<原著>各種呼吸器疾患におけるツベルクリン反応陰性化現象とその機序に関する検討

Abstract

Three hundred fifty five cases (pulmonary tuberculosis (TB) 65 cases, sarcoidosis (SAR) 126, idiopathic pulmonary fibrosis (IPF) 28, interstitial pneumonia associated with collagen vascular diseases (CVD) 18, diffuse panbronchiolitis (DPB) 31, lung cancer (LC) 62, healthy controls (HC) 25) were performed tuberculin (0.05μg PPDs) skin test (TST) and immunological laboratory tests to study the mechanism of tuberculin anergy. Twenty TST negative patients (DPB 7 cases, bronchiectasis 5, LC3, CVD2, SAR, bronchial asthma, Sjogren's syndrome 1 case, respectively) were further performed BCG vaccination. The rate of TST negative cases were 89% in CVD, 50% (SAR), 48% (DPB), 25% (IPF), 24% (LC), 20% (HC), and 9% (TB), respectively. In the TST negative group the values of in vitro lymphocyte responses to PPD, PHA, ConA, were lower than that of the TST positive group. Tuberculin reactions after BCG vaccination were increased in all cases. Reactivity to TST (0.05μg PPDs) after were correlated to the reactivity to TST (0.5μg PPDs) be fore vaccination. The value of immunological parameters, tested before and after vaccination, did not show any changes. These results suggest that the tuberculin anergy means the decreased cell-mediated immunity resulted from totally decreased value of various immunological parameters and that the increased tuberculin reaction after BCG vaccination is due to the effect of vaccination which may differentiate and proliferate the memory T cells into the effector T cells.