Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.
Semin Arthritis Rheum. 2013 Feb;42(4):424-32. doi: 10.1016/j.semarthrit.2012.07.001. Epub 2012 Aug 2.
To estimate the positivity and agreement between QuantiFERON-tuberculosis (TB) gold in tube test (QFT-GIT) and tuberculin skin test (TST) according to underlying rheumatic diseases and to identify the influencing factors on discrepancies between the 2 tests.
Among the 757 patients who underwent both QFT-GIT and TST simultaneously from September 2008 to November 2010, patients with indeterminate QFT-GIT results (n = 21), with active (n = 11) or suspicious (n = 1) findings for tuberculosis on a chest radiograph, were excluded. Finally, 724 patients were recruited for this study: 497 patients with rheumatoid arthritis (RA), 198 with ankylosing spondylitis (AS), and 29 with juvenile rheumatoid arthritis (JRA). The agreement between the 2 tests was estimated by Cohen's κ and factors influencing discrepancies were identified using multivariate analysis.
The positivity of QFT-GIT was higher in RA than AS or JRA (30.2%, 16.2%, and 3.4%, respectively). In contrast, TST positivity was highest in AS compared to RA and JRA (45.5%, 28.2%, and 17.2%, respectively). The agreement between the 2 tests was low in all patients (κ = 0.285). The only predictor of a discrepancy between the 2 tests was older age. Factors associated with discordant QFT-GIT-negative/TST-positive results were female [odds ratio (OR) = 2.33, confidence interval (CI) 1.11 to 4.89] and AS (OR = 3.12, CI 1.44 to 6.79), whereas a discordant QFT-GIT-positive/TST-negative result was associated with glucocorticoid use (OR = 2.44, CI 1.24 to 4.81).
The agreement between the 2 tests is low; therefore, it would be better to perform both tests than to use any 1 test alone for the detection of LTBI in TB-endemic regions. Female and underlying AS are related to being QFT-GIT-negative/TST-positive, and the use of glucocorticoid is associated with being QFT-GIT-positive/TST-negative.
根据潜在的风湿性疾病，估计结核分枝杆菌（TB）管内试验（QFT-GIT）和结核菌素皮肤试验（TST）的阳性率和一致性，并确定两种试验之间差异的影响因素。
2008 年 9 月至 2010 年 11 月，同时进行 QFT-GIT 和 TST 的 757 例患者中，排除了 QFT-GIT 结果不确定（n=21）、胸部 X 线检查有活动性（n=11）或可疑性（n=1）结核病发现的患者。最终，724 例患者纳入本研究：497 例类风湿关节炎（RA）患者、198 例强直性脊柱炎（AS）患者和 29 例幼年特发性关节炎（JRA）患者。通过 Cohen's κ 评估两种检测方法的一致性，并通过多变量分析确定影响差异的因素。
RA 患者的 QFT-GIT 阳性率高于 AS 或 JRA（分别为 30.2%、16.2%和 3.4%）。相比之下，AS 患者的 TST 阳性率最高，其次是 RA 和 JRA（分别为 45.5%、28.2%和 17.2%）。两种检测方法的一致性在所有患者中均较低（κ=0.285）。两种检测方法之间差异的唯一预测因素是年龄较大。与 QFT-GIT 阴性/TST 阳性结果不一致相关的因素是女性[比值比（OR）=2.33，95%置信区间（CI）为 1.11 至 4.89]和 AS（OR=3.12，CI 为 1.44 至 6.79），而 QFT-GIT 阳性/TST 阴性结果不一致与糖皮质激素的使用有关（OR=2.44，CI 为 1.24 至 4.81）。
两种检测方法的一致性较低；因此，在结核病流行地区，最好同时进行两种检测，而不是单独使用任何一种检测来检测 LTBI。女性和潜在的 AS 与 QFT-GIT 阴性/TST 阳性有关，而糖皮质激素的使用与 QFT-GIT 阳性/TST 阴性有关。
