Kampmann B, Whittaker E, Williams A, Walters S, Gordon A, Martinez-Alier N, Williams B, Crook A M, Hutton A-M, Anderson S T
Academic Dept of Paediatrics, 2nd Floor Wright-Fleming Building, Imperial College London, London, UK.
Eur Respir J. 2009 Jun;33(6):1374-82. doi: 10.1183/09031936.00153408. Epub 2009 Feb 5.
Data are lacking on the performance of interferon-gamma release assays (IGRAs) in children. Although IGRAs are recommended for screening for latent tuberculosis infection (LTBI), many clinicians wish to employ them as a diagnostic test for active tuberculosis (TB). The objective of the present study was to compare the performance of the two commercially available IGRAs and the tuberculin skin test (TST) side-by-side in children with active TB and LTBI. In a prospective study, 209 children were investigated for active (n = 91) or latent TB (n = 118). TST, QuantiFERON-TB Gold In-tube (QFG-IT; Cellestis, Carnegie, Australia) and T-SPOT.TB (Oxford Immunotec, Abingdon, UK) assays were simultaneously used. For culture-confirmed active TB, the sensitivity of the TST was 83%, compared with 80% for QFG-IT and 58% for T-SPOT.TB. IGRAs did not perform significantly better than TST, although QFG-IT was significantly better than T-SPOT.TB. The agreement between QFG-IT and T-SPOT.TB in culture-confirmed TB was poor at 66.7%. In LTBI, the agreement between QFG-IT and T-SPOT.TB was very good (92%) with moderate agreement between TST and T-SPOT.TB (75%) and QFG-IT and TST (77%). A negative interferon-gamma release assay should not dissuade paediatricians from diagnosing and treating presumed active tuberculosis. If used for diagnosis of latent tuberculosis infection, interferon-gamma release assays could significantly reduce the numbers of children receiving chemoprophylaxis. Very good concordance between both tests was found.
关于儿童中干扰素-γ释放检测（IGRAs）性能的数据尚缺。尽管IGRAs被推荐用于潜伏性结核感染（LTBI）的筛查，但许多临床医生希望将其用作活动性结核病（TB）的诊断检测。本研究的目的是在患有活动性TB和LTBI的儿童中，对两种市售IGRAs和结核菌素皮肤试验（TST）进行并列比较。在一项前瞻性研究中，对209名儿童进行了活动性（n = 91）或潜伏性TB（n = 118）调查。同时使用了TST、全血γ-干扰素释放试验（QFG-IT；Cellestis公司，澳大利亚卡内基）和T-SPOT.TB（牛津免疫技术公司，英国阿宾登）检测。对于培养确诊的活动性TB，TST的敏感性为83%，QFG-IT为80%，T-SPOT.TB为58%。IGRAs的表现并不显著优于TST，尽管QFG-IT显著优于T-SPOT.TB。在培养确诊的TB中，QFG-IT和T-SPOT.TB之间的一致性较差，为66.7%。在LTBI中，QFG-IT和T-SPOT.TB之间的一致性非常好（92%），TST和T-SPOT.TB之间的一致性中等（75%），QFG-IT和TST之间的一致性为77%。干扰素-γ释放检测结果为阴性不应阻止儿科医生对疑似活动性结核病进行诊断和治疗。如果用于潜伏性结核感染的诊断，干扰素-γ释放检测可显著减少接受化学预防的儿童数量。发现两种检测之间具有很好的一致性。
