Soborg Bolette, Ruhwald Morten, Hetland Merete Lund, Jacobsen Søren, Andersen Aase Bengaard, Milman Nils, Thomsen Vibeke Ostergaard, Jensen Dorte Vendelbo, Koch Anders, Wohlfahrt Jan, Ravn Pernille
Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, Copenhagen S, Denmark.
J Rheumatol. 2009 Sep;36(9):1876-84. doi: 10.3899/jrheum.081292. Epub 2009 Jul 31.
To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression.
The interferon-gamma response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests.
QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5-18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6-13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1-11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6-10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1-1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02-0.3, p = 0.002).
The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.
检测在炎症性疾病患者中，使用结核菌素γ干扰素释放试验（QFT）和结核菌素皮肤试验（TST）时，结核分枝杆菌筛查结果是否存在差异；并评估可能存在的差异是否受危险因素或免疫抑制的影响。
用QFT检测对结核分枝杆菌特异性抗原体外刺激的γ干扰素反应，并将结果与TST进行比较。对两种检测方法分析与卡介苗（BCG）接种、危险因素和免疫抑制的相关性。
分别有294/302和241/302例患者获得了QFT和TST结果；234例患者两种检测均有结果。21例（7%）QFT检测呈阳性，45例（19%）TST检测呈阳性。QFT阳性与结核分枝杆菌感染的危险因素相关：即在结核病流行地区出生或成长[风险比（RR）=7.8，95%可信区间（CI）1.5 - 18.2，p<0.001]、既往结核治疗史（RR 4.7，95%CI 1.6 - 13.5，p = 0.005）以及任何潜伏性结核感染危险因素（RR 4.7，95%CI 2.1 - 11.0，p = 0.0002）。使用皮质类固醇增加了QFT结果不确定的风险（RR 4.2，95%CI 1.6 - 10.7，p = 0.04），并降低了TST阳性结果的风险（RR 0.4，95%CI 0.1 - 1.0，p = 0.04）。两种检测方法之间的一致性较低（kappa 0.2, 95%CI 0.02 - 0.3, p = 0.002）。
该研究记录了QFT和TST阳性结果之间存在高度不一致性情况。与TST相比，QFT阳性与结核分枝杆菌感染的危险因素更密切相关。使用皮质类固醇通过增加QFT结果不确定的风险和降低TST阳性结果的风险来影响检测结果。
