{"id":10045,"date":"2020-04-23T03:54:52","date_gmt":"2020-04-23T00:54:52","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/quantiferon-tbc-test\/"},"modified":"2025-07-01T07:57:06","modified_gmt":"2025-07-01T04:57:06","slug":"quantiferon-tbc-test","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/quantiferon-tbc-test\/","title":{"rendered":"\u0422\u0435\u0441\u0442 QuantiFERON TB Gold"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong>QuantiFERON-TB Gold Plus Test<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">\u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u044b\u0439 \u0442\u0435\u0441\u0442 \u2013 \u044d\u0442\u043e \u0438\u043d\u043d\u043e\u0432\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u0442\u0435\u0441\u0442 \u0434\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u043b\u0430\u0442\u0435\u043d\u0442\u043d\u043e\u0439 \u0442\u0443\u0431\u0435\u0440\u043a\u0443\u043b\u0435\u0437\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438. \u0412 \u043e\u0441\u043d\u043e\u0432\u0435 \u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u043e\u0433\u043e \u0442\u0435\u0441\u0442\u0430 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u043e\u0446\u0435\u043d\u043a\u0430 T-\u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0433\u043e \u0438\u043c\u043c\u0443\u043d\u043d\u043e\u0433\u043e \u043e\u0442\u0432\u0435\u0442\u0430 \u0443 \u0447\u0435\u043b\u043e\u0432\u0435\u043a\u0430. <em>Mycobaterium tuberculosis<\/em> (<em>M. tuberculosis<\/em>, <em>M. bovis<\/em> \u0438 <em>M. africanum<\/em>).<\/p>\n<p style=\"text-align: justify;\">Infec\u0163ia tuberculoas\u0103 cuprinde at\u00e2t forme active c\u00e2t \u015fi latente; tuberculoza latent\u0103 se produce atunci c\u00e2nd o persoan\u0103 devine expus\u0103 la <em>M. tuberculosis<\/em> iar organismul controleaz\u0103 infec\u0163ia dar nu reu\u015fe\u015fte s\u0103 o eradicheze. Se estimeaz\u0103 c\u0103 aproximativ 10% din persoanele cu tuberculoz\u0103 latent\u0103 vor progresa \u00een cursul vie\u0163ii c\u0103tre o form\u0103 activ\u0103. Printre cauzele asociate cu reactivarea infec\u0163iei latente se num\u0103r\u0103 infec\u0163ia HIV \u015fi tratamentele cu antagoni\u015fti de TNF\u03b1. Din acest motiv, diagnosticarea tuberculozei latente reprezint\u0103 o etap\u0103 important\u0103 \u00een prevenirea reactiv\u0103rii infec\u0163iei \u00een special la persoanele cu risc crescut. Tratamentul tuberculozei latente poate reduce semnificativ riscul de progresie c\u0103tre formele active<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\">QuantiFERON TB Gold Test, dezvoltat de firma Cellestis Limited (Australia), a fost aprobat de FDA \u00een mai 2005 ca test <em>in vitro<\/em> cu utilitate \u00een diagnosticul infec\u0163iei cu <em>Mycobacterium tuberculosis<\/em>, at\u00e2t pentru forma latent\u0103 c\u00e2t \u015fi pentru cea activ\u0103. \u00cen Comunitatatea European\u0103 testul a fost certificat pentru a fi folosit \u00een acelea\u015fi situa\u0163ii \u00een care este indicat testul la tuberculin\u0103. Testul m\u0103soar\u0103 intensitatea r\u0103spunsului imun celular fa\u021b\u0103 de antigenele ce simuleaz\u0103 proteinele ESAT-6 (early secretory antigenic target-6) \u0219i CFP-10 (culture filtrate protein) produse de mycobacterii. Astfel, persoanele infectate cu microorganismele incluse \u00een complexul <em>Mycobaterium tuberculosis <\/em>prezint\u0103 \u00een mod obi\u0219nuit \u00een s\u00e2nge limfocite T care recunosc aceste antigene. Procesul de recunoa\u0219tere include generarea \u0219i eliberarea de citokine, \u00een special \u03b3-interferon, ce poate fi detectat \u0219i cuantificat printr-o metod\u0103 imunoenzimatic\u0103.