Nienhaus A, Schablon A, Tripodi D, Torres Costa J
Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg.
Pneumologie. 2011 Dec;65(12):726-9. doi: 10.1055/s-0031-1291392. Epub 2011 Oct 17.
Health-care workers are regularly screened for tuberculosis. To date, there has been no systematic analysis of the results of such a screening. A TB network for company doctors was created when interferon-γ release assays (IGRAs) were introduced in order to systematically collate their experience with IGRAs in preventive check-ups.
Data have so far been recorded from 2,028 preventive check-ups. There are also data from preventive check-ups in France (n=148) and Portugal (n=2,889) for the purposes of a combined analysis. QuantiFERON-TB® Gold In-Tube and the tuberculin skin test with RT23 were used in the three cohorts.
The prevalence of latent tuberculosis infections (LTBI) is dependent on age and country. Among young health-care workers (<25 years old), 3% had a positive IGRA in Germany, compared with 18% in Portugal. Among health-care workers aged 55 and over, 25% were positive in Germany and 45% were positive in Portugal. In the French cohort an increase from 23% to 33% was observed when the youngest and oldest age categories were compared. Active tuberculosis has so far been diagnosed in 12 health-care workers in Portugal, four of whom developed culturally confirmed TB within the first two years following a positive IGRA. The risk of progression subsequent to a positive IGRA was 0.2% per annum.
There is a low prevalence of LTBI among young health-care workers. In them a positive IGRA following close contact with an infectious patient is likely to indicate recent infection. Apart from that, older infections appear to prevail, as the IGRA results depend greatly on age, and the risk of progression following a positive IGRA appears to be low in the study groups. A positive IGRA should therefore be interpreted with caution as an indication of the need for chemotherapy.
医护人员会定期接受结核病筛查。迄今为止，尚未对这种筛查结果进行系统分析。在引入γ-干扰素释放试验（IGRAs）时，为公司医生创建了一个结核病网络，以便系统整理他们在预防性体检中使用IGRAs的经验。
到目前为止，已记录了2028例预防性体检的数据。还收集了法国（n = 148）和葡萄牙（n = 2889）预防性体检的数据用于联合分析。三个队列均使用了QuantiFERON-TB® Gold In-Tube和RT23结核菌素皮肤试验。
潜伏性结核感染（LTBI）的患病率取决于年龄和国家。在年轻医护人员（<25岁）中，德国3%的人IGRA呈阳性，而葡萄牙为18%。在55岁及以上的医护人员中，德国25%呈阳性，葡萄牙45%呈阳性。在法国队列中，比较最年轻和最年长年龄组时，观察到患病率从23%增加到33%。迄今为止，葡萄牙有12名医护人员被诊断为活动性结核病，其中4人在IGRA呈阳性后的头两年内培养确诊为结核病。IGRA呈阳性后每年进展的风险为0.2%。
年轻医护人员中LTBI的患病率较低。在他们当中，与感染患者密切接触后IGRA呈阳性可能表明近期感染。除此之外，似乎既往感染占主导，因为IGRA结果在很大程度上取决于年龄，并且在研究组中IGRA呈阳性后进展的风险似乎较低。因此，对于IGRA呈阳性作为需要化疗的指征应谨慎解读。
