伊朗 HIV 阳性个体中，与结核菌素皮肤试验相比，QuantiFERON-TB Gold 试验在检测潜伏性结核感染方面的性能。
Performance of QuantiFERON-TB Gold test compared to tuberculin skin test in detecting latent tuberculosis infection in HIV- positive individuals in Iran.
机构信息
Iranian Infectious Disease Research Center, Shaheed Beheshti Medical University, Tehran, Iran.
出版信息
Ann Thorac Med. 2010 Jan;5(1):43-6. doi: 10.4103/1817-1737.58959.
BACKGROUND
There is limited data about the performance of QuantiFERON-TB Gold (QFT-G) test in detecting latent tuberculosis infection (LTBI) in our region. We intended to determine the performance of QFT-G compared to conventional tuberculin skin test (TST) in detecting LTBI in HIV-positive individuals in Iran.
METHODS
This study was conducted in a HIV clinic in Tehran, Iran in April 2007. A total of 50 consecutive HIV-positive patients, not currently affected with active tuberculosis (TB), were recruited; 43 (86%) were male. The mean age was 38 ± 7.2 years (21-53). All had history of Bacillus Calmette Guerin (BCG) vaccination. A TST with purified protein derivative (PPD) and whole-blood interferon-gamma release assay (IGRA) in reaction to ESAT-6 and CFP-10 antigens was performed and measured by enzyme-linked immuno-sorbent assay (ELISA). The agreement between TST and QFT-G results were analyzed using Kappa test.
RESULTS
A total of 36 (72%) patients had negative and 14 (28%) revealed positive TST. For QFT-G, 20 (40%) tested positive, 19 (38%) tested negative, and the results in 11 cases (22%) were indeterminate. A total of 14 (28%) patients had a CD4 count of <200. Of the 14, TST + group, 12 had QFT-G +, only one case TST+/QFT-G-, and QFT-G was indeterminate in one TST positive case. Of the 36 patients with negative TST tests, 8 (22%) had positive GFT-G and 10 (28%) yielded indeterminate results. There was no association between a positive TST and receiving highly active anti-retroviral therapy (HAART) or absolute CD4 counts. Similarly, the association between QFT-G results and receiving HAART or CD4 counts was not significant (P = 0.06). Although TST results were not significantly different in patients with CD4 < 200 vs. CD4 >200 (P = 0.295), association between QFT-G results and CD4 cutoff of 200 reached statistical significance (P = 0.027). Agreement Kappa coefficient between TST and QFT-G was 0.54 (Kappa = 0.54, 95% CI = 38.4-69.6,P < 0.001).
CONCLUSION
Detecting LTBI in HIV-positive individuals showed moderate agreement between QFT-G and LTBI in our study. Interestingly, our findings revealed that nontuberculous mycobacteria and prior BCG vaccination have minimal influence on TST results in HIV patients in Iran.
背景
关于 QFT-G 检测我们地区潜伏性结核感染（LTBI）的性能，数据有限。我们旨在确定 QFT-G 与传统结核菌素皮肤试验（TST）在伊朗 HIV 阳性个体中检测 LTBI 的性能。
方法
这项研究于 2007 年 4 月在伊朗德黑兰的一家 HIV 诊所进行。共招募了 50 名连续的 HIV 阳性患者，目前未患有活动性肺结核（TB），其中 43 名（86%）为男性。平均年龄为 38 ± 7.2 岁（21-53 岁）。所有人均有卡介苗（BCG）接种史。使用纯化蛋白衍生物（PPD）进行 TST，并使用酶联免疫吸附试验（ELISA）测量 ESAT-6 和 CFP-10 抗原的全血干扰素 -γ释放试验（IGRA）。使用 Kappa 检验分析 TST 和 QFT-G 结果之间的一致性。
结果
共有 36 名（72%）患者的 TST 结果为阴性，14 名（28%）结果为阳性。对于 QFT-G，20 名（40%）测试结果为阳性，19 名（38%）为阴性，11 名（22%）结果为不确定。共有 14 名（28%）患者的 CD4 计数<200。在 14 名 TST+组中，12 名 QFT-G+，仅 1 名 TST+/QFT-G-，1 名 TST 阳性患者的 QFT-G 结果不确定。在 36 名 TST 阴性的患者中，8 名（22%）QFT-G 阳性，10 名（28%）结果不确定。TST 阳性与接受高效抗逆转录病毒治疗（HAART）或绝对 CD4 计数之间没有关联。同样，QFT-G 结果与接受 HAART 或 CD4 计数之间的关联也没有统计学意义（P=0.06）。尽管 TST 结果在 CD4<200 与 CD4>200 的患者之间没有显著差异（P=0.295），但 QFT-G 结果与 CD4 截止值 200 的关联达到统计学意义（P=0.027）。TST 和 QFT-G 之间的 Kappa 系数为 0.54（Kappa=0.54，95%CI=38.4-69.6，P<0.001）。
结论
在我们的研究中，QFT-G 与 LTBI 之间检测 HIV 阳性个体中的 LTBI 表现出中度一致性。有趣的是，我们的发现表明，非结核分枝杆菌和既往 BCG 接种对伊朗 HIV 患者的 TST 结果影响最小。
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