COVID-19 大流行期间结核感染筛查中 Mitogen 管 QuantiFERON 检测 IFN-γ 低反应的临床和流行病学相关性：COVID-19 死亡率的基于人群的标志物？
Clinical and Epidemiological Correlates of Low IFN-Gamma Responses in Mitogen Tube of QuantiFERON Assay in Tuberculosis Infection Screening During the COVID-19 Pandemic: A Population-Based Marker of COVID-19 Mortality?
机构信息
Unidad de Referencia Regional de Micobacterias, AGC Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).
Unidad de Enfermedades Infecciosas, Hospital Universitario de Cabueñes, Gijón, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).
出版信息
Arch Bronconeumol. 2022 Sep;58(9):649-659. doi: 10.1016/j.arbres.2022.01.011. Epub 2022 Feb 13.
BACKGROUND
The clinical and epidemiological implications of abnormal immune responses in COVID-19 for latent tuberculosis infection (LTBI) screening are unclear.
METHODS
We reviewed QuantiFERON TB Gold Plus (QFT-Plus) results (36,709 patients) from July 2016 until October 2021 in Asturias (Spain). We also studied a cohort of ninety hospitalized patients with suspected/confirmed COVID-19 pneumonia and a group of elderly hospitalized patients with COVID-19 who underwent serial QFT-Plus and immune profiling testing.
RESULTS
The indeterminate QFT-Plus results rate went from 1.4% (July 2016 to November 2019) to 4.2% during the COVID-19 pandemic. The evolution of the number of cases with low/very low interferon-gamma (IFN-gamma) response in the mitogen tube paralleled the disease activity and number of deaths during the pandemic waves in our region (from March 2020 to October 2021). The percentages of positive QFT-plus patients did not significantly change before and during the pandemic (13.9% . 12.2%). Forty-nine patients from the suspected/confirmed COVID-19 pneumonia cohort (54.4%) had low/very low IFN-gamma response to mitogen, 22 of them (24.4%) had severe and critical pneumonia. None received immunosuppressants prior to testing. Abnormal radiological findings (P = 0.01) but not COVID-19 severity was associated with low mitogen response. Immune profiling showed a reduction of CD8 + T cells and a direct correlation between the number of EMRA CD8 + T-cells and IFN-gamma response to mitogen (P = 0.03).
CONCLUSION
Low IFN-gamma responses in mitogen tube of QFT-Plus often occur in COVID-19 pneumonia, which is associated with a low number of an effector CD8 + T-cell subset and does not seem to affect LTBI screening; however, this abnormality seems to parallel the dynamics of COVID-19 at the population level and its mortality.
背景
COVID-19 中异常免疫反应对潜伏性结核感染（LTBI）筛查的临床和流行病学意义尚不清楚。
方法
我们回顾了 2016 年 7 月至 2021 年 10 月在阿斯图里亚斯（西班牙）进行的 QuantiFERON TB Gold Plus（QFT-Plus）检测结果（36709 例患者）。我们还研究了一组 90 例疑似/确诊 COVID-19 肺炎住院患者和一组老年 COVID-19 住院患者，这些患者接受了连续的 QFT-Plus 和免疫谱检测。
结果
不确定的 QFT-Plus 检测结果率从 2016 年 7 月至 2019 年 11 月的 1.4%上升到 COVID-19 大流行期间的 4.2%。在我们地区的疾病活动和死亡人数在大流行期间（2020 年 3 月至 2021 年 10 月），丝裂原管中低/极低干扰素-γ（IFN-γ）反应的病例数呈下降趋势。大流行前后（13.9%、12.2%），QFT-Plus 阳性患者的百分比没有显著变化。在疑似/确诊 COVID-19 肺炎队列中，有 49 例（54.4%）患者对丝裂原的 IFN-γ反应较低/极低，其中 22 例（24.4%）患者患有严重和危重症肺炎。在检测前，他们均未接受免疫抑制剂治疗。异常的影像学发现（P=0.01）而非 COVID-19 严重程度与丝裂原低反应相关。免疫谱分析显示 CD8+T 细胞减少，并且 EMRA CD8+T 细胞数量与丝裂原 IFN-γ反应呈直接相关（P=0.03）。
结论
QFT-Plus 丝裂原管中 IFN-γ 反应低下常发生在 COVID-19 肺炎中，这与效应 CD8+T 细胞亚群数量减少有关，似乎不会影响 LTBI 筛查；然而，这种异常似乎与人群水平 COVID-19 的动态及其死亡率平行。
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