Pneumologie 2006; 60(1): 29-44
DOI: 10.1055/s-2005-919075
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Interferon-γ-Tests in der Tuberkulose-Diagnostik - Aktueller Stand

Interferon-γ Assays - Description and Assessment of a New Tool in the Diagnosis of TuberculosisB.  Hauer1 (federführend) , R.  Loddenkemper1 (federführend) unter Mitarbeit von (in alphabetischer Reihenfolge): A.  Detjen2 , M.  Forßbohm3 , W.  Haas4 , G.  Loytved5 , K.  Magdorf2 , H.  Mauch6 , A.  Nienhaus7 , H.  L.  Rieder8 , D.  Sagebiel1 , T.  Schaberg9
  • 1Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
  • 2Klinik für Pädiatrische Pneumologie, HELIOS Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin
  • 3Gesundheitsamt Wiesbaden
  • 4Robert Koch-Institut, Berlin
  • 5Gesundheitsamt Würzburg
  • 6Institut für Mikrobiologie, Immunologie und Laboratoriumsmedizin, HELIOS Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin
  • 7Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, Hamburg
  • 8Kirchlindach/Schweiz
  • 9Zentrum für Pneumologie, Diakoniekrankenhaus Rotenburg
Further Information

Publication History

Eingang: 27. September 2005

Akzeptiert: 12. Oktober 2005

Publication Date:
23 January 2006 (online)

Zusammenfassung

Zur Diagnostik der latenten tuberkulösen Infektion (LTBI) stand bislang lediglich der Tuberkulinhauttest (THT) zur Verfügung. Dieses Verfahren weist jedoch weder eine 100 %ige Sensitivität, noch - und dies insbesondere aufgrund seiner Kreuzreaktogenität mit BCG und Umweltmykobakterien - eine 100 %ige Spezifität auf. Der Wunsch nach einem zuverlässigen in vitro-Test wird derzeit besonders in Deutschland noch dadurch verstärkt, dass aufgrund der vollständigen Umstellung von Stempeltest auf Tuberkulintestung nach Mendel-Mantoux und durch die Produktionseinstellung des bisher in Deutschland verwendeten Tuberkulins große Verunsicherung herrscht. Hersteller immunologischer Testverfahren, wie des QuantiFERON®-TB Gold In-Tube (ELISA-Verfahren) und des T SPOT-TB-Tests (ELISPOT-Verfahren), welche auf der Interferon-γ (IFN-γ)-Produktion sensibilisierter T-Lymphozyten basieren, bieten ihre Produkte als mögliche Alternative an. Dieser Beitrag vermittelt einen Überblick über die Funktionsweise der IFN-γ-Tests, die aktuelle Datenlage sowie die noch unbeantworteten wissenschaftlichen Fragestellungen, mögliche Anwendungsbereiche und Anforderungen an zukünftige klinische Studien. Obgleich die neuen Testverfahren das Potenzial haben, sich langfristig als hilfreiches zusätzliches diagnostisches Mittel anzubieten, ist ein kompletter Ersatz des Tuberkulinhauttests nach Einschätzung der Autoren verfrüht. Als ergänzende diagnostische Verfahren könnten sich die IFN-γ-Tests jedoch bereits jetzt durchaus als nützlich erweisen.

Abstract

Up to now the diagnosis of latent tuberculosis infection (LTBI) was based solely on the tuberculin skin test. However, this method offers neither 100 % sensitivity nor - and this is in particular due to its cross-reactivity with BCG and environmental mycobacteria - a 100 % specificity. The demand in Germany for a more reliable in vitro test is currently enhanced by the change from the multipuncture test to the intradermal (Mendel-Mantoux) test and by the uncertainty resulting from the ceased production of the tuberculin previously used in Germany. The manufacturers of immunologic test methods such as the QuantiFERON®-TB Gold In-Tube (ELISA assay) and the T SPOT-TB Test (ELISPOT assay), which are based on the Interferon-γ (IFN-γ) production of sensitized T lymphocytes, offer their products as possible alternatives. This article explains the function of the IFN-γ tests and gives an overview of the most recent data, possible indications and the open scientific questions to be investigated by future clinical studies. Although the new test methods have the potential to eventually prevail as an additional helpful diagnostic tool, the authors consider a complete replacement of the tuberculin skin test as premature. The IFN-γ tests may, however, prove already now to be a useful additional diagnostic method.

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1 Beim Heaf-Test handelt es sich um eine überwiegend in Großbritannien verwendete Multipunkturmethode, mit der unter Verwendung eines speziellen Applikators Tuberkulin in die Haut eingebracht wird [23].

Prof. Dr. R. Loddenkemper

Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK), HELIOS Klinikum Emil von Behring · Lungenklinik Heckeshorn

Zum Heckeshorn 33

14109 Berlin ·

Email: loddheck@zedat.fu-berlin.de