在初级卫生保健工作者中，比较干扰素-γ释放试验与结核菌素皮肤试验两个临界值以检测潜伏性结核分枝杆菌感染的情况。
Comparison of interferon-γ release assay to two cut-off points of tuberculin skin test to detect latent Mycobacterium tuberculosis infection in primary health care workers.
作者信息
de Souza Fernanda Mattos, do Prado Thiago Nascimento, Pinheiro Jair dos Santos, Peres Renata Lyrio, Lacerda Thamy Carvalho, Loureiro Rafaela Borge, Carvalho Jose Américo, Fregona Geisa, Dias Elias Santos, Cosme Lorrayne Beliqui, Rodrigues Rodrigo Ribeiro, Riley Lee Wood, Maciel Ethel Leonor Noia
机构信息
Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil; Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
Coordenador do Núcleo de Controle da Tuberculose - Secretaria Municipal de Saúde - Manaus, Amazonas, Brazil.
出版信息
PLoS One. 2014 Aug 19;9(8):e102773. doi: 10.1371/journal.pone.0102773. eCollection 2014.
BACKGROUND
An interferon-γ release assay, QuantiFERON-TB (QFT) test, has been introduced an alternative test for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Here, we compared the performance of QFT with tuberculin skin test (TST) measured at two different cut-off points among primary health care work (HCW) in Brazil.
METHODS
A cross-sectional study was carried out among HCWs in four Brazilian cities with a known history of high incidence of TB. Results of the QFT were compared to TST results based on both ≥5 mm and ≥10 mm as cut-off points.
RESULTS
We enrolled 632 HCWs. When the cut-off value of ≥10 mm was used, agreement between QFT and TST was 69% (k = 0.31), and when the cut-off of ≥5 mm was chosen, the agreement was 57% (k = 0.22). We investigated possible factors of discordance of TST vs QFT. Compared to the TST-/QFT- group, risk factors for discordance in the TST+/QFT- group with TST cut-off of ≥5 mm included age between 41-45 years [OR = 2.70; CI 95%: 1.32-5.51] and 46-64 years [OR = 2.04; CI 95%: 1.05-3.93], BCG scar [OR = 2.72; CI 95%: 1.40-5.25], and having worked only in primary health care [OR = 2.30; CI 95%: 1.09-4.86]. On the other hand, for the cut-off of ≥10 mm, BCG scar [OR = 2.26; CI 95%: 1.03-4.91], being a household contact of a TB patient [OR = 1.72; CI 95%: 1.01-2.92] and having had a previous TST [OR = 1.66; CI 95%: 1.05-2.62], were significantly associated with the TST+/QFT- group. No statistically significant associations were found among the TST-/QFT+ discordant group with either TST cut-off value.
CONCLUSIONS
Although we identified BCG vaccination to contribute to the discordance at both TST cut-off measures, the current Brazilian recommendation for the initiation of LTBI treatment, based on information gathered from medical history, TST, chest radiograph and physical examination, should not be changed.
背景
一种γ-干扰素释放试验，即QuantiFERON-TB（QFT）检测，已被引入作为诊断潜伏性结核分枝杆菌感染（LTBI）的替代检测方法。在此，我们比较了QFT与结核菌素皮肤试验（TST）在巴西初级卫生保健工作者（HCW）中两个不同截断点的检测性能。
方法
在巴西四个已知结核病高发病率历史的城市的HCW中进行了一项横断面研究。将QFT的结果与基于≥5mm和≥10mm作为截断点的TST结果进行比较。
结果
我们纳入了632名HCW。当使用≥10mm的截断值时，QFT与TST之间的一致性为69%（k = 0.31），当选择≥5mm的截断值时，一致性为57%（k = 0.22）。我们调查了TST与QFT不一致的可能因素。与TST-/QFT-组相比，TST+/QFT-组中TST截断值≥5mm时不一致的危险因素包括年龄在41 - 45岁[OR = 2.70；95%CI：1.32 - 5.51]和46 - 64岁[OR = 2.04；95%CI：1.05 - 3.93]、卡介苗疤痕[OR = 2.72；95%CI：1.40 - 5.25]以及仅在初级卫生保健机构工作[OR = 2.30；95%CI：1.09 - 4.86]。另一方面，对于≥10mm的截断值，卡介苗疤痕[OR = 2.26；95%CI：1.03 - 4.91]、是结核病患者的家庭接触者[OR = 1.72；95%CI：1.01 - 2.92]以及曾接受过TST[OR = 1.66；95%CI：1.05 - 2.62]与TST+/QFT-组显著相关。在TST-/QFT+不一致组中，无论TST截断值如何，均未发现统计学上的显著关联。
结论
尽管我们发现卡介苗接种在两种TST截断测量中均导致不一致，但基于从病史、TST、胸部X线和体格检查收集的信息，目前巴西关于启动LTBI治疗的建议不应改变。
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