<\/p>\n<p style=\"text-align: justify;\">P\u00e2n\u0103 nu demult, IDR la tuberculin\u0103 a reprezentat singura metod\u0103 de diagnostic a infec\u0163iei TBC. De\u015fi larg folosit, testul la tuberculin\u0103 prezint\u0103 o serie de limit\u0103ri. \u00cen cazul QuantiFERON-ului, care este un test de laborator efectuat din s\u00e2nge, stimularea limfocitelor cu antigenele TBC are loc \u00een tubul de flebotomie \u015fi nu intradermic. Din acest motiv se exclude efectul de \u201cbooster\u201d care poate s\u0103 apar\u0103 \u00een cazul testului la tuberculin\u0103 (efectuarea unui test cutanat la o persoan\u0103 care nu a fost expus\u0103 la infec\u0163ia TBC stimuleaz\u0103 sistemul imun \u015fi-l determin\u0103 s\u0103 reac\u0163ioneze la tuberculin\u0103 \u00eentr-o etap\u0103 ulterioar\u0103, c\u00e2nd se repet\u0103 testul cutanat).<\/p>\n<p style=\"text-align: justify;\">Spre deosebire de IDR la tuberculin\u0103, rezultatele testului nu sunt influen\u0163ate de vaccinarea BCG; infec\u0163iile \u00een antecedente cu mycobacterii netuberculoase exercit\u0103 de asemenea o influen\u0163\u0103 mai redus\u0103. Sunt eliminate \u015fi reac\u0163iile adverse de hipersensibilitate care pot s\u0103 apar\u0103 \u00een cazul testului cutanat. De asemenea rezultatele la QuantiFERON TBC test sunt mult mai obiective, f\u0103r\u0103 s\u0103 intervin\u0103 erori \u00een citire \u015fi interpretare<sup>1;2;3;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Indica\u0163iile testului<\/em><\/strong>:<\/p>\n<ol style=\"text-align: justify;\">\n<li>Poate fi folosit \u00een toate situa\u0163iile \u00een care este utilizat \u00een mod obi\u015fnuit testul la tuberculin\u0103:<\/li>\n<\/ol>\n<ul style=\"text-align: justify;\">\n<li>suspiciune clinic\u0103 \u015fi radiologic\u0103 de tuberculoz\u0103 activ\u0103;<\/li>\n<li>contac\u0163ii pacien\u0163ilor cu forme contagioase de TBC;<\/li>\n<li>screening-ul persoanelor cu risc crescut: personalul din unit\u0103\u0163i sanitare \u015fi institu\u0163ii de \u00eengrijire, persoane provenite din medii cu igien\u0103 deficitar\u0103, etc<sup>1;2;3<\/sup>.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Un studiu din 2008 a indicat faptul c\u0103 testul poate fi aplicat \u015fi copiilor peste 2 ani \u00een scopul\u00a0diagnostic\u0103rii tuberculozei latente, cu acelea\u015fi caracteristici de performan\u0163\u0103 ca \u015fi la adul\u0163i<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <u>Men\u0163iune<\/u>: QuantiFERON TBC \u00eenlocuie\u015fte testul la tuberculin\u0103; nu trebuie folosite concomitent\u00a0ambele teste<sup>1;2;3<\/sup>.<\/p>\n<ol style=\"text-align: justify;\" start=\"2\">\n<li>Poate constitui un instrument pentru monitorizarea pacien\u0163ilor cu tuberculoz\u0103 activ\u0103. Exist\u0103\u00a0unele studii care indic\u0103 poten\u0163iala utilitate a testului \u00een evaluarea eficien\u0163ei tratamentului<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 tuberculostatic prin urm\u0103rirea cantit\u0103\u0163ii de interferon gamma eliberate care se modific\u0103 \u00een timp<sup>6<\/sup>.\u00a0Conform unui studiu, evaluarea prin QuantiFERON la 2 luni de la ini\u0163ierea terapiei poate avea\u00a0valoare predictiv\u0103 semnificativ\u0103 asupra probabilit\u0103\u0163ii ca la sf\u00e2r\u015fitul fazei intensive de tratament\u00a0culturile din sput\u0103 s\u0103 r\u0103m\u00e2n\u0103 pozitive<sup>6;7<\/sup>.