Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.
Liver Transpl. 2011 Oct;17(10):1205-11. doi: 10.1002/lt.22375.
The ability of interferon-gamma release assays (IGRAs) to detect latent tuberculosis (TB) infection before liver transplantation (LT)is not well established. The aims of this study were (1) to compare the ability of the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-IT) test (a whole-blood IGRA) to diagnose latent TB infections in patients awaiting LT and (2) to correlate the results with the severity of liver disease. We conducted a prospective, cross-sectional study of patients who were evaluated for LT between July 2008 and July 2010. The 95 patients who were included underwent the 2-step TST and the QFT-IT test. The mean Model for End-Stage Liver Disease (MELD) score was 13.8. Forty-four patients (46.3%) had positive TST results, 42 (44.2%) had positive QFT-IT results, and 2 (2.1%) had indeterminate QFT-IT results. Simultaneous TST and QFT-IT testing yielded a positivity rate of 55.8% [95% confidence interval (CI) = 45.3-65.9] with either test, and the 2-step TST yielded a positivity rate of 46.3% (95% CI = 36.1-56.8); the difference was 9.5% (P = 0.004). In an adjusted analysis, the rates for positive TST results were lower in patients with MELD scores > or = 18 [odds ratio (OR) = 0.2, 95% CI = 0.04-0.7], lower in Child-Pugh-Turcotte (CPT) class C patients versus CPT class A patients (OR = 0.1, 95% CI = 0.02-0.6), and higher in males (OR = 6.4, 95% CI = 1.9-22.0). In contrast, only being male (OR = 3.5, 95% CI = 1.1-11.0) was associated with positive QFT-IT results; no association was found with the MELD score (OR = 0.8, 95% CI = 0.2-2.8) or the CPT class (OR = 0.3; 0.05-1.4). In conclusion, the QFT-IT test is better than the TST for detecting latent TB infection in patients with more advanced liver disease. Our results support the regular use of the QFT-IT test for screening patients with end-stage liver disease for latent TB infection before LT.
干扰素-γ 释放试验（IGRAs）在肝移植（LT）前检测潜伏性结核病（TB）感染的能力尚未得到充分证实。本研究的目的是：（1）比较结核菌素皮肤试验（TST）和 QuantiFERON-TB Gold In-Tube（QFT-IT）试验（全血 IGRA）在 LT 患者中诊断潜伏性 TB 感染的能力；（2）将结果与肝病严重程度相关联。我们进行了一项前瞻性、横断面研究，评估了 2008 年 7 月至 2010 年 7 月期间接受 LT 评估的患者。95 例患者接受了 2 步 TST 和 QFT-IT 检测。平均终末期肝病模型（MELD）评分为 13.8。44 例患者（46.3%）TST 结果阳性，42 例（44.2%）QFT-IT 结果阳性，2 例（2.1%）QFT-IT 结果不确定。同时进行 TST 和 QFT-IT 检测，阳性率为 55.8%[95%置信区间（CI）=45.3-65.9]，2 步 TST 的阳性率为 46.3%（95%CI=36.1-56.8）；差异为 9.5%（P=0.004）。在调整分析中，MELD 评分≥18 的患者 TST 阳性率较低[比值比（OR）=0.2，95%CI=0.04-0.7]，Child-Pugh-Turcotte（CPT）C 级患者较 CPT A 级患者（OR=0.1，95%CI=0.02-0.6），男性阳性率较高（OR=6.4，95%CI=1.9-22.0）。相比之下，仅为男性（OR=3.5，95%CI=1.1-11.0）与 QFT-IT 阳性结果相关，与 MELD 评分（OR=0.8，95%CI=0.2-2.8）或 CPT 分级（OR=0.3；0.05-1.4）无关。总之，在患有更严重肝病的患者中，QFT-IT 试验比 TST 更能检测潜伏性 TB 感染。我们的结果支持常规使用 QFT-IT 试验筛查 LT 前终末期肝病患者的潜伏性 TB 感染。
