干扰素γ释放试验用于诊断偏远原住民社区潜伏性结核感染的可行性以及与结核菌素皮肤试验结果不一致的预测因素。
The feasibility of the interferon gamma release assay and predictors of discordance with the tuberculin skin test for the diagnosis of latent tuberculosis infection in a remote Aboriginal community.
作者信息
Alvarez Gonzalo G, Van Dyk Deborah D, Davies Naomi, Aaron Shawn D, Cameron D William, Desjardins Marc, Mallick Ranjeeta, Obed Natan, Baikie Maureen
机构信息
Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada; Government of Nunavut, Department of Health, Iqaluit, Nunavut.
出版信息
PLoS One. 2014 Nov 11;9(11):e111986. doi: 10.1371/journal.pone.0111986. eCollection 2014.
BACKGROUND
The tuberculin skin test (TST) is the standard test used to screen for latent TB infection (LTBI) in the northern Canadian territory of Nunavut. Interferon gamma release assays (IGRA) are T cell blood-based assays to diagnose LTBI. The Bacillus Calmette-Guerin (BCG) vaccine is part of the routine immunization schedule in Nunavut. The objective of this study was to test the feasibility, and predictors of discordance between the Tuberculin Skin Test (TST) and the IGRA assay in a medically under-serviced remote arctic Aboriginal population.
METHODS
Both the TST and QuantiFERON-TB Gold (Qiagen group) IGRA tests were offered to people in their homes as part of a public health campaign aimed at high TB risk residential areas in Iqaluit, Nunavut, Canada. Feasibility was measured by the capacity of the staff to do the test successfully as measured by the proportion of results obtained.
RESULTS
In this population of predominantly young Inuit who were mostly BCG vaccinated, the use of IGRA for the diagnosis of LTBI was feasible. IGRA testing resulted in more available test results reaching patients (95.6% vs 90.9% p = 0.02) but took longer (median 8 days (IGRA) vs 2 days (TST), p value < 0.0001). 44/256 participants (17.2%) had discordant results. Multivariable regression analysis suggested that discordant results were most likely to have received multiple BCG vaccinations (RR 20.03, 95% CI, 3.94-101.82)), followed by BCG given post infancy (RR 8.13, 95% CI, 2.54-26.03)) and then to a lesser degree when BCG was given in infancy (RR 6.43, 95% CI, 1.72-24.85).
INTERPRETATION
IGRA is feasible in Iqaluit, Nunavut, a remote Arctic community. IGRA testing results in more test results available to patients compared to TST. This test could result in fewer patients requiring latent TB treatment among those previously vaccinated with BCG in a region with limited public health human resources.
背景
结核菌素皮肤试验（TST）是加拿大努纳武特地区北部用于筛查潜伏性结核感染（LTBI）的标准检测方法。干扰素γ释放试验（IGRA）是基于血液中T细胞的用于诊断LTBI的检测方法。卡介苗（BCG）疫苗是努纳武特地区常规免疫计划的一部分。本研究的目的是在医疗服务不足的偏远北极原住民人群中，测试结核菌素皮肤试验（TST）和IGRA检测结果不一致的可行性及预测因素。
方法
作为一项针对加拿大努纳武特地区伊魁特市高结核病风险居住区的公共卫生活动的一部分，TST和结核感染T细胞检测（QuantiFERON-TB Gold，Qiagen公司）IGRA检测均在居民家中进行。通过工作人员成功进行检测的能力（以获得结果的比例衡量）来评估可行性。
结果
在这个以年轻因纽特人为主且大多接种过卡介苗的人群中，使用IGRA诊断LTBI是可行的。IGRA检测能让更多检测结果送达患者（95.6%对90.9%，p = 0.02），但耗时更长（中位数8天（IGRA）对2天（TST），p值<0.0001）。44/256名参与者（17.2%）结果不一致。多变量回归分析表明，结果不一致最可能发生在多次接种卡介苗的人群中（相对风险20.03，95%置信区间，3.94 - 101.82）），其次是婴儿期后接种卡介苗的人群（相对风险8.13，95%置信区间，2.54 - 26.03）），然后是婴儿期接种卡介苗的人群，程度较轻（相对风险6.43，95%置信区间，1.72 - 24.85））。
解读
在努纳武特地区伊魁特市这个偏远的北极社区，IGRA检测是可行的。与TST相比，IGRA检测能让更多患者获得检测结果。在公共卫生人力资源有限的地区，对于先前接种过卡介苗的人群，这种检测可能会减少需要进行潜伏性结核治疗的患者数量。
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