Interferon-γ release assays do not identify more children with active tuberculosis than the tuberculin skin test
Interferon-γ release assays do not identify more children with active tuberculosis than the tuberculin skin test
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DOI：
10.1183/09031936.00153408
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发表时间：
2009-06-01
影响因子：
24.3
通讯作者：
Anderson, S. T.
中科院分区：
文献类型：
--
作者：
Kampmann, B.;Whittaker, E.;Anderson, S. T.
关于儿童干扰素γ释放试验（IGRAs）的性能数据缺乏。尽管IGRAs被推荐用于筛查潜伏性结核感染（LTBI），但许多临床医生希望将其用作活动性结核（TB）的诊断测试。本研究的目的是比较两种市售IGRAs和结核菌素皮肤试验（TST）在活动性结核病和LTBI儿童中的表现。在一项前瞻性研究中，209名儿童接受了活动性（n=91）或潜伏性结核病（n=118）的调查。TST， QuantiFERON-TB金管（QFG-IT; Cellestis, Carnegie, Australia）和T-SPOT。同时使用TB （Oxford immunnote, Abingdon， UK）测定法。对于培养确认的活动性结核，TST的敏感性为83%，而QFG-IT为80%，T-SPOT.TB为58%。尽管QFG-IT明显优于T-SPOT.TB，但IGRAs的表现并没有明显优于TST。QFG-IT与T-SPOT之间的协议。结核菌确诊结核病的发生率较低，为66.7%。在LTBI中，QFG-IT和T-SPOT之间的协议。TB非常好（92%），TST和T-SPOT之间的一致性中等。TB（75%）、QFG-IT和TST（77%）。干扰素释放试验阴性不应阻止儿科医生诊断和治疗推定的活动性结核病。如果用于诊断潜伏性结核感染，干扰素释放试验可以显著减少接受化学预防治疗的儿童人数。两种测试结果的一致性非常好。
Data are lacking on the performance of interferon-gamma release assays (IGRAs) in children. Although IGRAs are recommended for screening for latent tuberculosis infection (LTBI), many clinicians wish to employ them as a diagnostic test for active tuberculosis (TB). The objective of the present study was to compare the performance of the two commercially available IGRAs and the tuberculin skin test (TST) side-by-side in children with active TB and LTBI.In a prospective study, 209 children were investigated for active (n=91) or latent TB (n=118). TST, QuantiFERON-TB Gold In-tube (QFG-IT; Cellestis, Carnegie, Australia) and T-SPOT.TB (Oxford Immunotec, Abingdon, UK) assays were simultaneously used.For culture-confirmed active TB, the sensitivity of the TST was 83%, compared with 80% for QFG-IT and 58% for T-SPOT.TB. IGRAs did not perform significantly better than TST, although QFG-IT was significantly better than T-SPOT.TB. The agreement between QFG-IT and T-SPOT.TB in culture-confirmed TB was poor at 66.7%. In LTBI, the agreement between QFG-IT and T-SPOT.TB was very good (92%) with moderate agreement between TST and T-SPOT.TB (75%) and QFG-IT and TST (77%).A negative interferon-gamma release assay should not dissuade paediatricians from diagnosing and treating presumed active tuberculosis. If used for diagnosis of latent tuberculosis infection, interferon-gamma release assays could significantly reduce the numbers of children receiving chemoprophylaxis. Very good concordance between both tests was found.