Department of Paediatrics, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
Int J Tuberc Lung Dis. 2018 Oct 1;22(10):1172-1178. doi: 10.5588/ijtld.17.0883.
As conclusive data on the performance of interferon-gamma release assays (IGRAs) in paediatric TB are lacking, many guidelines do not recommend their use for TB diagnosis in this population in Brazil.
To evaluate the performance of an IGRA by investigating its concordance with the tuberculin skin test (TST) and the role of IGRAs in clinical management and treatment outcomes in children with TB.
A historic cohort study was used to evaluate the performance of T-SPOT®.TB (ELISpot) and other tests, such as the TST, in paediatric patients with or without immunodeficiency who were under investigation for latent tuberculous infection (LTBI) or active tuberculosis (TB).
Of 86 paediatric patients evaluated, 41 (48%) were immunocompetent and 45 (52%) immunocompromised. All patients underwent T-SPOT.TB, while 63 underwent both ELISpot and TST; test results were concordant in 50 patients (79.4%): 22/31 (71%) in immunocompetent (κ = 0.418, P = 0.02) and 28/32 (87.5%) in immunocompromised patients (κ = 0.526, P = 0.003). TB was diagnosed on the basis of the ELISpot result in 21% (18/86) cases; the contribution of the ELISpot assay was greater in immunocompetent patients than in those who were immunocompromised (13/41, 31.7% vs. 5/45, 11.1%, χ2 P = 0.038).
ELISpot and TST results were moderately concordant in both groups of patients. ELISpot contribution was higher among immunocompetent patients than among immunocompromised patients.
由于缺乏关于干扰素-γ释放试验（IGRAs）在儿科结核病中性能的明确数据，许多指南不建议在巴西的该人群中使用这些检测来诊断结核病。
通过研究其与结核菌素皮肤试验（TST）的一致性，以及 IGRAs 在儿童结核病的临床管理和治疗结果中的作用，评估一种 IGA 的性能。
采用历史队列研究来评估 T-SPOT.TB（ELISpot）和其他检测方法（如 TST）在患有或不患有免疫缺陷的儿童中进行潜伏性结核感染（LTBI）或活动性结核病（TB）筛查的表现。
在 86 名接受评估的儿科患者中，41 名（48%）为免疫功能正常，45 名（52%）为免疫功能低下。所有患者均接受了 T-SPOT.TB 检测，而 63 名患者同时接受了 ELISpot 和 TST 检测；在 50 名患者（79.4%）中，检测结果是一致的：31 名免疫功能正常患者中 22 名（71%）（κ=0.418，P=0.02）和 32 名免疫功能低下患者中 28 名（87.5%）（κ=0.526，P=0.003）。根据 ELISpot 结果诊断为结核病的患者占 21%（18/86）；在免疫功能正常的患者中，ELISpot 检测的贡献大于免疫功能低下的患者（13/41，31.7%比 5/45，11.1%，χ2 P=0.038）。
ELISpot 和 TST 结果在两组患者中均呈中度一致。在免疫功能正常的患者中，ELISpot 的贡献高于免疫功能低下的患者。