<\/p>\n<ol style=\"text-align: justify;\" start=\"3\">\n<li>Poate fi folosit \u00eenaintea unei terapii imunosupresoare (de exemplu cu anticorpi anti-TNF\u03b1) sau\u00a0\u00eenaintea transplantului de organe pentru a exclude o infec\u0163ie latent\u0103 cu <em>M. tuberculosis<\/em><sup>2;3<\/sup>.<\/li>\n<\/ol>\n<p style=\"text-align: justify;\"><strong><em>Preg\u0103tire pacient<\/em><\/strong> \u2013 se va \u00eentrerupe terapia imunosupresoare cu cel pu\u0163in 14 zile \u00eenaintea recolt\u0103rii<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Specimen recoltat <\/em><\/strong>\u2013 s\u00e2nge venos<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recipient(e) de recoltare <\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Se recolteaz\u0103 o eprubet\u0103 cu <strong>heparinat de litiu<\/strong> minim 10 mL de s\u00e2nge sau 3 eprubete cu heparinat de litiu de 4 mL. S\u00e2ngele trebuie s\u0103 ajung\u0103 \u00een 12 ore (max.16 ore) la laborator \u0219i \u00een aceast\u0103 perioad\u0103 se p\u0103streaz\u0103 la temperatura camerei. Este contraindicat\u0103 refrigerarea sau congelarea probei. Dac\u0103 proba nu poate ajunge \u00een max. 16 ore \u00een laborator, s\u00e2ngele va fi transferat \u00een tuburi de transfer, conform urm\u0103toarei proceduri:<\/p>\n<ul style=\"text-align: justify;\">\n<li>se omogenizeaz\u0103 u\u0219or eprubeta cu s\u00e2nge heparinat care urmeaz\u0103 a fi trasferat\u0103;<\/li>\n<li>se transfer\u0103 c\u00e2te 1mL de sange \u00een fiecare din cele 4 tuburi de transfer etichetate corespunz\u0103tor:<\/li>\n<\/ul>\n<div style=\"text-align: justify;\">\u2013 tubul cu capac gri (control Nil) va avea eticheta barcod cu termina\u021bia 01;<\/div>\n<div style=\"text-align: justify;\">\u2013 tubul cu capac verde (TB1 Antigen) va avea eticheta barcod cu termina\u021bia 02;<\/div>\n<div style=\"text-align: justify;\">\u2013 tubul cu capac galben (TB2 Antigen) va avea eticheta barcod cu termina\u021bia 02;<\/div>\n<div style=\"text-align: justify;\">\u2013 tubul cu capac mov (control Mitogen) va avea eticheta barcod cu termina\u021bia 03;<\/div>\n<ul style=\"text-align: justify;\">\n<li>dup\u0103 ce s-a transferat c\u00e2te 1 mL de s\u00e2nge \u00een fiecare tub, acestea se vor agita energic de 10 ori astfel \u00eenc\u00e2t s\u00e2ngele s\u0103 intre \u00een contact cu aditivii din eprubet\u0103.<\/li>\n<li>se incubeaz\u0103 imediat la 37 \u00baC timp de 16-24 ore;<\/li>\n<li>se scot eprubetele din incubator, se las\u0103 s\u0103 ajung\u0103 la temperatura camerei \u0219i apoi se centrifugheaz\u0103 la 3500 rpm timp de 15 minute.<\/li>\n<li>probele ob\u021binute se pot p\u0103stra la 2-8 \u00baC timp de 28 zile daca nu se pot lucra imediat.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong><em>Volum prob\u0103 <\/em><\/strong>\u2013 minim 10 mL s\u00e2nge heparinat<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Cauze de respingere a probei<\/em><\/strong> \u2013 specimene care au dep\u0103\u015fit intervalul de stabilitate, probe refrigerate sau congelate, utilizarea altui anticoagulant \u00een afara heparinatului de litiu<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Metod\u0103<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">S\u00e2ngele heparinat al pacientului se incubeaz\u0103 timp de 16-24 ore \u00eempreun\u0103 cu un amestec de peptide sintetice ce simuleaz\u0103 cele 2 proteine specifice pentru <em>M. tuberculosis<\/em>\u00a0: