Latent tuberculosis infection (LTBI) testing and treatment in high risk populations is an important tool for tuberculosis control. In China, tuberculin skin test (TST) has been recommended as a primary testing method for Mycobacterium tuberculosis (MTB) infection in new students and close contacts in schools, which laid a solid foundation for the early case finding and management. However, Due to the influence of multiple factors including BCG vaccination and nontuberculous mycobacteria infection, TST showed limitations in specificity for MTB infection detection. Guidelines issued by other countries showed that using the two-step approach (TST-IGRA) has advantages in improving diagnostic accuracy as compared with using TST alone. From the perspective of precise intervention, two-step approach for MTB infection testing might be a favorable choice for tuberculosis control in schools in China.
高危人群结核分枝杆菌感染的检测和预防性干预在结核病防控工作中具有重要意义。我国《学校结核病防控工作规范（2017版）》要求在入校新生和密切接触者中开展结核病筛查工作，使用结核菌素皮肤试验（TST）进行结核分枝杆菌感染状态的检测，为学校结核病患者的主动发现奠定了坚实的基础。然而，因受卡介苗接种、环境非结核分枝杆菌感染等多种因素的影响，TST的检测结果在特异性上具有明显局限性。多个国家的经验提示，相比单独使用TST，使用γ-干扰素释放试验（IGRA）对TST阳性结果进行进一步确认的两步法（TST-IGRA）在感染检测的准确性上更具优势。考虑到我国的国情和卡介苗接种策略，从精准干预的角度出发，采用两步法在有需要的学生群体中进行结核分枝杆菌感染检测可能是我国学校结核病控制工作更为有利的选择。.
Keywords: Interferon-gamma release assay; Tuberculin skin test; Tuberculosis infection; Two-step approach.