干扰素释放试验-QuantiFERON Gold Plus（QFT-Plus）与结核菌素皮肤试验（TST）在免疫功能低下儿童结核病感染检测中的比较。
Comparison between the Interferon Release Assay-QuantiFERON Gold Plus (QFT-Plus)-and Tuberculin Skin Test (TST) in the Detection of Tuberculosis Infection in Immunocompromised Children.
机构信息
Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38 Bandung 40161, Indonesia.
出版信息
Pulm Med. 2020 May 10;2020:7159485. doi: 10.1155/2020/7159485. eCollection 2020.
BACKGROUND
Immunocompromised patients are at a higher risk of having latent tuberculosis infection (LTBI). QuantiFERON-TB Gold Plus (QFT-Plus) has been proven to perform effectively in LTBI detection among immunocompromised adults and can overcome the limitations of the tuberculin skin test (TST). However, the role of QFT-Plus in detecting LTBI in immunocompromised paediatric patients has not been well established. Therefore, the aim of this study was to assess the test agreement between QFT-Plus and the TST in LTBI detection among immunocompromised children.
METHOD
In this cross-sectional study, we enrolled immunocompromised paediatric patients, aged between 5 and 18 years, who were treated with corticosteroids and/or chemotherapy from June to November 2019. We categorized them into three groups based on the following diseases: hematologic malignancies and nephrological and immunological diseases. We recorded the patient characteristics and QFT-Plus and TST results, in which the positive result of the TST was induration ≥ 5 mm. Within the same group, comparisons between the two tests were performed using the McNemar test, and results were statistically significant for values of <0.05. The kappa index was used to assess the agreement between the two test results.
RESULTS
Among 71 patients (median age: 11.8 years) who underwent TST and QFT-Plus testing, 52% were females, and 69% had a normal nutritional status. Chemotherapy was the most common treatment modality for hematologic malignancy compared to other immunosuppressive treatments. The total number of patients with positive QFT-Plus and TST results was 11/71 (15.5%) and 4/71 (5.6%), respectively, among whom 3/11 patients had positive results in both tests, and one patient with positive TST results exhibited a discrepancy, as this was not followed by positive QFT-Plus results. QFT-Plus generated more positive results than the TST in immunocompromised children (McNemar, = 0.039 ( < 0.05)). The diagnostic agreement between the tests was fair ( = 0.345, 95% CI: 0.05-0.745).
CONCLUSION
QFT-Plus detected LTBI more effectively than the TST in immunocompromised children.
背景
免疫功能低下的患者发生潜伏性结核感染（LTBI）的风险较高。QuantiFERON-TB Gold Plus（QFT-Plus）已被证明可有效检测免疫功能低下的成年人中的 LTBI，并能克服结核菌素皮肤试验（TST）的局限性。然而，QFT-Plus 检测免疫功能低下的儿科患者 LTBI 的作用尚未得到充分确立。因此，本研究旨在评估 QFT-Plus 与 TST 在检测免疫功能低下的儿童 LTBI 中的试验一致性。
方法
在这项横断面研究中，我们纳入了 2019 年 6 月至 11 月接受糖皮质激素和/或化疗治疗的 5 至 18 岁免疫功能低下的儿科患者。我们根据以下疾病将他们分为三组：血液系统恶性肿瘤和肾脏及免疫性疾病。我们记录了患者的特征以及 QFT-Plus 和 TST 结果，其中 TST 的阳性结果为硬结≥5mm。在同一组内，采用 McNemar 检验比较两种检测方法的结果，且 值<0.05 为差异有统计学意义。采用 Kappa 指数评估两种检测结果的一致性。
结果
在接受 TST 和 QFT-Plus 检测的 71 例患者中（中位年龄：11.8 岁），52%为女性，69%的营养状况正常。与其他免疫抑制治疗相比，化疗是血液系统恶性肿瘤最常见的治疗方式。QFT-Plus 和 TST 阳性结果的患者总数分别为 11/71（15.5%）和 4/71（5.6%），其中 3/11 例患者两种检测均为阳性，1 例 TST 阳性结果的患者出现不一致，因为 TST 阳性结果后并未出现 QFT-Plus 阳性结果。QFT-Plus 在免疫功能低下的儿童中产生的阳性结果多于 TST（McNemar， = 0.039（<0.05））。两种检测的诊断一致性为中等（ = 0.345，95%CI：0.05-0.745）。
结论
QFT-Plus 检测免疫功能低下的儿童 LTBI 的效果优于 TST。
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