ESAT- 6 \u0219i CFP- 10. Aceste proteine sunt produse de toate tulpinile patogene de <em>M. tuberculosis<\/em> \u0219i de tulpinile patogene de <em>M. bovis<\/em> \u0219i sunt absente absente \u00een tulpinile incluse \u00een vaccinul BCG c\u00e2t \u0219i \u00een majoritatea mycobacteriilor netuberculoase, cu excep\u021bia <em>M. kansasii<\/em>, <em>M. szulgai<\/em> \u0438 <em>M. marinum<\/em>. Astfel, QuantiFERON este mai specific dec\u00e2t testul la tuberculin\u0103 \u00een detectarea infec\u0163iei cu <em>M. tuberculosis.<\/em> Dac\u0103 \u00een proba de s\u00e2nge sunt limfocite T cu memorie pentru aceste proteine (ceea ce se \u00eentampl\u0103 \u015fi \u00een cazul unei infec\u0163ii cu mul\u0163i ani \u00een urm\u0103), aceste celule vor produce \u03b3-interferon \u00een contact cu antigenul specific.<\/p>\n<p style=\"text-align: justify;\">Determinarea cantitativ\u0103 a \u03b3-interferonului eliberat \u00een plasm\u0103 se face printr-o metod\u0103 imunoenzimatic\u0103 \u00eenalt sensibil\u0103 (ELISA) iar rezultatele se exprim\u0103 \u00een UI\/mL. Se utilizeaz\u0103 obligatoriu controale pozitive \u015fi negative pentru a asigura validitatea testului. Controlul pozitiv este reprezentat de fitohemaglutinin\u0103 (substan\u0163a mitogen\u0103 universal\u0103) iar controlul negativ (Nil) de ser fiziologic (folosit ca un blank pentru a m\u0103sura nivelul bazal de \u03b3-interferon). Astfel, pentru ca testul s\u0103 fie valid valoarea ob\u021binut\u0103 pentru controlul Nil trebuie s\u0103 fie \u2264 8 UI\/mL, iar valoarea ob\u021binut\u0103 pentru controlul mitogen din care se scade valoarea antigenului Nil (Mitogen \u2013 Nil) trebuie s\u0103 fie \u2265 0.5 UI\/mL. Cantitatea final\u0103 de \u03b3-interferon eliberat\u0103 ce va fi utilizat\u0103 pentru interpretarea rezultatelor va fi calculat\u0103 prin sc\u0103derea valorii corespunz\u0103toare controlului negativ (Nil) din valoarea total\u0103 ob\u021binut\u0103 pentru amestecul de antigene TBC (Antigen TB \u2013 Nil)<sup>2;3;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">\u00cen varianta actual\u0103 \u00eembun\u0103t\u0103\u021bit\u0103 a testului \u2013 <strong>QuantiFERON TB Gold Plus<\/strong> \u2013 se folosesc pentru antigenul TBC dou\u0103 tuburi distincte, fiecare con\u021bin\u00e2nd peptide antigenice ce mimeaz\u0103 proteinele ESAT-6 \u0219i CFP-10. Primul tub (antigen TB1) con\u021bine peptide ce sunt destinate s\u0103 induc\u0103 un r\u0103spuns imun de c\u0103tre limfocitele T helper CD4+, \u00een timp ce al doilea tub (antigen TB2) con\u021bine un set suplimentar de peptide ce \u021bintesc producerea unui r\u0103spuns imun de c\u0103tre limfocitele T citotoxice CD8+. \u00cen istoria natural\u0103 a infec\u021biei TBC celulele T CD4+ de\u021bin un rol esen\u021bial \u00een controlul imunologic prin producerea de \u03b3-interferon. Cu toate acestea, datele actuale sus\u021bin implicarea \u00een r\u0103spunsul imun al gazdei fa\u021b\u0103 de infec\u021bia TBC \u0219i a limfociteler T CD8+, prin producerea de \u03b3-interferon dar \u0219i de al\u021bi factori solubili ce activeaz\u0103 macrofagele pentru a suprima cre\u0219terea mycobacteriilor, distruge celulele infectate sau a determina liza intracelular\u0103 direct\u0103 a microorganismelor. De\u0219i limfocite T CD8+ specifice fa\u021b\u0103 de antigenele <em>M. tuberculosis<\/em> au fost detectate at\u00e2t la persoane cu TBC latent c\u00e2t \u0219i cu TBC activ, cele \u00eendreptate fa\u021b\u0103 de ESAT-6 \u0219i CFP-10 sunt prezente mai frecvent \u00een cazurile de TBC activ \u0219i ar putea fi asociate cu o expunere recent\u0103 la agentul patogen. \u00cen plus, limfocite T CD8+ produc\u0103toare de \u03b3-interferon au fost raportate \u0219i la persoane av\u00e2nd TBC activ \u0219i coinfec\u021bie HIV, precum \u0219i la copiii cu infec\u021bie TBC.