Routine hospital use of a new commercial whole blood interferon-γ assay for the diagnosis of tuberculosis infection
Routine hospital use of a new commercial whole blood interferon-γ assay for the diagnosis of tuberculosis infection
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DOI：
10.1164/rccm.200502-196oc
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发表时间：
2005-09-01
影响因子：
24.7
通讯作者：
Richeldi, L
中科院分区：
文献类型：
--
作者：
Ferrara, G;Losi, M;Richeldi, L
原理：干扰素（IFN）-γ血液检测可能会提高目前结核感染诊断的准确性水平。Quanti-FERON-TB Gold（QFT-Gold）已用于选定人群，显示出比结核菌素皮肤试验（TST）更高的特异性。目的：评价QFT-Gold试验在脑卒中患者中的应用价值，并评价其与TST的一致性。方法：在我院微生物实验室对全血标本进行8个月的常规检测。收集了人口统计学、临床和微生物学数据，并将其与QFT-Gold结果相关联。测量和主要结果：在318例受试患者中，68例（21.4%）给出了不确定（低阳性有丝分裂原对照）QFT-Gold结果。在TST阴性的患者中，不确定结果的比例显着过高（28.9% vs. 6.6%，TST阳性患者; p < 0.0001，卡方检验），并且在接受免疫抑制治疗的患者中比未接受此类治疗的患者更常见。（比值比，3.35; 95%置信区间，1.84-6.08; p < 0.0001）。排除不确定结果后，卡介苗接种个体（41.5%）的QFT-Gold和TST之间的一致性显著低于未接种个体（80.3%）（p < 0.0001）。在11例活动性肺结核患者（5例经培养证实）中，QFT-Gold提供的阳性结果高于TST（66.7% vs. 33.3%; p = 0.165）。结论：QFT-Gold试验在医院常规使用诊断结核感染是可行的。与TST一样，免疫抑制可能会对测试的性能产生负面影响，在最脆弱的人群中，不确定结果的发生率很高。
Rationale: Interferon (IFN)-gamma blood tests may improve the current level of diagnostic accuracy for tuberculosis infection. The Quanti-FERON-TB Gold (QFT-Gold) has been used in selected populations and shows higher specificity than the tuberculin skin test (TST). Objective: To evaluate the QFT-Gold test in unselected patients and assess the level of agreement with the TST. Methods: The test has been routinely performed on whole blood samples in our microbiology laboratory for 8 months. Demographic, clinical, and microbiological data have been collected and correlated to the QFT-Gold results. Measurements and Main Results: Of 318 patients tested, 68 (21.4%) gave an indeterminate (low positive mitogen control) QFT-Gold result. Indeterminate results were significantly overrepresented in patients with a negative TST (28.9% vs. 6.6% in TST-positive patients; p < 0.0001, chi(2) test) and were more frequent in patients receiving immunosuppressive therapies than in those who were not receiving such treatments (odds ratio, 3.35; 95% confidence interval, 1.84-6.08; p < 0.0001). After excluding indeterminate results, the concordance between QFT-Gold and TST was significantly lower in Bacille Calmette-Guerin-vaccinated individuals (41.5%) than in nonvaccinated individuals (80.3%) (p < 0.0001). In 11 patients with active tuberculosis (5 culture-confirmed), QFT-Gold provided more positive results than the TST (66.7% vs. 33.3%; p = 0.165). Conclusions: The QFT-Gold test is feasible in routine hospital use for the diagnosis of tuberculosis infection. As with the TST, immunosuppression may negatively affect the test's performance, with a significant rate of indeterminate results in the most vulnerable population.