Abstract：
The present study aimed to clinically evaluate the effect of T-cell dysfunction in hemodialysis (HD) patients with latent tuberculosis (TB) infection (LTBI) who were false-negatives in the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Whole blood samples from a total of 20 active TB patients, 83 HD patients, and 52 healthy individuals were collected, and the QFT-GIT test was used for measuring Mycobacterium tuberculosis (MTB)-specific interferon gamma (IFN-γ) level. The positive rate of the IFN-γ release assays (IGRAs) in HD patients was lower than the negative rate. The mean value of MTB-specific IFN-γ level, which determines the positive rate of the IGRA test, was highest in active TB, followed by HD patients and healthy individuals. Among HD patients, phytohemagglutinin A (PHA)-stimulated IFN-γ levels of approximately 40% were 10.00 IU/mL or less. However, there was no low level of PHA-stimulated IFN-γ in the healthy individuals. This reveals that T-cell function in HD patients was reduced compared to healthy individuals, which leads to the possibility that QFT-GIT results in HD patients are false-negative. The clinical manifestations of TB in patients on HD are quite non-specific, making timely diagnosis difficult and delaying the initiation of curative treatment, delay being a major determinant of outcome.
摘要：
本研究旨在临床评估T细胞功能障碍对患有潜伏性结核（TB）感染（LTBI）的血液透析（HD）患者的影响，这些患者在QuantiFERON-TB金管（QFT-GIT）测试中出现假阴性。来自总共20名活动性结核病患者的全血样本，83例HD患者,收集了52名健康个体，用QFT-GIT检测结核分枝杆菌(MTB)特异性干扰素γ(IFN-γ)水平。HD患者的IFN-γ释放试验（IGRAs）阳性率低于阴性率。MTB特异性IFN-γ水平的平均值，这决定了IGRA测试的阳性率，在活动性结核病中最高，其次是HD患者和健康个体。在HD患者中,植物血凝素A（PHA）刺激的IFN-γ水平约为40％，为10.00IU/mL或更低。然而,在健康个体中没有低水平的PHA刺激的IFN-γ。这表明，与健康个体相比，HD患者的T细胞功能降低，这导致HD患者的QFT-GIT结果可能是假阴性。HD患者的结核病临床表现相当非特异性，使及时诊断困难，延误了治愈性治疗的开始，延迟是结果的主要决定因素。