<\/p>\n<p style=\"text-align: justify;\">Pe buletinul final de analize vor ap\u0103rea cantit\u0103\u021bile de \u03b3-interferon corespunz\u0103toare cele dou\u0103 amestecuri antigenice (AgTB1 \u0219i AgTB2)<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong><u>Rezultatul este considerat negativ dac\u0103 sunt \u00eendeplinite urm\u0103toarele condi\u021bii:<\/u><\/strong><\/p>\n<ol style=\"text-align: justify;\">\n<li>Cantit\u0103\u021bile de \u03b3-interferon eliberate dup\u0103 stimularea cu cele dou\u0103 amestecuri antigenice (AgTB1-Nil \u0219i AgTB2-Nil) &lt; 0.35 UI\/mL sau \u2265 0.35 UI\/mL dar &lt; 25% din valoarea ob\u021binut\u0103 pentru controlul Nil;<\/li>\n<li>Nil \u2264 8 UI\/mL;<\/li>\n<li>Mitogen \u2013 Nil \u2265 0.5 UI\/mL.<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">\u00cen condi\u0163iile date se poate exclude o infec\u0163ie cu <em>Mycobacterium tuberculosis<\/em>. Totu\u015fi, la pacien\u0163ii cu infec\u0163ie cronic\u0103 HIV sau alte cauze care dau o imunodeficien\u0163\u0103 severa (tratament imunosupresor, anumite afec\u0163iuni hematologice: leucemii, limfoame, anumite tumori solide: pulmonare sau din regiunea cap-g\u00e2t, diabet, silicoz\u0103, insuficien\u0163\u0103 renal\u0103 cronic\u0103) trebuie luat \u00een considerare statusul imun actual \u015fi utilizate \u015fi alte metode de diagnostic al infec\u0163iei<sup>1;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Un studiu efectuat \u00een Japonia indic\u0103 faptul c\u0103 QuantiFERON TB test este mai util \u00een diagnosticarea infec\u0163iei tuberculoase la pacien\u0163i imunodeprima\u0163i dec\u00e2t testul la tuberculin\u0103. Totu\u015fi, av\u00e2nd \u00een vedere faptul c\u0103 s-a ob\u0163inut o rat\u0103 crescut\u0103 de rezultate neconcludente la pacien\u0163ii cu limfopenie care primesc tratament imunosupresor rezultatele trebuie interpretate cu pruden\u0163\u0103 la aceast\u0103 categorie de pacien\u0163i<sup>8<\/sup>.<\/p>\n<p style=\"text-align: justify;\">\u00cen cazul unui rezultat negativ la persoanele care au venit recent \u00een contact cu pacien\u0163i diagnostica\u0163i cu forme de TBC contagios acesta va fi confirmat printr-un nou test efectuat la 6-8 s\u0103pt\u0103m\u00e2ni de la sf\u00e2r\u015fitul perioadei de expunere (ca \u015fi \u00een cazul testului la tuberculin\u0103)<sup>1;3;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Rezultatul este considerat pozitiv dac\u0103 sunt \u00eendeplinite urm\u0103toarele condi\u021bii:<\/u><\/strong><\/p>\n<ol style=\"text-align: justify;\">\n<li>Oricare din cantit\u0103\u021bile de \u03b3-interferon eliberate dup\u0103 stimularea cu cele dou\u0103 amestecuri antigenice (AgTB1-Nil \u0219i\/sau AgTB2-Nil) \u2265 0.35 UI\/mL \u0219i \u2265 25% din valoarea ob\u021binut\u0103 pentru controlul Nil;<\/li>\n<li>Nil \u2264 8 UI\/mL.<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">Un rezultat pozitiv indic\u0103 o infec\u0163ie cu <em>M. tuberculosis<\/em>. \u00cen majoritatea cazurilor, diferen\u0163ierea dintre o infec\u0163ie latent\u0103 \u015fi una activ\u0103 nu este posibil\u0103 cu acest test.