Wang Ping-Huai, Lin Shu-Yung, Liou Hung-Hsiang, Chen Chien-Chia, Shu Chin-Chung, Lee Chih-Yuan, Tsai Meng-Kun, Yu Chong-Jen
Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Infect Dis Ther. 2023 Jul;12(7):1907-1920. doi: 10.1007/s40121-023-00839-5. Epub 2023 Jul 6.
Bacillus Calmette-Guérin (BCG) vaccination has been reported to be protective against latent tuberculosis infection (LTBI) in the general population. The aim of this study was to investigate the protective effect of BCG vaccination against LTBI in adult patients with end-stage renal disease (ESRD) and renal transplants.
Patients aged ≥ 20 years with ESRD who received hemodialysis (HD), peritoneal dialysis (PD) or kidney transplant were enrolled from January 2012 to December 2019 at a medical center and a regional hemodialysis center. Patients with active tuberculosis (TB), previously treated TB, active immunosuppressant therapy or human immunodeficiency virus infection were excluded. LTBI status was determined by QuantiFERON-TB Gold In-tube (QFT-GIT).
After the exclusion of indeterminate results of QFT-GIT, 517 participants were enrolled and 97 (18.8%) were identified as having LTBI. Participants with LTBI were older (55.1 ± 11.4 vs. 48.5 ± 14.6 years, p < 0.001) and had a significantly higher proportion receiving HD than those without LTBI (70.1% vs. 56.7%, p = 0.001). The percentage with BCG scars was higher in the non-LTBI group than in the LTBI group (94.8% vs. 81.4%, p < 0.001), whereas the neutrophil-to-lymphocyte ratio (NLR) (≥ 2.68) was significantly higher in the LTBI group (62.8% vs. 45.5%, p = 0.02). By multivariate logistic regression analysis, presence of BCG scar and high NLR were independent protective factors against LTBI [adjusted OR: 0.19 (0.063-0.58, p = 0.001) and 0.50 (0.28-0.89, p = 0.02)].
The prevalence of LTBI was as high as 18.8% in patients with end-stage kidney disease or kidney transplant. BCG vaccination and high NLR might have protective effects against LTBI in patients with renal failure or transplant.
据报道，卡介苗（BCG）接种对普通人群的潜伏性结核感染（LTBI）具有保护作用。本研究旨在调查BCG接种对终末期肾病（ESRD）成年患者及肾移植患者LTBI的保护作用。
2012年1月至2019年12月期间，从一家医疗中心和一个区域血液透析中心招募年龄≥20岁、接受血液透析（HD）、腹膜透析（PD）或肾移植的ESRD患者。排除患有活动性结核病（TB）、既往接受过结核病治疗、正在接受活动性免疫抑制治疗或感染人类免疫缺陷病毒的患者。通过全血γ-干扰素释放试验（QFT-GIT）确定LTBI状态。
排除QFT-GIT不确定结果后，共纳入517名参与者，其中97名（18.8%）被确定患有LTBI。患有LTBI的参与者年龄更大（55.1±11.4岁 vs. 48.5±14.6岁，p<0.001），接受HD的比例显著高于未患LTBI的参与者（70.1% vs. 56.7%，p=0.001）。非LTBI组有BCG接种瘢痕的百分比高于LTBI组（94.8% vs. 81.4%，p<0.001），而LTBI组的中性粒细胞与淋巴细胞比值（NLR）（≥2.68）显著更高（62.8% vs. 45.5%，p=0.02）。通过多因素logistic回归分析，有BCG接种瘢痕和高NLR是预防LTBI的独立保护因素[调整后的比值比：0.19（0.063-0.58，p=0.001）和0.50（0.28-0.89，p=0.02）]。
终末期肾病或肾移植患者中LTBI的患病率高达18.8%。BCG接种和高NLR可能对肾衰竭或肾移植患者的LTBI具有保护作用。
