韩国军队中定量干扰素-γ释放试验预测结核病的回顾性队列研究。

Quantitative interferon-gamma releasing assay in predicting tuberculosis in South Korean military: a retrospective cohort study.

机构信息

Department for Infection Control, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea.

Department of Military Service Examination, Gyeongin Regional Military Manpower Administration, Suwon, Republic of Korea.

出版信息

Clin Microbiol Infect. 2024 Oct;30(10):1284-1290. doi: 10.1016/j.cmi.2024.04.014. Epub 2024 Apr 30.

DOI:10.1016/j.cmi.2024.04.014

PMID:38697393

Abstract

OBJECTIVE

The interferon-gamma releasing assay (IGRA) has been widely used to diagnose latent tuberculosis infection (TBI). However, there are limited data on the association between performance in the IGRA and risk of tuberculosis disease (TBD), as well as on the appropriate IGRA threshold for initiating TBI treatment.

METHODS

The analysis was performed using the IGRA results in the Korean Military Manpower Administration database (January 2017 to December 2021), and TBD cases reported to the Korean Military Medical Command (January 2017 to June 2023). All Korean candidates for 18-month military service underwent the IGRA in the pre-enlistment examination, and enlistees who tested positive (≥0.35 IU/mL) were advised to receive TBI treatment before enlistment.

RESULTS

From 2017 to 2021, 1 647 941 individuals were screened, with 29 574 testing positive for IGRA. Excluding nonenlistees namely individuals with TBD before enlistment, 19 387 individuals were IGRA positive and 1 356 324 IGRA negative. Of the positives, 4351 were excluded due to discontinued or ongoing TBI treatment at or after enlistment. During follow-up of 9219 untreated and 5818 treated positive individuals and 1 356 324 negatives, TBD occurred in 22 of the IGRA-positive individuals (97.5/100 000 person-years [95% CI, 61.1-147.7]), predominantly in the untreated group (18 cases, 130.1/100 000 person-years [95% CI, 77.1-205.7]) compared to the treated group (4 cases, 45.9/100 000 person-years [95% CI 12.5 - 117.4]), whereas 57 cases occurred in the IGRA-negative group (2.8/100 000 person-years [95% CI, 2.2-3.6]). Elevating the cutoff of IGRA from 0.35 IU/mL to 1.33 IU/mL increased positive predictive value (0.2% vs. 0.4%, p 0.03), with insignificant loss of sensitivity (24% vs. 20%, p 0.69) and decreased numbers needing treatment from 790.5 to 415.3.

DISCUSSION

Elevated IGRA levels before enlistment are associated with risk of TBD during military service. It is worth considering raising the IGRA threshold for treatment of TBI in cohorts of healthy, young military individuals.

摘要

目的

干扰素释放试验（IGRA）已广泛用于诊断潜伏性结核感染（TBI）。然而，关于 IGRA 检测结果与结核病发病风险之间的关联，以及启动 TBI 治疗的适当 IGRA 阈值，数据有限。

方法

分析使用了韩国兵役管理局数据库中的 IGRA 结果（2017 年 1 月至 2021 年 12 月）和向韩国军事医疗司令部报告的结核病发病病例（2017 年 1 月至 2023 年 6 月）。所有参加 18 个月兵役的韩国应征者在入伍前检查中都接受了 IGRA 检测，IGRA 检测结果阳性（≥0.35IU/mL）的应征者在入伍前被建议接受 TBI 治疗。

结果

2017 年至 2021 年，共有 1 647 941 人接受了筛查，其中 29 574 人 IGRA 检测结果阳性。排除入伍前已患有结核病的非入伍者，共有 19 387 人 IGRA 阳性和 1 356 324 人 IGRA 阴性。在阳性者中，有 4351 人因入伍后或入伍前已停止或正在接受 TBI 治疗而被排除。在对 9219 名未经治疗和 5818 名经治疗的阳性者以及 1 356 324 名阴性者进行随访后，IGRA 阳性者中有 22 人（97.5/100 000 人年[95%CI，61.1-147.7]）发生结核病，主要发生在未经治疗组（18 例，130.1/100 000 人年[95%CI，77.1-205.7]），而在经治疗组（4 例，45.9/100 000 人年[95%CI，12.5-117.4]）和 IGRA 阴性组（57 例，2.8/100 000 人年[95%CI，2.2-3.6]）中则较少见。将 IGRA 截断值从 0.35IU/mL 提高到 1.33IU/mL 增加了阳性预测值（0.2%比 0.4%，p 0.03），但敏感性无显著下降（24%比 20%，p 0.69），需要治疗的人数从 790.5 人减少到 415.3 人。