<\/p>\n<p style=\"text-align: justify;\">\u00cen cazul suspiciunii clinice de tuberculoz\u0103 activ\u0103 r\u0103m\u00e2n valabile toate metodele de diagnostic microbiologic (microscopie, cultur\u0103) \u015fi de biologie molecular\u0103<sup>1;2\u00a0;3\u00a0;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Rezultat <\/u><\/strong><strong><u>este considerat<\/u><\/strong><strong><u> neconcludent \u00een urm\u0103toarele condi\u021bii:<\/u><\/strong><\/p>\n<ol style=\"text-align: justify;\">\n<li>Mitogen \u2013 Nil &lt; 0.5 UI\/mL iar AgTB1-Nil \u0219i AgTB2-Nil &lt; 0.35 UI\/mL sau \u2265 0.35 UI\/mL dar &lt; 25% din valoarea ob\u021binut\u0103 pentru controlul Nil<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">ori<\/p>\n<ol style=\"text-align: justify;\" start=\"2\">\n<li>Nil &gt; 8 UI\/mL<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">Dac\u0103 recoltarea \u015fi transportul probei s-au efectuat \u00een condi\u0163ii adecvate, lipsa de validare a controlului mitogen indic\u0103 cel mai probabil o imunosupresie sever\u0103 cauzat\u0103 de SIDA \u015fi tratamentul curent cu medicamente imunosupresoare (corticosteroizi \u00een doze mari, antagoni\u015fti ai TNF\u03b1, medicamente folosite la pacien\u0163ii cu transplant de organe)<sup>1;3<\/sup>. Lipsa de validare a controlului negativ (Nil) se produce \u00een prezen\u0163a unei produc\u0163ii bazale crescute de \u03b3-interferon nespecific\u0103 (cel mai adesea) sau asociat\u0103 cu imuniz\u0103ri<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Caracteristicile de performan<\/em><\/strong><strong><em>\u021b\u0103 al testului TBC Gold Plus<\/em><\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li>Specificitate global\u0103: 97.6% (95.6-98.8%)<\/li>\n<li>Sensibilitatea global\u0103 pentru TBC activ: 95.3% (90.9-97.9%).<\/li>\n<\/ul>\n<div style=\"text-align: justify;\"><strong><em>Limite \u0219i interferen\u021be<\/em><\/strong><\/div>\n<div style=\"text-align: justify;\">Valoarea predictiv\u0103 a testului depinde de prevalen\u0163a infec\u0163iei cu <em>M. tuberculosis<\/em> \u00een popula\u0163ia testat\u0103. Fiecare rezultat trebuie interpretat \u00een contextul clinic \u015fi epidemiologic al pacientului<sup>1;2;3;4<\/sup>.<\/div>\n<div style=\"text-align: justify;\">Rareori este posibil s\u0103 se ob\u021bin\u0103 un rezultat fals-pozitiv la pacien\u021bii ce prezint\u0103 infec\u021bii cu mycobacteriile netuberculoase <em>M. kansasii<\/em>, <em>M. szulgai<\/em> \u0438 <em>M. marinum<\/em><sup>3<\/sup>.<\/div>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\"><strong>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/span><\/p>\n<ol>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">Laboratory Corporation of America.Directory of Services and Interpretive Guide. QuantiFERON\u00ae-TB Gold <a href=\"http:\/\/www.labcorp.com\/\" rel=\"nofollow noopener\" target=\"_blank\">www.labcorp.com<\/a> 2017. Ref Type: Internet Communication<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">Gerald H. Mazurek, MD, John Jereb, MD, Andrew Vernon, MD, Phillip LoBue, MD, Stefan Goldberg, MD, Kenneth Castro, MD. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection \u2014 United States, 2010. <em>Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, CDC. <\/em><em>MMWR <\/em>2010; 59(RR05);1-25.<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2017. Ref Type: Catalog.