NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Int J Infect Dis. 2024 Apr;141:106982. doi: 10.1016/j.ijid.2024.02.025. Epub 2024 Feb 24.
We investigated whether quantifying the serial QuantiFERON-TB Gold (QFT) response improves tuberculosis (TB) risk stratification in pulmonary TB (PTB) contacts.
A total of 297 untreated adult household PTB contacts, QFT tested at baseline and 3 months after index notification, were prospectively observed (median 1460 days). Normal variance of serial QFT responses was established in 46 extrapulmonary TB contacts. This informed categorisation of the response in QFT-positive PTB contacts as converters, persistently QFT-positive with significant increase (PP), and without significant increase (PP).
In total, eight co-prevalent TB (disease ≤3 months after index notification) and 12 incident TB (>3 months after index notification) cases were diagnosed. Genetic linkage to the index strain was confirmed in all culture-positive progressors. The cumulative 2-year incident TB risk in QFT-positive contacts was 8.4% (95% confidence interval, 3.0-13.6%); stratifying by serial QFT response, significantly higher risk was observed in QFT converters (28%), compared with PP (4.8%) and PP (3.7%). Converters were characterised by exposure to index cases with a shorter interval from symptom onset to diagnosis (median reduction 50.0 days, P = 0.013).
QFT conversion, rather than quantitative changes of a persistently positive serial QFT response, is associated with greater TB risk and exposure to rapidly progressive TB.
我们研究了定量监测结核菌素纯蛋白衍生物（QuantiFERON-TB Gold，QFT）反应是否能改善肺结核（PTB）接触者的结核（TB）风险分层。
对 297 例未经治疗的成年家庭性 PTB 接触者进行前瞻性观察（中位时间 1460 天），这些接触者在基线和索引通知后 3 个月时进行 QFT 检测。在 46 例肺外结核接触者中确定了 QFT 反应的正常方差。根据这一信息，将 QFT 阳性 PTB 接触者的反应分为转化者、持续 QFT 阳性伴显著增加（PP）和无显著增加（PP）。
总共诊断出 8 例同期 TB（疾病发生在索引通知后 3 个月内）和 12 例新发 TB（>3 个月后索引通知）病例。所有培养阳性进展者的基因与索引株均有遗传联系。QFT 阳性接触者的 2 年累积新发 TB 风险为 8.4%（95%置信区间，3.0-13.6%）；根据连续 QFT 反应分层，QFT 转化者的风险显著高于 PP（4.8%）和 PP（3.7%）。转化者的特征是接触到索引病例的时间间隔较短，从症状出现到诊断的时间中位数减少了 50.0 天（P=0.013）。
与定量变化的持续阳性 QFT 反应相比，QFT 转化与更高的 TB 风险和暴露于快速进展的 TB 相关。
