Negative and Positive Predictive Value of a Whole-Blood Interferon-γ Release Assay for Developing Active Tuberculosis An Update
Negative and Positive Predictive Value of a Whole-Blood Interferon-γ Release Assay for Developing Active Tuberculosis An Update
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DOI：
10.1164/rccm.201006-0974oc
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发表时间：
2011-01-01
影响因子：
24.7
通讯作者：
Nienhaus, Albert
中科院分区：
文献类型：
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作者：
Diel, Roland;Loddenkemper, Robert;Nienhaus, Albert
基本原理干扰素-γ释放检测对潜伏性结核病感染进展为活动性结核病（TB）的预测价值只有有限的数据。目的：在我们最初的研究基础上，比较QuantiFERON-TB Gold试管内检测（QFT）和结核菌素皮肤试验（TST）在密切接触结核病患者中的作用，并评估长达4年的活动性结核病进展。方法：对2005年5月至2008年4月间建立的涂阳指示病例的密切接触者队列进行QFT和TST检测：至2010年4月，连续记录活动性结核病进展者。在1，414名接触者（141名儿童）中，1，033人在研究期结束时仍居住在汉堡，954人的两项检测结果均可用。QFT而非TST结果与暴露时间相关（P < 0.0001）。对于QFT，954例中有198例（20.8%）为阳性; 63.3%（604例）TST阳性大于5 mm，25.4%大于10 mm。903例接触者拒绝化学预防，19例发展为活动性TB。所有19例患者（100%）均为QFT阳性，在观察期内的进展率为12.9%（19/147）。TST的相应值显著较低：大于5 mm时分别为89.5%（17/19）和3.1%（17/555），大于10 mm时分别为52.6%（10/19）和4.8%（10/207）。QFT阳性儿童的进展率为28.6%（6/21），显著高于成人的10.3%（13/126）（P = 0.03）。结论：结果表明，QFT比TST更可靠地识别那些谁很快将进展为活动性结核病，特别是在儿童中。
Rationale Only limited data are available on the predictive value of interferon-gamma release assays for progression from latent tuberculosis infection to active tuberculosis (TB).Objectives: To build on our initial study comparing the QuantiFERON-TB Gold in-tube assay (QFT) with the tuberculin skin test (TST) in close contacts of patients with TB and evaluating progression to active TB for up to 4 years.Methods: A cohort of close contacts of smear-positive index cases established between May 2005 and April 2008 was tested with QFT and TST: Through April 2010, progressors to active TB were consecutively recorded.Measurements and Main Results: Of the 1,414 contacts (141 children), 1,033 were still resident in Hamburg at the end of the study period, and results of both tests were available for 954. QFT, but not TST, results were associated with exposure time (P < 0.0001). For QFT, 198 of 954 (20.8%) were positive; 63.3% (604) were TST positive at greater than 5 mm and 25.4% at greater than 10 mm. Nine hundred and three contacts refused chemoprevention and 19 developed active TB. All 19 (100%) had been QFT positive with a progression rate of 12.9% (19 of 147) over the observation period. Corresponding values for the TST were significantly lower: 89.5% (17 of 19) and 3.1% (17 of 555) at greater than 5 mm, and 52.6% (10 of 19) and 4.8% (10 of 207) at greater than 10 mm, respectively. The progression rate of 28.6% (6 of 21) for QFT-positive children was significantly higher than 10.3% (13 of 126) for adults (P = 0.03).Conclusions: Results suggest that QFT is more reliable than the TST for identifying those who will soon progress to active TB, especially in children.