据i>γ.据/i>在一些患者中）。另一方面，由于一些患有正常淋巴细胞计数的患者仍然减少了特定的IFN-据i>γ.据/i>生产，其他如此外观未识别的淋巴细胞计数无关因素，如调节性T细胞效应[据一种href="#B20">20.据/一种>]可以解释IFN-据i>γ.据/i>回复。虽然在正常淋巴细胞计数的患者中很少观察到较差的丝分裂性反应，但仍然可以在一些严重淋巴细胞病患者中介导的良好介无止药反应。这可能表明T细胞以外的某些白细胞可能产生IFN-据i>γ.据/i>响应于促丝裂原的全血刺激。本研究还表明中性粒细胞计数与特定IFN -据i>γ.据/i>回复。一种可能性可能是由于中性粒细胞显性高炎症状态，晚期结核病，淋巴细胞减少[据一种href="#B21">21.据/一种>］．据/p> <p>由于LTBI的风险与暴露和邻近痰涂层阳性肺结核病患者的持续时间密切相关，因此TB暴露用作LTBI的替代物。但是，由于没有适当的黄金标准用于诊断LTBI，因此人们不能证明LTBI的存在或不存在[据一种href="#B22">22.据/一种>］．因此，为了估计t细胞试验的敏感性和特异性，一般使用未经治疗的培养阳性结核病患者和健康的、低风险的、没有已知结核病暴露史的个人[据一种href="#B23">23.据/一种>那据一种href="#B24">24.据/一种>］．据/p> <p>然而，活动性结核病和无症状LTBI之间的宿主免疫可能是不同的。最近，Harari等人发现TNF-占主导地位据i>α.据/i>TB-specific CD4据sup>+据/sup>T细胞反应将区分潜在感染和活性疾病[据一种href="#B25">25.据/一种>］．然而，他们排除了免疫抑制患者（如艾滋病毒据sup>+据/sup>)、营养不良(体重< 50 kg)、淋巴细胞减少(<3000个/mm)据sup>3.据/sup>）.TB疾病严重程度与总淋巴细胞和CD4的更大抑郁有关据sup>+据/sup>T细胞计数。CD4据sup>+据/sup>T细胞计数在一个月的抗核化化疗后大多数患者恢复正常水平[据一种href="#B26">26.据/一种>］．活跃的Tb衰减抗原刺激的IFN-据i>γ.据/i>由于疾病过程本身免疫抑制和特定T细胞的迁移出来的生产导致外周血[据一种href="#B27">27.据/一种>］．活性TB的这种免疫抑制可能会使活性TB种群混淆为LTBI的替代物。我们需要选择已知的免疫活力度健康人，尽可能地将TB感染作为替代品。从相反的角度来看，具有活性TB疾病和相关免疫抑制的群体可以用作具有LTBI的免疫抑制宿主的替代物。据/p> <p>通常，制造商指令中给出的0.35 IU / ml的单个截止值均匀地应用于目前QFT的阳性结果的解释。因为QFT用于评估怀疑被感染结核病的个体，所以通过使用用于临床决策的单个截止，必须确定测试结果是否是“正”或“负”。但是，因为测试测量抗原刺激的IFN-据i>γ.据/i>从全血细胞生产，结果是内在连续变量。对测试结果(包括转换和逆转)的解释可能需要理解连续数据的非特异性变异性和再现性[据一种href="#B28">28.据/一种>］．而且，具体IFN-据i>γ.据/i>如上文所述，细胞免疫受损，如淋巴细胞减少，可能会影响产量。在这里，使用0.35 IU/mL的当前临界值，在淋巴细胞计数充足的人群中，敏感性为89%，而在严重的人群中(<700个细胞/mm)据sup>3.据/sup>）和中度（700-1500个细胞/ mm据sup>3.据/sup>）淋巴细胞缺乏症人群，敏感度范围为33％至75％（表据一种href="//www.newsama.com/journals/trt/2011/940642/tab3/" target="_blank">3.据/一种>）.抗原特异性反应和检测性能明显减弱，特别是在严重的淋巴细胞减少症。因此，伴有严重淋巴细胞减少的免疫抑制可能会影响检测性能。最近的一份报告表明，与低负担国家(83%)相比，在高发病率环境(69%)中使用0.35 IU/mL临界值的QFT敏感性可能更低，这可能是由于包括艾滋病毒合并感染、晚期疾病和营养不良在内的几个因素[据一种href="#B29">29.据/一种>］．制造商定义的检测临界值0.35 IU/mL允许高特异性，但可能在敏感性方面付出一些代价，特别是在伴有淋巴细胞减少的免疫抑制条件下。我们的数据提示，0.2 IU/mL的临界值可能更适合于淋巴细胞计数正常、炎症反应水平较低的tb感染免疫受试者，这与LTBI一致。同样，在中度淋巴细胞减少人群中，0.1 IU/mL的临界值使敏感性最大化而不丧失特异性。在低负担的情况下，我们建议如果特异性反应大于0.1 IU/mL，尤其是在与淋巴细胞减少相关的免疫抑制条件下，检测结果应被认为是阳性(见表)据一种href="//www.newsama.com/journals/trt/2011/940642/tab4/" target="_blank">4.据/一种>）.据/p> <div class="floats-partial-section partial-other-wrapper" data-section="tab4"> <div class="floats-partial-content fig-content-tab4"> <table class="table-group" id="tab4"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="5"> <hr></td> </tr> <tr> <td align="center" colspan="2">破坏宿主据sup>一种据/sup></td> <td align="center" colspan="3">免疫活性主持人（成人）据/T.d> </tr> <tr> <td align="center" colspan="5"> <hr></td> </tr> <tr> <td align="left">≥0.1据sup>B.