定量干扰素-γ释放试验反应在预测肾移植受者活动性肺结核中的作用：一项准实验研究。
The usefulness of quantitative interferon-gamma releasing assay response for predicting active tuberculosis in kidney transplant recipients: A quasi-experimental study.
机构信息
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
J Infect. 2020 Sep;81(3):403-410. doi: 10.1016/j.jinf.2020.06.070. Epub 2020 Jun 29.
OBJECTIVES
We evaluated the effectiveness of IGRA-based isoniazid (INH) treatment with the diagnostic value of quantitative IGRA titer for post-transplant tuberculosis (TB) in kidney transplant (KT) recipients.
METHODS
All adult KT recipients were enrolled from January 2014 to December 2017. The development of TB after KT was observed, stratified by quantitative IGRA results as well as by IGRA results with/without INH treatment.
RESULTS
Of 1150 KT recipients, 322 (28%) revealed positive IGRA results (≥0.35 IU/mL) and 12 (1.0%) developed TB. Seven (3.2%) of 217 patients with positive IGRA without INH developed TB, whereas none of 105 patients with positive IGRA with INH developed TB (rate difference -1616 per 100,000 person-years, P = 0.016) and 5 (0.6%) of 828 patients with negative or indeterminate IGRA developed TB (rate difference -1388 per 100,000 person-years, P<0.001). Among the 217 positive IGRA patients without INH, 6 (6.4%) of 94 patients who had positive IGRA titer>2.96 IU/mL developed TB, whereas one (0.8%) of 123 patients who had positive IGRA titer≤2.96 IU/mL developed TB (rate difference 2964 per 100,000 person-years, P = 0.017).
CONCLUSIONS
IGRA-based INH treatment with risk stratification by quantitative IGRA results appears to be effective to prevent the development of TB in KT recipients.
目的
我们评估了基于 IGRA 的异烟肼（INH）治疗在肾移植（KT）受者中诊断移植后结核（TB）的效果，以及定量 IGRA 效价在其中的诊断价值。
方法
所有成人 KT 受者均于 2014 年 1 月至 2017 年 12 月期间入组。观察 KT 后 TB 的发生情况，并按定量 IGRA 结果以及 IGRA 结果伴/不伴 INH 治疗进行分层。
结果
在 1150 例 KT 受者中，322 例（28%）IGRA 结果阳性（≥0.35 IU/mL），12 例（1.0%）发生 TB。217 例 IGRA 阳性而无 INH 的患者中，有 7 例（3.2%）发生 TB，而 105 例 IGRA 阳性伴 INH 的患者中无一例发生 TB（率差为-1616/100000 人年，P=0.016），828 例 IGRA 阴性或不确定的患者中，有 5 例（0.6%）发生 TB（率差为-1388/100000 人年，P<0.001）。在 217 例无 INH 的 IGRA 阳性患者中，94 例 IGRA 效价>2.96 IU/mL 的患者中有 6 例（6.4%）发生 TB，而 123 例 IGRA 效价≤2.96 IU/mL 的患者中仅 1 例（0.8%）发生 TB（率差为 2964/100000 人年，P=0.017）。
结论
基于 IGRA 的 INH 治疗并结合定量 IGRA 结果进行风险分层，似乎可有效预防 KT 受者发生 TB。
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