在沙特阿拉伯透析患者中使用管内结核菌素金标检测法筛查潜伏性结核病。
The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients.
作者信息
Al Wakeel Jamal Saleh, Makoshi Ziyad, Al Ghonaim Mohammed, Al Harbi Ali, Al Suwaida Abdulkareem, Algahtani Farjah, Al Hedaithy Mogbil, Almogairin Sultan, Abdullah Sami
机构信息
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Neurosurgery Department, The Ottawa Hospital-Civic Campus, The University of Ottawa, Ontario, Canada.
出版信息
Ann Thorac Med. 2015 Oct-Dec;10(4):284-8. doi: 10.4103/1817-1737.157295.
BACKGROUND AND AIM
Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients.
METHODS
This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years.
RESULTS
A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043).
CONCLUSIONS
Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB.
背景与目的
结核病筛查是控制感染的关键策略。本研究旨在检测透析患者中的潜伏性结核病。
方法
这是一项在利雅得的沙特国王大学进行的前瞻性研究，纳入年龄≥18岁的血液透析（HD）和腹膜透析（PD）患者。采用结核菌素皮肤试验（TST）和结核感染T细胞检测（QFT-GIT）对患者进行潜伏性结核感染（LTBI）筛查。所有参与者在2年时间里每3个月进行一次临床和影像学随访。
结果
共纳入243例患者（181例HD患者和62例PD患者），其中男性112例（46.1%）。HD患者中45.3%的QFT呈阳性，敏感性为91.7%，特异性为71.4%，阳性预测值（PPV）为19.5%，阴性预测值（NPV）为91.1%。HD患者的TST结果显示，TST阳性率为17.4%，敏感性为63.2%，特异性为95..5%，PPV为51.5%，NPV为91.1%。PD患者中5例（8.1%）的QFT呈阳性，敏感性为7.7%，特异性为91.8%，PPV为6.6%，NPV为92.3%。PD患者的TST结果显示，TST阳性率为9.8%，敏感性为35.7%，特异性为97.9%，PPV为55.8%，NPV为93.3%。既往结核感染仅在HD患者中与QFT显著相关，但在HD和PD患者中均与TST显著相关。在HD患者中，QFT也与TST显著相关（P = 0.043）。
结论
由于QFT-GIT敏感性差异较大，我们建议根据其NPV使用该检测方法，并在筛查潜伏性结核时使用TST或QFT。
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