据/sup></td> <td align="center"><0.1据/T.d> <td align="center">≥0.3.据/T.d> <td align="center">0.1-0.3据/T.d> <td align="center"><0.1据/T.d> </tr> <tr> <td align="left">积极的据/T.d> <td align="center">消极的据/T.d> <td align="center">post据/T.d> <td align="center">边缘据/T.d> <td align="center">消极的据/T.d> </tr> <tr class="table-tr"> <td colspan="5"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> <tr class="table-fn"> <td>笔记：据sup>一种据/sup>：患有细胞介导的免疫和淋巴细胞病受损的宿主，例如接受慢性免疫抑制治疗，晚期恶性疾病，营养不良，血液透析，艾滋病毒感染和住院老年人的患者。据sup>B.据/sup>：iu / ml。据B.r></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表4.据/span> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/trt/2011/940642/tab4/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 建议全血t细胞试验免疫能力分层阳性标准和边界区(QuantiFERON-TB Gold)。据/div> </div> </div> <p>序列检测的T细胞测定中转换的截止值和定义是高负荷设施中的辩论和研究问题[据一种href="#B30">30.据/一种>］．由于既有单独的免疫多样性也是IFN的确定的固有变异据i>γ.据/i>值，它可能与建立边界灰色区域相关[据一种href="#B31">31.据/一种>］．我们提出，在免疫活性的健康受试者中，来自我们分析的最佳截止0.2 IU / ml的两侧边缘区域将是相关的（即0.1-0.3 IU / ml）。任何小于0.1 iu / ml的值被认为是“绝对是负”，等于或大于0.3 iu / ml的任何值被认为是“绝对是积极的”（表据一种href="//www.newsama.com/journals/trt/2011/940642/tab4/" target="_blank">4.据/一种>）.在日本，目前QFT的否定标准少于0.1IU / mL，并且试验结果被认为是“等因素”界面，如果对特定抗原的响应相等或大于0.1且小于0.35 IU /ml。在目前的长期研究中，我们使用QFT测定具有两种特异性抗原：ESAT-6和CFP-10。在QFT-IT测定中，介绍了新的Tb-抗原7.7除了两种常规抗原之外，还可以逐步提高灵敏度[据一种href="#B32">32.据/一种>那据一种href="#B33">33.据/一种>];但是，截止0.35 IU / mL保持不变。据/p> <p>总之，我们的大型纵向研究表明，外周血淋巴细胞的绝对数量与抗原刺激的IFN -据i>γ.据/i>在未选择的TB患者中的全血症中的生产。应分层分配阳性结果的标准，以取决于受试者的免疫状况，特别是在免疫调节患者的免疫功能下，患有患者介导的免疫力患者，患者患有进展的患者增加至活性结核病病的风险。据/p> <h4 id="acknowledgments">致谢据/h4> <p>作者感谢渡边绫子(Ayako Watanabe)和井上靖子(Yasuko Inoue)对实验室分析的技术支持。田村俊树，后藤皓美，以及他们医院的所有医生，感谢他们的支持。这项工作得到了日本厚生劳动省为星野幸男提供的新发和再发传染病研究补助金的部分支持。以及由日本文部科学省为星野洋行颁发的科学研究补助金(C)。据/p> </div> <div class="xml-content"> <h4 class="references" id="references">参考据/h4> <ol> <li id="B1">“针对结核病感染的靶向结核病检测和治疗。1999年7月，ATS董事会通过了美国胸科学会的这一官方声明。这是美国胸部社会（ATS）的联合声明和疾病控制和预防中心（CDC）。本声明是由美国传染病学会理事会认可的。（IDSA），1999年9月，以及本声明的部分，“据i>美国呼吸和重症监护医学杂志据/i>号，第161卷。4、第2部分，pp. S221-S247, 2000。据span 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Rozot&author=F. B. Enders et al.&publication_year=2011" target="_blank">谷歌学术据/一种></span></li> <li id="B26">B. E. Jones, M. M. Oo, E. K. Taikwel等，“人类免疫缺陷病毒阴性肺结核患者的CD4细胞计数”，据i>临床传染病据/i>，卷。