Fournier A, Antoun F, Collignon A, Muller G, Rouvier J, Ayache B, Guesnon M-S, Larnaudie S
Centre de lutte antituberculeuse de Paris (CLAT 75), sous-direction de la santé, DASES, département de Paris, 15-17, rue Charles-Bertheau, 75013 Paris, France.
Rev Mal Respir. 2012 Jan;29(1):28-39. doi: 10.1016/j.rmr.2011.10.007. Epub 2011 Nov 30.
There are two reasons for screening contacts: one is to identify cases of secondary tuberculosis disease (TB) and the other is to identify new cases of latent tuberculosis infection (LTBI). The tuberculin skin test (TST) and the interferon-gamma-release assay (IGRA) have their limitations when used for the detection of LTBI. They neither allow a definite diagnosis of LTBI nor provide information as to the date of onset. The present study was observational, multi-centre (four centers) and retrospective. Six hundred and one contacts were included. The results of the QFT test showed 88 positive (15 %). Among the 144 index cases, all presented with pulmonary disease and 89 cases were sputum positive. In our series, 101 contacts belonged to the family circle. The four factors that had a significant positive impact on the result of the QFT test were: increasing age, the region of birth of the contact (high incidence areas), both of which may indicate old infection, while contact within the family and sputum positivity of the index case probably indicate recent infection. Only sputum positivity influenced the decision to treat the LTBI. We propose a tool aimed at facilitating the decision making process in QFT positive cases. Estimation of the duration of LTBI should help the physician to decide on the need for preventative treatment as well as a search for factors that increase the risk of progression to TB disease.
一是识别继发性结核病病例，二是识别潜伏性结核感染（LTBI）新病例。结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）在用于检测LTBI时存在局限性。它们既不能明确诊断LTBI，也不能提供发病日期的信息。本研究为观察性、多中心（四个中心）和回顾性研究。纳入了601名接触者。QFT试验结果显示88例阳性（15%）。在144例索引病例中，均表现为肺部疾病，89例痰菌阳性。在我们的系列研究中，101名接触者属于家庭圈子。对QFT试验结果有显著正向影响的四个因素是：年龄增长、接触者的出生地（高发病率地区），这两者可能表明既往感染，而家庭内部接触和索引病例的痰菌阳性可能表明近期感染。只有痰菌阳性影响LTBI治疗决策。我们提出一种工具，旨在促进QFT阳性病例的决策过程。估计LTBI的持续时间应有助于医生决定是否需要预防性治疗以及寻找增加进展为结核病风险的因素。
