Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
Clin Microbiol Infect. 2010 Jul;16(7):960-5. doi: 10.1111/j.1469-0691.2009.02949.x. Epub 2009 Nov 10.
Haemodialysis patients are at higher risk of developing active tuberculosis (TB) infection. However, tuberculin skin tests (TST) have limitations and the diagnostic usefulness of interferon-γ-release assays (IGRAs) remains unclear in immunocompromised hosts including haemodialysis patients. Haemodialysis patients were enrolled from a dialysis centre in Korea, an intermediate TB-burden country with a high bacille Calmette-Guérin (BCG) vaccination rate. The QuantiFERON-Gold TB In tube test (QFT) and the T-SPOT TB test (TSPOT) were performed, along with the TST. We stratified patients to low- and high-risk groups, according to the risk factors for latent TB. Association between each of the three diagnostic tests and the risk of latent TB was analysed. One hundred and sixty-seven patients were enrolled. The positive rates for the TST, the QFT and TSPOT were 23.5, 45.9 and 60.4%, respectively. Previous BCG vaccination increased the TST-positive rate in the low-risk group (OR 4.438), whereas it affected neither QFT nor TSPOT. The positive QFT rates were 41.2 and 62.5% in the low- and high-risk groups, respectively. The QFT was associated with the high-risk group (OR 2.578), whereas the TST was not. The positive TSPOT rates were 58.9 and 65.7% in the low- and high-risk groups, respectively. The frequency of indeterminate results was higher for the QFT (12.6%) compared with the TSPOT (4.8%). In conclusion, the IGRAs can be useful for the diagnosis of latent TB infection in haemodialysis patients.
血液透析患者发生活动性结核病（TB）感染的风险较高。然而，结核菌素皮肤试验（TST）存在局限性，干扰素-γ释放分析（IGRAs）在包括血液透析患者在内的免疫功能低下宿主中的诊断价值尚不清楚。本研究纳入了来自韩国一个透析中心的血液透析患者，韩国是一个结核病负担中等的国家，卡介苗（BCG）接种率较高。进行了 QuantiFERON-Gold TB In tube 检测（QFT）和 T-SPOT TB 检测（TSPOT），同时还进行了 TST。根据潜伏性 TB 的危险因素，我们将患者分层为低危和高危组。分析了三种诊断检测方法与潜伏性 TB 风险之间的关系。共纳入 167 例患者。TST、QFT 和 TSPOT 的阳性率分别为 23.5%、45.9%和 60.4%。既往 BCG 接种增加了低危组的 TST 阳性率（OR 4.438），但对 QFT 和 TSPOT 没有影响。低危和高危组的 QFT 阳性率分别为 41.2%和 62.5%。QFT 与高危组相关（OR 2.578），而 TST 则不然。低危和高危组的 TSPOT 阳性率分别为 58.9%和 65.7%。QFT 的不确定结果频率（12.6%）高于 TSPOT（4.8%）。总之，IGRAs 可用于诊断血液透析患者的潜伏性 TB 感染。