24，不。5，pp。988-991，1997。据span class="reflinks">视图:据一种href="https://scholar.google.com/scholar_lookup?title=CD4%20cell%20counts%20in%20human%20immunodeficiency%20virus-negative%20patients%20with%20tuberculosis&author=B. E. Jones&author=M. M. Oo&author=E. K. Taikwel et al.&publication_year=1997" target="_blank">谷歌学术据/一种></span></li> <li id="B27">J. Vekemans，C. Lienhardt，J.S.Sillah等，“结核病接触但不是患者对ESAT-6具有更高的γ干扰素，而不是冈比亚的社区控制”据i>感染和免疫据/i>，卷。69，没有。10，pp。6554-6557,2001。据span class="reflinks">视图:据一种href="https://doi.org/10.1128/IAI.69.10.6554-6557.2001">出版商网站据/一种><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=Tuberculosis%20contacts%20but%20not%20patients%20have%20higher%20gamma%20interferon%20responses%20to%20ESAT-6%20than%20do%20community%20controls%20in%20The%20Gambia&author=J. Vekemans&author=C. Lienhardt&author=J. S. Sillah et al.&publication_year=2001" target="_blank">谷歌学术据/一种></span></li> <li id="B28">A. Veerapathran，R.Joshi，K.Goswami等，“结核感染的T细胞测定：使用再现性数据导出用于转换的截止，”据i>普罗斯一体据/i>，卷。3，不。3，e1850,2008。据span class="reflinks">视图:据一种href="https://doi.org/10.1371/journal.pone.0001850">出版商网站据/一种><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=T-cell%20assays%20for%20tuberculosis%20infection:%20deriving%20cut-offs%20for%20conversions%20using%20reproducibility%20data&author=A. Veerapathran&author=R. Joshi&author=K. Goswami et al.&publication_year=2008" target="_blank">谷歌学术据/一种></span></li> <li id="B29">K. Dheda, R. Z. Smit, M. Badri，和M. Pai，“t细胞干扰素释放检测用于结核病快速免疫诊断:高负担与低负担环境的临床应用”据i>目前肺药的意见据/i>，卷。15，不。3，pp。188-200,2009。据span class="reflinks">视图:据一种href="https://doi.org/10.1097/MCP.0b013e32832a0adc">出版商网站据/一种><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=T-cell%20interferon-gamma%20release%20assays%20for%20the%20rapid%20immunodiagnosis%20of%20tuberculosis:%20clinical%20utility%20in%20high-burden%20vs.%20low-burden%20settings&author=K. Dheda&author=R. Z. Smit&author=M. Badri&author=&author=M. Pai&publication_year=2009" target="_blank">谷歌学术据/一种></span></li> <li id="B30">M. Pai，R.Joshi，S. Dogra等，“使用干扰素-γ测定的结核病医疗工作者的序列测试”据i>美国呼吸和重症监护医学杂志据/i>，卷。174，不。3，pp。349-355,2006。据span class="reflinks">视图:据一种href="https://doi.org/10.1164/rccm.200604-472OC">出版商网站据/一种><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=Serial%20testing%20of%20health%20care%20workers%20for%20tuberculosis%20using%20interferon-gamma%20assay&author=M. Pai&author=R. Joshi&author=S. Dogra et al.