Li Tao, Bao Lei, Diao Ni, Sun Feng, Gao Yan, Wong Ka-Wing, Xi Xiuhong, Liu Xuhui, Wang Sen, Wu Jing, Hui Ma, Fan Xiaoyong, Zhang Ying, Zhang Wenhong, Lu Shuihua
Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Clin Exp Med. 2015 Aug;15(3):303-9. doi: 10.1007/s10238-014-0296-3. Epub 2014 Jun 13.
Diagnosis of active tuberculosis (TB) in children remains difficult. This study aimed at evaluating the ability of interferon-gamma release assays (IGRAs) in the detection of active TB in human immunodeficiency virus-negative children vaccinated with Bacille Calmette-Guérin and investigating the effect of prednisolone treatment on the IGRAs performance. Among the 162 children with suspected TB disease recruited in China, 60 were tested with QuantiFERON-TB Gold In Tube (QFT-GIT) and 102 were tested with T-SPOT.TB. QFT-GIT presented a sensitivity of 83.9 % (95 % CI 66.9-93.4 %) and a specificity of 88.5 % (95 % CI 70.2-96.8 %), while T-SPOT.TB had a sensitivity of 75.9 % (95 % CI 63.4-85.2 %) and a specificity of 94.7 % (95 % CI 81.8-99.5 %). The positive predictive value was high in both assays, 92.9 % for QFT-GIT and 95.7 % for T-SPOT.TB. In total of these two kinds of IGRAs, false negative rate was significantly higher in children receiving systemic prednisolone (1 mg/kg/day) therapy for >1 week (two tested with T-SPOT.TB and five tested with QFT-GIT) than in those with ≤1 week of prednisolone therapy and without prednisolone therapy (57.1 vs. 18.3 %, p = 0.035). There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old. Both types of IGRAs showed good diagnostic values in detecting childhood TB before microbiological evidence was available. Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week. Age made no difference on the performance of these tests in children.
儿童活动性结核病的诊断仍然困难。本研究旨在评估干扰素-γ释放试验（IGRAs）在检测接种卡介苗的人类免疫缺陷病毒阴性儿童活动性结核病方面的能力，并研究泼尼松龙治疗对IGRAs检测性能的影响。在中国招募的162例疑似结核病儿童中，60例接受了全血γ-干扰素释放试验（QFT-GIT）检测，102例接受了结核感染T细胞检测（T-SPOT.TB）。QFT-GIT的敏感性为83.9%（95%置信区间66.9-93.4%），特异性为88.5%（95%置信区间70.2-96.8%）；而T-SPOT.TB的敏感性为75.9%（95%置信区间63.4-85.2%），特异性为94.7%（95%置信区间81.8-99.5%）。两种检测方法的阳性预测值均较高，QFT-GIT为92.9%，T-SPOT.TB为95.7%。在这两种IGRAs检测中，接受全身泼尼松龙（1mg/kg/天）治疗超过1周的儿童（2例接受T-SPOT.TB检测，5例接受QFT-GIT检测）的假阴性率显著高于接受泼尼松龙治疗≤1周和未接受泼尼松龙治疗的儿童（57.1%对18.3%，p=0.035）。与≥5岁儿童相比，<5岁儿童的两种检测阳性率无显著差异。在获得微生物学证据之前，两种类型的IGRAs在检测儿童结核病方面均显示出良好的诊断价值。如果糖皮质激素治疗超过1周，会对IGRAs产生显著负面影响。年龄对儿童这些检测的性能没有影响。
