Two techniques of measurement of the delayed hypersensitivity skin test response for the assessment of bacterial host resistance
作者:
NicolasV.ChristouM.D., Ph.D., F.R.C.S. (C), F.A.C.S.,
GinetteBoisvertM.D.,
MaryBroadheadR.N.,
JonathanL.MeakinsM.D., D.Sc, F.R.C.S (C), F.A.C.S.,
期刊:
World Journal of Surgery
(Springer Available online 2005)
卷期:
Volume 9,
issue 5
页码: 798-804
ISSN:0364-2313
年代: 2005
DOI:10.1007/BF01655198
出版商: Springer-Verlag-New_York
数据来源: Springer
摘要:
We evaluated 2 methods for measuring the delayed hypersensitivity skin test response and related the data to clinical outcome in 586 subjects. Individual intradermal injections of 5 recall antigens and a saline control (Candida, mumps, PPD, trichophytin, and Varidase®) were used in one arm. A specially designed device that applied, simultaneously, 7 antigens and a glycerin control (tetanus, diphtheria, strep antigen, old TB,Candida, Trichophytin, andProteus mirabilis) was used at a separate site. Mean diameters of induration were recorded at 24 and 48 hours. Sepsis was defined as a bacteremia or an abscess identified at surgery or autopsy. Regression analysis of the sums of the mean diameters of induration of the first skin test response obtained by each of the 2 methods showed a positive correlation between the individual antigen technique and the multitest technique (n=1508, X=0.29Y+1.6, r2= 0.633,p<0.0001). Anergy to the individual antigen technique (n=155) was associated with a sepsis rate of 34% and a mortality of 38% compared with 7% sepsis and 3% death rates in reactive patients (n=281,p<0.0001). Similarly, anergy (n=281) to the 7 multitest antigens was associated with a 26% sepsis rate and 23% mortality compared to 5% sepsis and 5% mortality in the reactive subjects (n=242,p<0.0001). Despite the different antigens used in the 2 methods, both gave similar correlations between the delayed hypersensitivity skin test response (DTH) skin test score and sepsis—individual antigen technique: sepsis = 33.1 − 7.9*ln(DTH score) r2= −0.89,p<0.001; multitest technique: sepsis = 27.4 − 7.0*ln(DTH score) r2= −0.79,p<0.001. Patient acceptance of both tests was equal. Both techniques of assessing the DTH response demonstrated a close association with bacterial sepsis, and are useful tools for assessing host resistance in surgica
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