IGRA検査の理論と検査技術に ... - chiringi.or.jp

1 IGRA T- .TB 25 5 25 1. 2. T- .TB 1. PPD BCG BCG M. tuberculosis M. bovis PNAS, 100, p7877-7882, 2003 2. PPD 3. 2 4. PPD BCG BCG ESAT-6 1995 P. Andersen T IFN-g ESAT-6 (the early secreted antigenic target 6 kDa protein) P. Andersen et al. Recall of long-lived immunity to Mycobacterium tuberculosis infection in mice. J. Immunol., Vol. 154, p3359, 1995.

2 A. L Sorensen et al. Purification and characterization of a low-molecular-mass T-cell antigen secreted by Mycobacterium tuberculosis. Infection and Immunity, Vol. 63, p1710, 1995. 1996 ESAT-6 M. bovis BCG RD1 CFP-10 CFP-10 (10 kDa culture filtrate protein) Berthet, et al. A Mycobacterium tuberculosis operon encoding ESAT-6 and a novel low-molecular-mass culture filtrate protein (CFP-10). Microbiology, Vol. 144, p3195, 1998. Skjot, et al. Comparative evaluation of low-molecular-mass proteins from Mycobacterium tuberculosis identifies members of the ESAT-6 family as immunodominant T-cell antigens. Infect. Immun., Vol 68, p214, 2000. ESAT-6/CFP-10 Tuberculosis complex Environmental strains M. tuberculosis M. kansasii M. africanum M.

3 Marinum M. bovis M. szulgai M. flavescens M. gastri ESAT-6/CFP-10 BCG substrains Gothenburg Moreau Tice Tokyo Danish Glaxo Montreal Pasteur Environmental strains M. avium M. intracellulare etc ESAT-6/CFP-10 BCG MAC T IFN-g T IFN-g BCG Interferon-Gamma Release Assays (IGRA) ESAT-6, CFP-10 1. - 1. - - 1.

4 2. T- .TB T- .TB T- .TB Interferon-Gamma Release Assays - QFT QuantiFERON -TB Gold ( )(QFT-Gold In-Tube) 15 .IFN-g 4 . 1mL 37 C 16-24 Stage 1: ESAT-6+CFP-10+ 2:IFN-gELISA ELISA IFN-g T- . TB(ELISPOT) ESAT-6/CFP-10 Y Y Y PBMCs PBMCs Y Y YY Y YELISPOT 2 IFN-g Nil Panel A Panel B Mitogen Nil Panel A Panel B Mitogen T- .TB 1 1 6 T- .TB 1 5mL) T- .TB T-Cell Xtend 32 QFT RD1 (ESAT-6 CFP-10) T 100 BCG QFT 32 PBMCs IFN- PBMCs PBMCs PBMCs IGRA IGRA T- IGRA T.

5 TB QFT-3G Detjen et al Clin Infect Dis (2007) (26/28) (26/28) Dominguez et al Clin Vacc Immunol (2008) (36/39) (33/39) Goletti et al. PLoS ONE. (2008) (58/69) (52/69) Chee et al., J Clin Microbiol (2008) (254/270) 83% (224/270) (374/406) (335/406) IGRA IGRA T- .TB QFT-3G Higuchi et al IJTLD (2012) (110/111) (96/97) Mancuso et al AJRCCM (2011) (1336/1354) (1338/1354) Total (1446/1465) (1434/1451) 1. Born in TB endemic countries. 2. Live in cities where TB incidences are more than 25 per 100,000. 3. Have lived more than 1 month in cities of foreign countries where TB is endemic. 4. Have abnormal chest X-ray observations. 5. Have had contact with TB patients.

6 6. Have TB patients among family members, friends, or acquaintances. 7. Have experiences working in places where TB infection is thought to be more likely, such as hospitals, prisons, the Self-Defense Forces, nursing homes, rehabilitation facilities, etc. Exclusion criteria of Healthy subjects Higuchi et al IJTLD (2012) T- .TB CDC 10 8 10 5 6 7 10 4 10 10 5 20 T- .TB -1 1 [ A ].. [ B ].. 2 1 6 5 10 20 T PHA 20 A B T.

7 TB -2 1. 5 7 8 5 10 8 10 6 7 10 5 10 4 10 10 5 20 T- .TB -3 QFT-3G T- .TB n % n % Specificity 110/111 110/111 QFT-3G IU/ml IU/ml T- 6 spots 5 spots QFT-3G T- .TB -1 QFT-3G T- .TB n % n % Specificity 96/111 110/111 QFT-3G T- .TB -2 QFT-IT IU/ml IU/ml IU/ml T.

8 TB 8 spots 5-7 spots 4 spot p = 120 116 HIV 95 Richeldi et al Chest 2009 T- .TB QFT-3G 13/369 ( ) 27/369 ( ) T- .TB QFT-3G ; QFT-3G T- .TB QFT-3G T- .TB QFT-3G 4 Bergamini et al Pediatrics 2009 T- .TB QFT-3G Other papers of interest: Ferrara et al Lancet 2006, Kobashi et al Scand J Inf Dis 2008, Kobashi et al Int Med 2009, Chung et al J Infect 2010 IGRA 496 (0-19 , 11 ) 1 2 IGRA HIV-1 , QFT-3G T- .TB CD4 128 HIV T.

9 TB QFT-IT IGRA Leidl et al., ERJ (2009) HIV HIV - 42/49 ( ) QFT-3G 13/19 ( ) 74/109 ( ) T- .TB 17/19 ( ) 59/109 ( ) HIV CD4 : QFT IFN- T- .TB CD4 T-Cell Xtend 60/62: 95%CI; 1 T-Cell Xtend T- .TB QFT IGRA T- .TB T- .TB T- .TB T- .TB 32 Research Institute of Immune Diagnosis (RIID) 238 190-0013 1-34-1 301 TEL: 042-595-8868 FAX: 042-595-8867 URL: E-mail: RIID