Wilson Fernando A, Miller Thaddeus L, Stimpson Jim P
University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE.
University of North Texas Health Science Center, Department of Health Management and Policy, Fort Worth, TX.
Public Health Rep. 2016 Mar-Apr;131(2):303-10. doi: 10.1177/003335491613100214.
We used a recent source of nationally representative population data on tuberculosis (TB) infection to characterize concordance between the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) blood test for immigrants in the United States.
We used TB screening data from the 2011-2012 National Health and Nutrition Examination Survey to examine concordance between the TST and QFT-GIT--an interferon-gamma release assay (IGRA) blood test--for 7,097 U.S. natives, naturalized citizens, and noncitizens.
Consistent with prior findings, one in five immigrants in the survey was identified with latent TB infection (LTBI), a rate 14 times higher than for U.S. natives. We also found higher rates of discordant TST/IGRA results among immigrants than among U.S. natives. Unadjusted discordance between TST and IGRA was 3% among U.S. natives (weighted N=5,684,274 of 191,179,213) but ranged up to 19% for noncitizens (weighted N=3,722,960 of 19,377,147). Adjusting for age, sex, and race/ethnicity, noncitizens had more than nine times the odds of having a positive TST result but negative QFT-GIT result compared with U.S. natives.
Our findings suggest that whether and how either of these tests should be deployed is highly context sensitive. Significant discordance in test results when used among immigrants raises the possibility of missed opportunities for harm reduction in this already at-risk population. However, we found little distinction between the tests in terms of diagnostic outcome when used in a U.S. native population, suggesting little benefit to the adoption and use of the QFT-GIT test in place of TST on the basis of test performance alone for this population.
我们利用近期具有全国代表性的结核病（TB）感染人群数据，来描述美国移民中结核菌素皮肤试验（TST）与全血γ干扰素释放试验（QFT - GIT）血液检测之间的一致性。
我们使用了2011 - 2012年国家健康与营养检查调查中的结核病筛查数据，来检验7097名美国本土居民、入籍公民和非公民中TST与QFT - GIT（一种γ干扰素释放试验（IGRA）血液检测）之间的一致性。
与先前的研究结果一致，调查中五分之一的移民被确定为潜伏性结核感染（LTBI），这一比例是美国本土居民的14倍。我们还发现，移民中TST/IGRA结果不一致的比例高于美国本土居民。美国本土居民中TST与IGRA未经调整的不一致率为3%（加权N = 5684274，占191179213的比例），但非公民中这一比例高达19%（加权N = 3722960，占19377147的比例）。在对年龄、性别和种族/族裔进行调整后，与美国本土居民相比，非公民TST结果为阳性但QFT - GIT结果为阴性的几率高出九倍多。
我们的研究结果表明，是否以及如何应用这两种检测方法在很大程度上取决于具体情况。在移民中使用时检测结果存在显著差异，这增加了在这个本就处于高危状态的人群中减少危害的机会被错过的可能性。然而，我们发现，在美国本土人群中使用时，这两种检测方法在诊断结果方面几乎没有区别，这表明仅基于检测性能，用QFT - GIT检测代替TST对该人群几乎没有益处。
