确诊性γ-干扰素释放试验在韩国学校结核病暴发中的作用

Role of confirmatory interferon-gamma release assays in school outbreaks of tuberculosis in South Korea.

作者信息

Kim H J, Lee G-H, Ryoo S, Oh S-Y, Lee J-B, Kim J H, Shin C, Lee S H

机构信息

Korean Institute of Tuberculosis, Osong, Republic of Korea.

Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.

出版信息

Int J Tuberc Lung Dis. 2015 May;19(5):576-81. doi: 10.5588/ijtld.14.0636.

DOI:10.5588/ijtld.14.0636

PMID:25868027

Abstract

OBJECTIVE

To investigate the usefulness of confirmatory QuantiFERON(®) (QFT) testing among tuberculin skin test (TST) positive contacts to diagnose latent tuberculous infection (LTBI) in tuberculosis (TB) outbreaks among adolescents.

DESIGN

We used the Korean national claims database to identify the development of active TB disease in relation to initial TST (cut-off 10 mm induration) and subsequent QFT results.

RESULTS

A total of 7475 contacts in 89 schools were divided into four groups: TST- (n = 5714), TST+/QFT+ (n = 534), TST+/QFT- (n = 697) and TST+ only (n = 530). The mean duration of follow-up was 3.9 ± 0.9 years. For contacts with no LTBI treatment (n = 6868), TB incidence rates per 1000 person-years (py) and the adjusted hazard ratio (HR) compared with TST- individuals were as follows: TST+/QFT+, 66.2/1000 py (HR 35.59, 95%CI 14.03-90.31, P < 0.001); TST+ only, 10.1/1000 py (HR 5.16, 95%CI 2.91-9.17, P < 0.001); TST+/QFT-, 4.0/1000 py (HR 2.05, 95%CI 1.05-4.01, P = 0.035); and TST- 2.0/1000 py. The TB progression rate was significantly higher in TST+/QFT+ than in TST+/QFT- individuals (HR 16.82, 95 CI 5.84-48.46, P < 0.001).

CONCLUSION

A confirmatory QFT for TST+ contacts could reduce the number of candidates for LTBI treatment after school TB outbreaks.

摘要

目的

探讨在青少年结核病（TB）暴发中，对结核菌素皮肤试验（TST）阳性的接触者进行QuantiFERON(®)（QFT）确证检测以诊断潜伏性结核感染（LTBI）的有效性。

设计

我们利用韩国国家索赔数据库，确定与初始TST（硬结直径截断值为10毫米）及后续QFT结果相关的活动性结核病的发病情况。

结果

89所学校的7475名接触者被分为四组：TST阴性（n = 5714）、TST阳性/QFT阳性（n = 534）、TST阳性/QFT阴性（n = 697）和仅TST阳性（n = 530）。平均随访时间为3.9±0.9年。对于未接受LTBI治疗的接触者（n = 6868），每1000人年（py）的结核病发病率以及与TST阴性个体相比的调整后风险比（HR）如下：TST阳性/QFT阳性，66.2/1000 py（HR 35.59，95%CI 14.03 - 90.31，P < 0.001）；仅TST阳性，10.1/1000 py（HR 5.16，95%CI 2.91 - 9.17，P < 0.001）；TST阳性/QFT阴性，4.0/1000 py（HR 2.05，95%CI 1.05 - 4.01，P = 0.035）；TST阴性，2.0/1000 py。TST阳性/QFT阳性个体的结核病进展率显著高于TST阳性/QFT阴性个体（HR 16.82，95%CI 5.84 - 48.46，P < 0.001）。