Agarwal S K, Gupta S, Bhowmik D, Mahajan S
Department of Nephrology, AIIMS, New Delhi - 110 029, India.
Indian J Nephrol. 2010 Jul;20(3):132-6. doi: 10.4103/0971-4065.70842.
Patients on renal replacement therapy (RRT) are at-risk for developing tuberculosis (TB). There is limited information on tuberculin skin test (TST) and its predictability for development of TB. In this prospective cohort study, patients taken for RRT were included. Patients with active TB were excluded. TST was done with 5-tuberculin unit. In addition to TST, age, sex, diabetes as basic disease, number of dialysis and blood transfusion (BT), pre-transplant TB, hepatitis B and C infections and type of immunosuppression were correlated with the development of TB. Of the 200 patients included, TST was positive in 21 and negative in 179. In TST negative group, 20 (11.1%) and in TST positive group 5 (23.8%) patients developed TB. TB free survival in two groups was similar (P = 0.08). On multivariate Cox regression analysis, hazard of development of TB by TST was 2.7 [P = 0.11, confidence interval (CI) 0.78-9.7]. There was no difference between TST non-responsive and TST negative patients (P = 0.18). Sensitivity and specificity of TST for predicting TB was only 20 and 9%, respectively. Our study shows that TST in patients on dialysis is an insensitive and nonspecific test to predict development of active TB.
接受肾脏替代治疗（RRT）的患者有患结核病（TB）的风险。关于结核菌素皮肤试验（TST）及其对结核病发生的预测性的信息有限。在这项前瞻性队列研究中，纳入了接受RRT的患者。排除了活动性结核病患者。采用5个结核菌素单位进行TST。除TST外，年龄、性别、作为基础疾病的糖尿病、透析次数和输血（BT）次数、移植前结核病、乙型和丙型肝炎感染以及免疫抑制类型与结核病的发生相关。在纳入的200例患者中，21例TST呈阳性，179例呈阴性。在TST阴性组中，20例（11.1%）患者发生了结核病，在TST阳性组中，5例（23.8%）患者发生了结核病。两组的无结核病生存率相似（P = 0.08）。多因素Cox回归分析显示，TST导致结核病发生的风险为2.7[P = 0.11，置信区间（CI）0.78 - 9.7]。TST无反应者和TST阴性患者之间无差异（P = 0.18）。TST预测结核病的敏感性和特异性分别仅为20%和9%。我们的研究表明，透析患者的TST是一种预测活动性结核病发生的不敏感且非特异性的检测方法。
