在涂片阴性的糖尿病合并肺结核患者中，结核感染T细胞检测（QuantiFERON(®)）的敏感性降低。
Reduced sensitivity of the QuantiFERON(®) test in diabetic patients with smear-negative tuberculosis.
作者信息
Choi J C, Jarlsberg L G, Grinsdale J A, Osmond D H, Higashi J, Hopewell P C, Kato-Maeda M
机构信息
Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA; Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, South Korea.
Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA.
出版信息
Int J Tuberc Lung Dis. 2015 May;19(5):582-8. doi: 10.5588/ijtld.14.0553.
SETTING
Immunosuppressive conditions have been associated with low sensitivity of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB). However, no systematic analysis of patient and bacterial characteristics has been performed before.
OBJECTIVE
To determine the sensitivity and the risk factors for false-negative QuantiFERON(®)-TB (QFT) assay and TST in TB patients.
DESIGN
We performed a retrospective analysis of data collected in a community-based study of TB in San Francisco, CA, USA. We included 300 TB patients who underwent QFT and TST.
RESULTS
The risk factors for false-negative QFT were human immunodeficiency virus infection and the use of QuantiFERON(®)-TB Gold. In patients with sputum smear-negative TB, diabetes mellitus (DM) was associated with false-negative QFT (OR 2.85, 95%CI 1.02-7.97, P = 0.045). TST sensitivity was higher than QFT sensitivity in DM patients (OR 9.46, 95%CI 2.53-35.3).
CONCLUSIONS
In San Francisco, QFT sensitivity was lower than that of TST, especially in patients with DM. Stratified analysis by sputum smear results showed that this association was specific to smear-negative TB. In contrast, TST was not affected by the presence of DM.
背景
免疫抑制状态与干扰素-γ释放试验（IGRAs）和结核菌素皮肤试验（TST）诊断结核病（TB）的低敏感性相关。然而，此前尚未对患者和细菌特征进行系统分析。
目的
确定结核病患者中QuantiFERON(®)-TB（QFT）检测和TST假阴性的敏感性及危险因素。
设计
我们对美国加利福尼亚州旧金山一项基于社区的结核病研究收集的数据进行了回顾性分析。纳入了300例接受QFT和TST检测的结核病患者。
结果
QFT假阴性的危险因素包括人类免疫缺陷病毒感染和使用QuantiFERON(®)-TB Gold。在痰涂片阴性的结核病患者中，糖尿病（DM）与QFT假阴性相关（OR 2.85，95%CI 1.02-7.97，P = 0.045）。糖尿病患者中TST的敏感性高于QFT的敏感性（OR 9.46，95%CI 2.53-35.3）。
结论
在旧金山，QFT的敏感性低于TST，尤其是在糖尿病患者中。按痰涂片结果进行分层分析表明，这种关联特定于涂片阴性的结核病。相比之下，TST不受糖尿病存在的影响。
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