中国全科医学 ›› 2025, Vol. 28 ›› Issue (29): 3684-3687.DOI: 10.12114/j.issn.1007-9572.2023.0573

• 论著 • 上一篇    下一篇

干扰素γ酶联免疫斑点检测在识别抗结核药物超敏反应患者致敏药物中的价值研究

吴于青*(), 刘㑇, 廖永美   

  1. 330006 江西省南昌市,江西省胸科医院感染性疾病科
  • 收稿日期:2023-06-25 修回日期:2023-12-27 出版日期:2025-10-15 发布日期:2025-08-26
  • 通讯作者: 吴于青

  • 作者贡献:

    吴于青负责研究的构思、设计与实施,撰写论文;吴于青、刘㑇进行数据收集整理、统计学处理、图表绘制;廖永美负责论文修订、文章质量控制。

  • 基金资助:
    国家自然科学基金地区科学基金资助项目(81960003)

The Value of Enzyme-linked Immunospot Assay in Identifying Causative Agents in Patients with Hypersensitivity Reactions to Antitubercular Agents

WU Yuqing*(), LIU Zhou, LIAO Yongmei   

  1. Infectious Diseases Department, Jiangxi Chest Hospital, Nanchang 330006, China
  • Received:2023-06-25 Revised:2023-12-27 Published:2025-10-15 Online:2025-08-26
  • Contact: WU Yuqing

摘要: 背景 抗结核药物超敏反应在临床上常见,药物激发试验是目前唯一有效的找出致敏药物的方法,但可诱发患者再次出现过敏甚至休克,严重时危及患者生命;也有患者放弃治疗导致结核菌耐药和播散。由于目前常用的抗结核方案需要4种药物联合使用,如何及时、精确地找出诱导患者出现超敏反应的致敏药物是临床迫切需要解决的问题。 目的 评估干扰素γ(IFN-γ)酶联免疫斑点法在快速识别出诱导抗结核药物治疗患者发生超敏反应的致敏药物中的临床价值。 方法 选取2021—2022年住院治疗的初治敏感肺结核且在治疗过程中发生药物超敏反应的患者50例,采集患者过敏急性期外周血单个核细胞,用酶联免疫斑点法检测药物特异性IFN-γ释放细胞的情况,采用药物激发试验作为判定何种药物诱导的超敏反应的金标准;分析酶联免疫斑点检测对识别抗结核四联方案(异烟肼、乙胺丁醇、利福平、吡嗪酰胺)所致超敏反应中的临床价值。 结果 酶联免疫斑点法在识别异烟肼、乙胺丁醇、利福平、吡嗪酰胺所致超敏反应中的灵敏度分别为69.2%(35/50)、61.5%(31/50)、75.0%(38/50)、66.7%(33/50),特异度为97.3%(49/50)、100.0%(50/50)、100.0%(50/50)、100.0%(50/50)。 结论 IFN-γ酶联免疫斑点检测在抗结核药物超敏反应患者急性期需进行致敏药物识别时,可作为一种体外检测的有效手段。

关键词: 结核, 抗结核药, 超敏反应, 酶联免疫斑点法, 干扰素γ

Abstract:

Background

Hypersensitivity reactions of antitubercular agents are very common in clinical practice. Drug provocation test is the only effective method to find out the causative agents, but it may cause re-sensitization or even shock, which can be life-threatening in severe cases; there are also patients who abandon treatment leading to drug resistance and dissemination of TB bacteria. Due to the fact that the conventional anti-tuberculosis treatment regimen involves the combination of four drugs, it is an urgent challenge for clinicians to quickly, safely, and accurately identify causative agents.

Objective

To evaluate the clinical application value of enzyme-linked immunospot assay in identifying causative agents in patients with hypersensitivity reactions to antitubercular agents.

Methods

A total of 50 patients with hypersensitivity reactions during the treatment of primary pulmonary tuberculosis hospitalized in Jiangxi Chest Hospital from 2021 to 2022 were selected. Mononuclear cells of peripheral blood were collected from patients in the acute phase of allergy, drug specific IFN-γ releasing cells was detected by enzyme-linked immunospot assay, and the drug provocation test (DPT) was used as the gold standard for determining which drug causes hypersensitivity reactions; the clinical value of the enzyme-linked immunospot assay in identifying hypersensitivity reactions caused by the antituberculosis quadruple regimen (isoniazid, ethambutol, rifampicin, pyrazinamide) .

Results

The sensitivity of the enzyme-linked immunospot assay in recognizing hypersensitivity reactions due to isoniazid, ethambutol, rifampicin, and pyrazinamide were 69.2% (35/50) 、61.5% (31/50) 、75.0% (38/50) 、66.7% (33/50), and the specificity were 97.3% (49/50) 、100.0% (50/50) 、100.0% (50/50) 、100.0% (50/50), respectively.

Conclusion

Enzyme linked immunospot assay can be used as an effective method for in vitro detection when causative agents identification is required in patients with hypersensitivity reactions to antitubercular agents at the acute stage.

Key words: Tuberculosis, Antitubercular agents, Hypersensitivity, Enzyme linked immunospot assay, IFN-γ

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