&publication_year=2006" target="_blank">谷歌学术据/一种></span></li> <li id="B31">M. Pai，R.Joshi，S. Dogra等，“T-Cell测定的趋势在印度农村结核病患者的家庭接触中的转换和逆转”据i>国际肺结核和肺病杂志据/i>，卷。13，不。1，pp。84-92,2009。据span class="reflinks">视图:据一种href="https://scholar.google.com/scholar_lookup?title=T-cell%20assay%20conversions%20and%20reversions%20among%20household%20contacts%20of%20tuberculosis%20patients%20in%20rural%20India&author=M. Pai&author=R. Joshi&author=S. Dogra et al.&publication_year=2009" target="_blank">谷歌学术据/一种></span></li> <li id="B32">N. HALADA，K. HIGUCHI，T. Yoshiyama等，“两种全血干扰素-γ-GAMMA测定对M.结核病感染的敏感性和特异性的比较”据i>感染杂志据/i>第56期5，页348-353,2008。据span class="reflinks">视图:据一种href="https://doi.org/10.1016/j.jinf.2008.02.011">出版商网站据/一种><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20the%20sensitivity%20and%20specificity%20of%20two%20whole%20blood%20interferon-gamma%20assays%20for%20M.%20tuberculosis%20infection&author=N. Harada&author=K. Higuchi&author=T. Yoshiyama et al.&publication_year=2008" target="_blank">谷歌学术据/一种></span></li> <li id="B33">H. Mahomed，E. J. Hughes，T. Hawkridge等，“梅特鲁克皮肤试验与三代全血IFN-Gamma测定的结核病感染，”据i>国际肺结核和肺病杂志据/i>，第10卷，第5期。3，页310 - 316,2006。据span class="reflinks">视图:据一种href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20Mantoux%20skin%20test%20with%20three%20generations%20of%20a%20whole%20blood%20IFN-gamma%20assay%20for%20tuberculosis%20infection&author=H. Mahomed&author=E. J. Hughes&author=T. Hawkridge et al.&publication_year=2006" target="_blank">谷歌学术据/一种></span></li> </ol> </div> <div class="xml-content"> <h4 class="copyright" id="copyright">版权据/h4> <p>版权所有©2011 Haruyuki Ariga等。这是分布下的开放式访问文章据一种rel="license" href="http://creativecommons.org/licenses/by/3.0/">创意公共归因许可证据/一种>，允许在任何媒介上不受限制地使用、传播和复制，但必须正确引用原作。据/p> </div> </div> </article> </div> </div> </div> <div class="biblio__Wrapper-sc-1nou1lz-0 eyHfWh journal_article__BiblioIntegratorWidget-sc-12fk6zy-5 dbAANp article_widget biblioWrapper hide"> <hr> <h4 class="biblio__H4-sc-1nou1lz-2 kgAKHb hrTitleRef">更多相关文章据/h4> <div id="biblio_widget" class="biblio__BiblioWrapper-sc-1nou1lz-1 ejXgSO"></div> </div> </div> </div> <div class="threeColumn__RightWrapper-sc-1bf4078-2 jzTMLK rightWrapper" id="rightSectionMenu"> <div> <div class="journal_article__ArticleStickyTopToolbar-sc-12fk6zy-0 gbrQxi