The Dynamics of QuantiFERON-TB Gold In-Tube Conversion and Reversion in a Cohort of South African Adolescents
The Dynamics of QuantiFERON-TB Gold In-Tube Conversion and Reversion in a Cohort of South African Adolescents
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DOI：
10.1164/rccm.201409-1704oc
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发表时间：
2015-03-01
影响因子：
24.7
通讯作者：
Scriba, Thomas J.
中科院分区：
文献类型：
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作者：
Andrews, Jason R.;Hatherill, Mark;Scriba, Thomas J.
原理：干扰素-γ释放试验用于诊断结核感染。在发达国家，高逆转率以下conversion has been described.Objectives：To assess QuantiFERON TB Gold In-Tube Test（QFT）conversion and reversion dynamics in a tuberculosis-endemic setting.Methods：招募了居住在开普敦附近的12-18岁青少年。在基线和2年随访后进行了阿曲库林皮肤试验（TST）和QFT。一半的参与者在其他时间点进行了TST和QFT。测量和主要结果：在5，357名参与者中，2，751名（51.4%）和2，987名（55.8%）基线时QFT和TST结果分别为阳性。年化QFT和TST转换风险分别为14.0%和13.0%，逆转风险分别为5.1%和4.1%。转换的一致性极佳（kappa = 0.74），但逆转的一致性较差（kappa = 0.42）。在最近的QFT转换者中，QFT值的大小与逆转风险呈强负相关（P < 0.0001）。当以横断面方式分析纵向QFT数据时，感染的年风险为7.3%，而在分析中纳入逆转显示感染的实际风险为14.0%。QFT逆转者的结核病发病率是所有阴性QFT结果参与者的8倍（1.47 vs. 0.18例/100人-年，P = 0.011）。结论：在结核病流行环境中，每年感染的风险极高，而QFT和TST转换一致性较高，QFT逆转率低于低负担环境中报告的。
Rationale: Interferon-gamma release assays are used to diagnose tuberculosis infection. In developed countries, high rates of reversion following conversion have been described.Objectives: To assess QuantiFERON TB Gold In-Tube test (QFT) conversion and reversion dynamics in a tuberculosis-endemic setting.Methods: Adolescents aged 12-18 years residing near Cape Town were recruited. Tuberculin skin tests (TSTs) and QFTs were performed at baseline and after 2 years of follow up. Half of the participants had TST and QFT performed at additional time points. Participants were Observed for incident tuberculosis disease for up to 5 years.Measurements and Main Results: Among 5,357 participants, 2,751 (51.4%) and 2,987 (55.8%) had positive QFT and TST results, respectively, at baseline. Annualized QFT and TST conversion risks were 14.0 and 13.0%, respectively, and reversion risks were 5.1 and 4.1%, respectively. Concordance was excellent for conversions (kappa = 0.74), but poor for reversions (kappa = 042). Among recent QFT converters, the magnitude of the QFT value was strongly inversely associated with risk of reversion (P < 0.0001). When longitudinal QFT data were analyzed in a cross-sectional manner, the annual risk of infection was 7.3%, whereas inclusion of reversions in the analysis showed that the actual risk of infection was 14.0%. Incident tuberculosis was 8-fold higher among QFT reverters than in participants with all negative QFT results (1.47 vs. 0.18 cases/100 person-years, P = 0.011).Conclusions: In this tuberculosis-endemic setting, annual risk of infection was extremely high, whereas QFT and TST conversion concordance was higher and QFT reversion rates were lower than reported in low-burden settings.