| Hepatitis C virus (HCV) is a major public health issue, and approximately200million people are infected with HCV worldwide. Surveys have found that the patientswith chronic hepatitis C have a high incidence of latent tuberculosis infection (LTBI).Interferon is the immune enhancers with broad-spectrum anti-viral effect, which caninhibit viral replication and block the spread of hepatitis viruses. Interferon canstimulate the body's own anti-viral effect of interferon system, but also can improve thebody's natural anti-viral ability to change the body's immune response to hepatitis virusinfection, to reduce or block viral pathological immune hepatitis injury. Interferontreatment of hepatitis C was considered the only effective drug, but not all patients areapplicable to treat with interferon, when a patient sufferred from TB and LTBI, theinterferon could speed up TB's condition. It is necessary to determine whether thepatients with chronic hepatitis C suffered from latent tuberculosis infection at the timeof hepatitis detection or whether the LTBI was directly related to the treatment ofhepatitis C. Interferon is an effective treatment for hepatitis C. However, interferon mayconvert latent tuberculosis into active tuberculosis if hepatitis C patients also sufferfrom LTBI. Interferon therapies may accelerate the progression of tuberculosis.Therefore, it is very important to diagnose latent tuberculosis in hepatitis C patients.The tuberculin skin test (TST) is the predominant means of diagnosing LTBI;however, the specificity of this test is limited because the purified protein derivativeused as the antigen broadly cross-reacts with antigens derived from a number ofmycobacterial species, including the vaccine strain Bacillus Chalmette-Guerin (BCG)and other non-tuberculosis mycobacteria (NTM). The TST has poor specificity and themisdiagnosis rates are very high in diagnosing LTBI. Therefore, there is an urgent need for a more sensitive and specific immunological tool for the diagnosis of latenttuberculosis infections.An IFN-γ ELISPOT assay is based on detecting the interferon-γ (IFN-γ) released byactivated T lymphocytes (T cells) that are stimulated by a number of secretary proteinsencoded by the RD1locus of the Mycobacterium tuberculosis complex but are absentfrom the majority of environmental isolates, including BCG strains. The early secretaryantigenic target6(ESAT-6) and culture filtrate protein10(CFP-10) proteins wereinitially tested and shown to elicit a strong T cell response in subjects with active TB orLTBI. Therefore, in this study, we evaluated the clinical value of this ELISPOT assayfor the diagnosis of LTBI in hepatitis C patients.Innovation:We used ELISPOT assay to study the diagnostic sensitivity and specificity ofhepatitis C combined with tuberculosis latent infection; the ELISPOT assay was used todo the differential diagnosis between hepatitis C combined with LTBI and TB; theELISPOT assay was used to evaluate the curative effects of hepatitis C combined withLTBI and TB.Meaning:The ELISPOT assay could provide useful support in diagnosing LTBI in hepatitis Cpatients and may provide guidance regarding the treatment of LTBI and hepatitis Cco-infection.The main contents and results:Contents:1. The evaluation of the ELISPOT assay: the abroad T-SPOT-TB kit, TST, the domesticELISPOT-TB kit were used to do the diagnostic sensitivity and specificity of hepatitis Ccombined with TB; the multiple experimental conditions of the domestic ELISPOT-TBkit.2. Diagnostic value of an ELISPOT assay to detect latent tuberculosis infection inhepatitis C patients: The domestic ELISPOT-TB kit were used to diagnose LTBI inhepatitis C patients; TST and the domestic ELISPOT-TB kit were used to do thediagnostic sensitivity and specificity of LTBI in hepatitis C patients. 3. The clinical applications of ELISPOT assay in LTBI in hepatitis C patients: TheELISPOT assay was used to do the differential diagnosis between hepatitis C combinedwith LTBI and TB; the ELISPOT assay was used to evaluate the curative effects ofLTBI and TB in hepatitis C patients.4. The study on the changes of CK in hepatitis C combined with LTBI and TB: Realtime-PCR and ELISA were used to detect the changes of FOXP3,IL-2,IFN-γ inhepatitis C combined with LTBI and TB.Results:1. The ELISPOT assay could diagnose the LTBI in hepatitis C patients.2. The ELISPOT assay could do the differential diagnosis between hepatitis C combinedwith LTBI and TB.3. The ELISPOT assay could evaluate the curative effects of LTBI and TB in hepatitis Cpatients.4. The reason why LTBI can progress to TB could be related with the changes ofFOXP3,IL-2,IFN-γ in hepatitis C.
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