QuantiFERON-TB Gold In-Tube assay 在成人肺部和肺外活动性结核病诊断中的应用。

Utility of QuantiFERON-TB Gold In-Tube assay in adult, pulmonary and extrapulmonary, active tuberculosis diagnosis.

机构信息

Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne - Université Paris 13 Paris Cité Sorbonne, 125 route de Stalingrad, 93000 Bobigny, France.

出版信息

Int J Infect Dis. 2016 Mar;44:25-30. doi: 10.1016/j.ijid.2016.01.004. Epub 2016 Jan 15.

DOI:10.1016/j.ijid.2016.01.004

PMID:26780268

Abstract

BACKGROUND

Tuberculosis remains a public health problem in France and the diagnosis of tuberculosis disease (TB) is sometimes difficult. The aim of this study was to analyse the contribution of the QuantiFERON-TB Gold In-Tube assay (QFT-GIT) to TB diagnosis.

METHODS

Sixty patients hospitalized with TB, for whom a QFT-GIT assay had been performed between June 2008 and June 2011 at the University Hospital of Bondy in the north-east of Paris, were identified retrospectively. Clinical and laboratory data were collected. The sensitivity, specificity, predictive values, and likelihood ratios of the QFT-GIT were all calculated. Furthermore, the characteristics of patients testing positive were compared to those of patients testing negative, as well as the QFT-GIT values according to several different factors.

RESULTS

The sensitivity of the QFT-GIT was 85% (95% confidence interval (CI) 0.73-0.92) and specificity was 73.3% (95% CI 0.68-0.78). The positive predictive value was 39.5% and the negative predictive value was 97.3%. The positive and negative likelihood ratios were 3.2 and 0.20, respectively. The prevalence of TB in this population was 15% (pre-test probability). After a positive test result, the probability of TB increased to 40% (post-positive probability test); after a negative test result, it decreased to 4.5% (post-negative probability test). The combination of the QFT-GIT test with the tuberculin skin test brought no significant improvement in sensitivity. Factors significantly associated with a negative QFT-GIT result included older age, high C-reactive protein, a low lymphocyte count, and immunosuppressant intake. The test value in quantitative terms was significantly higher in those with lymph node TB than in those with pulmonary TB, and in younger patients (<40 years) than in older patients (>40 years old).

CONCLUSION

On its own, QFT-GIT is an insufficient tool to confirm the diagnosis of TB disease. However, it may form part of an ensemble of tools in combination with clinical, biological, and radiological assessments.

摘要

背景

结核病仍然是法国的公共卫生问题，结核病的诊断有时较为困难。本研究旨在分析 Quantiferon-TB Gold In-Tube 检测（QFT-GIT）在结核病诊断中的作用。

方法

我们回顾性地分析了 2008 年 6 月至 2011 年 6 月在巴黎东北部邦迪大学医院因结核病住院且进行 QFT-GIT 检测的 60 例患者的临床和实验室数据。计算了 QFT-GIT 的敏感性、特异性、预测值和似然比。此外，我们比较了 QFT-GIT 阳性患者和阴性患者的特征，以及根据不同因素 QFT-GIT 值的差异。

结果

QFT-GIT 的敏感性为 85%（95%置信区间 0.73-0.92），特异性为 73.3%（95%置信区间 0.68-0.78）。阳性预测值为 39.5%，阴性预测值为 97.3%。阳性和阴性似然比分别为 3.2 和 0.20。该人群中结核病的患病率为 15%（先验概率）。QFT-GIT 阳性后，结核病的概率增至 40%（后验阳性概率）；QFT-GIT 阴性后，该概率降至 4.5%（后验阴性概率）。QFT-GIT 检测与结核菌素皮肤试验联合应用并未显著提高敏感性。与 QFT-GIT 阴性结果显著相关的因素包括年龄较大、C 反应蛋白升高、淋巴细胞计数较低和免疫抑制剂的使用。定量检测值在淋巴结结核患者中显著高于肺结核患者，在年轻患者（<40 岁）中显著高于老年患者（>40 岁）。