干扰素γ释放试验与结核菌素皮肤试验在维持性血液透析患者潜伏性结核诊断中的比较
Comparison of interferon gamma release assay & tuberculin skin tests for diagnosis of latent tuberculosis in patients on maintenance haemodialysis.
作者信息
Agarwal Sanjay K, Singh Urvashi B, Zaidi Sabahat H, Gupta Sanjay, Pandey Ravinder M
机构信息
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Indian J Med Res. 2015 Apr;141(4):463-8. doi: 10.4103/0971-5916.159297.
BACKGROUND & OBJECTIVES: Tuberculosis (TB) is a common infection in patients on haemodialysis. There is a definite role of treatment of latent TB (LTB) in these patients. However, diagnosis of LTB in these patients by tuberculin skin test (TST) is unreliable. There is suggestion that interferon gamma release assay (IGRA) will be more reliable test for diagnosis of LTB in this setting. Thus, we evaluated value of IGRA and TST for the diagnosis of LTB in patients on dialysis in an Indian setting.
METHODS
Patients with end stage kidney disease on dialysis were included. Patients with active TB were excluded. Each patient was subjected to TST (induration of ≥10 mm was taken as positive) and QuantiFERON TB Gold In-Tube test (QFT-GIT) for diagnosis of LTB.
RESULTS
A total of 185 patients were included; 129 (69.7%) were males and mean age was 36.7 ± 12.3 yr. Past history of TB was present in 18 (9.7%) patients. One hundred and thirty four (72.4%) patients had scar of BCG vaccination. QFT-GIT test was positive in 66 (36%), TST in 32 (17%) and both in 13 (7%) patients. Of the 66 patients positive with QFT-GIT, only 13 (19.6%) were positive for TST. Of the 32 patients positive with TST, only 13 (40.6%) were positive with QFT-GIT; 100 (54%) patients were negative for both the tests. Overall, 85 (45.9%) patients were positive for either of the two tests. Poor agreement was shown between the two methods. On logistic regression analysis, odds of QFT-GIT to be positive in patients with BCG vaccination was 1.23 and with history of TB 0.99, both being insignificant. odds of tuberculin skin test to be positive in patients with BCG vaccination was 1.04 and with history of TB 0.99, both again being insignificant.
INTERPRETATION & CONCLUSIONS: Our findings showed that more number of patients (36%) on haemodialysis were positive for QuantiFERON Gold In-Tube test as compared to TST (17%). There was poor agreement between the two tests. No significant effect of BCG vaccination and history of TB in past was observed on both tests.
背景与目的
结核病（TB）是血液透析患者中常见的感染。对这些患者进行潜伏性结核（LTB）治疗具有明确作用。然而，通过结核菌素皮肤试验（TST）诊断这些患者的LTB并不可靠。有建议认为，在这种情况下，干扰素γ释放试验（IGRA）对LTB的诊断将是更可靠的检测方法。因此，我们在印度环境中评估了IGRA和TST对透析患者LTB诊断的价值。
方法
纳入终末期肾病透析患者。排除活动性结核患者。对每位患者进行TST（硬结≥10mm为阳性）和结核感染T细胞检测（QFT-GIT）以诊断LTB。
结果
共纳入185例患者；129例（69.7%）为男性，平均年龄为36.7±12.3岁。18例（9.7%）患者有结核既往史。134例（72.4%）患者有卡介苗接种瘢痕。QFT-GIT检测阳性66例（36%），TST阳性32例（17%），两者均阳性13例（7%）。在66例QFT-GIT阳性患者中，仅13例（19.6%）TST阳性。在32例TST阳性患者中，仅13例（40.6%）QFT-GIT阳性；100例（54%）患者两种检测均为阴性。总体而言，85例（45.9%）患者两种检测中任一种为阳性。两种方法之间一致性较差。逻辑回归分析显示，接种卡介苗患者QFT-GIT阳性的比值比为1.23，有结核病史患者为0.99，两者均无统计学意义。接种卡介苗患者结核菌素皮肤试验阳性的比值比为1.04，有结核病史患者为0.99，两者同样无统计学意义。
解读与结论
我们的研究结果显示，血液透析患者中结核感染T细胞检测阳性的患者数量（36%）多于TST（17%）。两种检测之间一致性较差。既往接种卡介苗和结核病史对两种检测均未观察到显著影响。
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