Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Chin Med J (Engl). 2013;126(11):2039-44.
The health-care workers (HCWs) are at high risk of acquiring infection with Mycobacterium tuberculosis. The objectives of this study were to compare the performance of the T-SPOT.TB and tuberculin skin test (TST) for latent tuberculosis infection (LTBI), evaluate diagnostic concordance and risk factors for LTBI, and observe the progression to active tuberculosis (TB) disease among HCWs in a general hospital in Beijing.
The prospective cohort study enrolled HCWs in a tertiary general hospital in Beijing, China, to evaluate LTBI with T-SPOT.TB and TST. The subjects were evaluated every 12 months during the 60-month follow-up.
Of 101 participating HCWs, 96 and 101 had valid TST and T-SPOT.TB results, respectively. Twenty-nine (28.7%, 95% confidence interval (CI), 19.9% - 37.5%) were defined as positive by T-SPOT.TB and 53 (55.2%, 95%CI, 45.2% - 64.9%) were defined as positive by TST (using a ≥ 10 mm cutoff). An agreement between the two tests was poor (57.3%, κ = 0.18, 95%CI, 0.01% - 0.52%). In multivariate analysis, direct exposure to sputum smear-positive TB patients was a significant risk factor for a positive T-SPOT.TB (OR 5.76; 95%CI 1.38 - 24.00). Pooled frequency of antigen-specific IFN-γ secreting T-cells for subjects who reported direct contact with sputum smear-positive TB patients was significantly higher than that for participants without direct contact (P = 0.045). One of 20 participants with positive result of T-SPOT.TB and TST developed active TB at 24-month follow-up.
T-SPOT.TB is a more accurate, targeted method of diagnosing LTBI than TST.
医护人员（HCWs）感染结核分枝杆菌的风险较高。本研究的目的是比较 T-SPOT.TB 和结核菌素皮肤试验（TST）在潜伏性结核感染（LTBI）中的表现，评估 LTBI 的诊断一致性和危险因素，并观察北京一家综合医院 HCWs 中 LTBI 向活动性结核病（TB）的进展。
本前瞻性队列研究纳入了中国北京一家三级综合医院的 HCWs，使用 T-SPOT.TB 和 TST 评估 LTBI。在 60 个月的随访期间，每 12 个月对受试者进行一次评估。
在 101 名参与的 HCWs 中，96 名和 101 名分别有有效的 TST 和 T-SPOT.TB 结果。29 名（28.7%，95%置信区间[CI]，19.9% - 37.5%）被 T-SPOT.TB 定义为阳性，53 名（55.2%，95%CI，45.2% - 64.9%）被 TST 定义为阳性（使用≥10mm 的截定点）。两种检测方法之间的一致性较差（57.3%，κ=0.18，95%CI，0.01% - 0.52%）。多变量分析显示，直接接触痰涂片阳性的结核患者是 T-SPOT.TB 阳性的显著危险因素（OR 5.76；95%CI 1.38 - 24.00）。报告与痰涂片阳性的结核患者有直接接触的受试者中抗原特异性 IFN-γ分泌 T 细胞的频率明显高于无直接接触的受试者（P=0.045）。在 20 名 T-SPOT.TB 和 TST 阳性结果的受试者中，有 1 名在 24 个月随访时发生活动性 TB。
与 TST 相比，T-SPOT.TB 是一种更准确、有针对性的 LTBI 诊断方法。