<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">Mayo Clinic, Mayo Medical Laboratories. QuantiFERON-TB Gold In-Tube for Detection of Latent Tuberculosis, Blood. <a href=\"http:\/\/www.mayomedicallaboratories.com\/\" rel=\"nofollow noopener\" target=\"_blank\">http:\/\/www.mayomedicallaboratories.com<\/a> 2017. Ref Type: Internet Communication.<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\"><strong>Jennifer Lighter, MD, Mona Rigaud, MD, MPH, Roger Eduardo, BS, Chia-Hui Peng, MPH \u00a0 \u00a0 \u00a0 and Henry Pollack, MD. <\/strong>Latent Tuberculosis Diagnosis in Children by Using the QuantiFERON-TB Gold In-Tube Test. In <em>Pediatrics <\/em>Vol. 123 No. 1 January 2009, pp. 30-37.<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\"><strong>R. Markova, R. Drenska, Y. Todorova, V. Terzieva and D. Stefanova. <\/strong>Monitoring the efficacy of anti-TB therapy by using the QuantiFERON-TB Gold In tube test. In <em>European Respiratory Review<\/em>, 2008;17: 74-75.<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">Katiyar, S.K.;\u00a0Sampath, A.;\u00a0Bihari, S.;\u00a0Mamtani, M.;\u00a0Kulkarni, H. Use of the QuantiFERON-TB Gold In-Tube\u00ae test to monitor treatment efficacy in active pulmonary tuberculosis. In <em>The International Journal of Tuberculosis and<\/em> <em>Lung Disease<\/em>, Volume 12,\u00a0Number 10, October 2008 , pp. 1146-1152(7).<\/span><\/li>\n<li style=\"text-align: justify;\"><span style=\"font-size: 10pt;\"><strong>Y. Kobashi, K. Mouri, Y. Obase, M. Fukuda, N. Miyashita and M. Oka<\/strong><strong>. <\/strong>Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Division of Respiratory Diseases, Dept of Medicine, Kawasaki Medical School, Kurashiki, Japan, 2008.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; padding-left: 30px;\">","protected":false},"excerpt":{"rendered":"<p>\u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u044b\u0439 \u0442\u0435\u0441\u0442 \u2013 \u044d\u0442\u043e \u0438\u043d\u043d\u043e\u0432\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u0442\u0435\u0441\u0442 \u0434\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u043b\u0430\u0442\u0435\u043d\u0442\u043d\u043e\u0439 \u0442\u0443\u0431\u0435\u0440\u043a\u0443\u043b\u0435\u0437\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438. \u0412 \u043e\u0441\u043d\u043e\u0432\u0435 \u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u043e\u0433\u043e \u0442\u0435\u0441\u0442\u0430 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u043e\u0446\u0435\u043d\u043a\u0430 T-\u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0433\u043e \u0438\u043c\u043c\u0443\u043d\u043d\u043e\u0433\u043e \u043e\u0442\u0432\u0435\u0442\u0430 \u0443 \u0447\u0435\u043b\u043e\u0432\u0435\u043a\u0430.<\/p>\n<p>\u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u044b\u0439 \u0442\u0435\u0441\u0442 \u043e\u0431\u043b\u0430\u0434\u0430\u0435\u0442 \u0440\u044f\u0434\u043e\u043c \u0441\u0443\u0449\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u0438\u043c\u0443\u0449\u0435\u0441\u0442\u0432 \u043f\u0435\u0440\u0435\u0434 \u043a\u043e\u0436\u043d\u044b\u043c\u0438 \u043f\u0440\u043e\u0431\u0430\u043c\u0438. \u0412 \u043c\u043d\u043e\u0433\u043e\u0447\u0438\u0441\u043b\u0435\u043d\u043d\u044b\u0445 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f\u0445 \u0431\u044b\u043b\u0430 \u0434\u043e\u043a\u0430\u0437\u0430\u043d\u0430 \u0435\u0433\u043e \u0432\u044b\u0441\u043e\u043a\u0430\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c, \u0447\u0442\u043e \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u0435\u0442 \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u044c \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0443 \u0442\u0443\u0431\u0435\u0440\u043a\u0443\u043b\u0435\u0437\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u043d\u0430 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u043e \u043d\u043e\u0432\u043e\u043c \u0443\u0440\u043e\u0432\u043d\u0435. \u0414\u043b\u044f \u043f\u0440\u043e\u0432\u0435\u0434\u0435\u043d\u0438\u044f \u0442\u0435\u0441\u0442\u0430 \u043d\u0435 \u0442\u0440\u0435\u0431\u0443\u0435\u0442\u0441\u044f \u0432\u0432\u0435\u0434\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0432\u043e\u0446\u0438\u0440\u0443\u044e\u0449\u0438\u0445 \u0432\u0435\u0449\u0435\u0441\u0442\u0432, \u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e \u043e\u0434\u043d\u043e\u0433\u043e \u0432\u0437\u044f\u0442\u0438\u044f \u0432\u0435\u043d\u043e\u0437\u043d\u043e\u0439 \u043a\u0440\u043e\u0432\u0438.<\/p>\n<p>QuantiFERON \u00ae-TB Gold \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0442\u0435\u0441\u0442\u043e\u043c, \u043e\u0441\u043d\u043e\u0432\u0430\u043d\u043d\u044b\u043c \u043d\u0430 \u043c\u0435\u0442\u043e\u0434\u0435 IGRA (interferongamma release assay). \u041c\u0435\u0442\u043e\u0434 IGRA \u043e\u0441\u043d\u043e\u0432\u0430\u043d \u043d\u0430 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0438 \u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0433\u043e \u043e\u0442\u0432\u0435\u0442\u0430 T-\u043b\u0438\u043c\u0444\u043e\u0446\u0438\u0442\u043e\u0432 \u043d\u0430 \u0430\u043d\u0442\u0438\u0433\u0435\u043d\u044b \u0432\u043e\u0437\u0431\u0443\u0434\u0438\u0442\u0435\u043b\u044f. \u041f\u0440\u0438 \u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u043c \u043e\u0442\u0432\u0435\u0442\u0435 \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0434\u0438\u0442 \u0432\u044b\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u0438\u043d\u0442\u0435\u0440\u0444\u0435\u0440\u043e\u043d\u0430-\u0433\u0430\u043c\u043c\u0430, \u0443\u0440\u043e\u0432\u0435\u043d\u044c \u043a\u043e\u0442\u043e\u0440\u043e\u0433\u043e \u0441\u0432\u0438\u0434\u0435\u0442\u0435\u043b\u044c\u0441\u0442\u0432\u0443\u0435\u0442 \u043e \u043d\u0430\u043b\u0438\u0447\u0438\u0438 \u0438\u043b\u0438 \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0438 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0432 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0435. \u0414\u043b\u044f \u0441\u0442\u0438\u043c\u0443\u043b\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f \u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0433\u043e \u043e\u0442\u0432\u0435\u0442\u0430 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0441\u043c\u0435\u0441\u044c \u0440\u0435\u043a\u043e\u043c\u0431\u0438\u043d\u0430\u043d\u0442\u043d\u044b\u0445 \u0431\u0435\u043b\u043a\u043e\u0432 ESAT-6, CFP-10 \u0438 TB7.7, \u043d\u0435 \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u0449\u0438\u0445\u0441\u044f \u0432 \u0411\u0426\u0416. \u041f\u043e\u044d\u0442\u043e\u043c\u0443 \u0442\u0435\u0441\u0442 QuantiFERON-TB Gold \u043d\u0435 \u0432\u044b\u0437\u044b\u0432\u0430\u0435\u0442 \u0438\u043c\u043c\u0443\u043d\u043d\u044b\u0445 \u0440\u0435\u0430\u043a\u0446\u0438\u0439, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u044b\u0445 \u0441 \u0432\u0430\u043a\u0446\u0438\u043d\u0430\u0446\u0438\u0435\u0439 \u0411\u0426\u0416.<\/p>\n<p>\u041a\u0432\u0430\u043d\u0442\u0438\u0444\u0435\u0440\u043e\u043d\u043e\u0432\u044b\u0439 \u0442\u0435\u0441\u0442 \u043c\u043e\u0436\u0435\u0442 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