Yu Yuanyuan, Liu Yidian, Yao Lan, Shen Yanheng, Sun Qin, Sha Wei
Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China.
Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China.
Trop Med Infect Dis. 2022 Sep 30;7(10):278. doi: 10.3390/tropicalmed7100278.
Objectives The value of QuantiFERON-TB Gold In-Tube (QFT-GIT) in the diagnosis of TB varies by population, comorbidities, and other factors. In this study, we aimed to investigate factors that influence false-negative results of QFT-GIT test in the diagnosis of TB as well as the impact of different cutoffs on the diagnostic value. Methods A total of 3562 patients who underwent QFT-GIT tests at Shanghai Pulmonary Hospital were enrolled retrospectively between May 2016 and May 2017. False-negative and false-positive results were analyzed using different clinical stratifications. The optimal cutoff values were established under different clinical conditions. Results Positive QFT-GIT results greatly shortened the time taken to diagnose smear-negative TB. The factors of age, smear and culture results, site of TB, comorbidity with tumors, white blood cell count, neutrophil count, and CD4/CD8 ratio were significantly correlated with false-negative QFT-GIT results (p < 0.05). Personalized cutoff values were established according to different influencing factors. The results showed high consistency between the smear-negative and total populations. Conclusion QFT-GIT can facilitate the early diagnosis of smear-negative TB. The diagnostic performance of the QFT-GIT test in the diagnosis of active TB was shown to be affected by many clinical factors. Personalized cutoff values may have superior value in the identification of active tuberculosis under different conditions.
目的 全血γ-干扰素释放试验（QFT-GIT）在结核病诊断中的价值因人群、合并症及其他因素而异。本研究旨在探讨影响QFT-GIT试验在结核病诊断中出现假阴性结果的因素，以及不同临界值对诊断价值的影响。方法 回顾性纳入2016年5月至2017年5月在上海肺科医院接受QFT-GIT试验的3562例患者。采用不同的临床分层分析假阴性和假阳性结果。在不同临床条件下确定最佳临界值。结果 QFT-GIT阳性结果显著缩短了痰涂片阴性结核病的诊断时间。年龄、痰涂片和培养结果、结核部位、合并肿瘤、白细胞计数、中性粒细胞计数及CD4/CD8比值等因素与QFT-GIT假阴性结果显著相关（p<0.05）。根据不同影响因素确定个性化临界值。结果显示痰涂片阴性人群与总人群之间具有高度一致性。结论 QFT-GIT可促进痰涂片阴性结核病的早期诊断。QFT-GIT试验在活动性结核病诊断中的性能受多种临床因素影响。个性化临界值在不同条件下识别活动性结核病可能具有更高价值。