article_sticky_top_toolbar"> <div class="sc-gVLVqr innUZH article_top_toolbar"> <a class="sc-htpNat bUhGXt link sc-jtRfpW dIjoCg sc-cBdUnI 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src="data:image/svg+xml;base64,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" height="24"><span class="sc-gbOuXE SDMqt">下载其他格式据/span><span class="sc-dRFtgE jooXYL">更多的据/span></span> <span class="sc-htoDjs bMdQcY sc-bfYoXt VdeWO icon-colored _1CwL9R82TPl2HxDleeYGDR icon-themeable" title="" font-size="11"></span> </div> <div class="sc-cugefK dCMfhd"> <a class="sc-htpNat bUhGXt link sc-fnwBNb kfscSt open_panel" href="//www.newsama.com/downloads/journals/trt/2011/940642.xml" aria-label="XML" property="background-color" color="#D8D8D8"> <div class="sc-iNhVCk brvugV"> XML.据/div><img alt="" class="sc-EHOje jOLhQl sc-eAKXzc bESoPs" title="" role="presentation" src="data:image/svg+xml;base64,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" height="24"></a> </div> <a class="sc-htpNat bUhGXt link sc-hUfwpO jyXjfZ" href="//www.newsama.com/reprints/940642/confirm" aria-label="Order Printed Copies" target="_blank" property="background-color" color="#D8D8D8" id="toolbar__opcNav"><span><img alt="" class="sc-EHOje jOLhQl sc-eAKXzc bESoPs" title="" role="presentation" src="data:image/svg+xml;base64,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" height="24"><span class="sc-gbOuXE SDMqt">订单印刷副本据/span><span class="sc-dRFtgE jooXYL">命令据/span></span><span class="sc-htoDjs kNoiZu sc-bfYoXt VdeWO right__icon icon-colored _32KP5uexH-Bgs7Kj8Gk1Tz icon-themeable" title="" font-size="16"></span></a> <div class="sc-cqpYsc krPIEq"> <div class="sc-hBbWxd hdkxPJ"> <div> 意见据span>2944据/span> </div> <div> 下载据span>599.据/span> </div> </div> <div> <div class="sc-dyGzUR cmbuIE"> <span class="__dimensions_badge_embed__" data-doi="10.1155/2011/940642" data-style="small_circle"></span>引用据/div> </div> </div> <nav class="sc-bRBYWo fXBKFa sc-gkFcWv gXvjfo" id="toolbar__iconNav"> <h3 class="sc-Rmtcm hNPrIr">分享帖子据/h3> <ul class="sc-hzDkRC bnbfTS"> <li class="iconBorder"><a class="sc-htpNat bUhGXt link" href="https://twitter.com/share?url=https://doi.org/10.1155/2011/940642&via=Hindawi" aria-label="Sharing on Twitter" rel="noopener noreferrer" target="_blank"><img alt="" class="sc-EHOje jOLhQl socialTwitter" title="" role="presentation" 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