Tuberculin skin test and interferon-γ release assay show better correlation after the tuberculin 'window period' in tuberculosis contacts
Tuberculin skin test and interferon-γ release assay show better correlation after the tuberculin 'window period' in tuberculosis contacts
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DOI：
10.3109/00365548.2011.558912
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Gonzalez-Fernandez, Africa
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文献类型：
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作者：
Anibarro, Luis;Trigo, Matilde;Gonzalez-Fernandez, Africa
背景资料：T细胞干扰素-γ释放试验（IGRA）已被证明是检测结核分枝杆菌感染的有效工具，与结核菌素皮肤试验（TST）相比，它具有更高的特异性。大多数结核病（TB）接触研究显示IGRA与M强度有更好的相关性。结核病暴露比使用TST获得。然而，在结核菌素“窗口期”（感染与免疫反应变得可测量之间的时间）之前和之后进行的测试之间的相关性仍有待研究。方法：对结核病接触者进行纵向前瞻性分析。我们分析了市售IGRA（QuantiFERON（R）-TB Gold in-Tube，QFT）与结核菌素窗口期（2个月）前后TST之间的相关性。使用Kappa系数（kappa）评估两种检测之间的一致性。同时分析了两种检测方法与结核病暴露程度的相关性。结果：152例结核病接触者被纳入研究。TST和IGRA之间的一致性在窗口期后更好（首次访视时kappa = 0.60，2个月后kappa = 0.73），特别是对于未接种BCG的受试者（kappa = 0.81）。在窗口期后，阳性TST和QFT均与接触部位的大小（接触部位越小，阳性检测的概率越高）（分别为p = 0.022和p = 0.02）以及与索引病例花费的总小时数（TST为p = 0.006，QFT为p = 0.007）相关。结论：IGRA是一个很好的替代TST接触追踪研究，特别是在结核菌素窗口期。
Background: T-cell interferon-gamma release assays (IGRAs) have been shown to be effective tools for the detection of Mycobacterium tuberculosis infection, offering an enhanced specificity compared to the tuberculin skin test (TST). Most tuberculosis (TB) contact studies have shown a better correlation of IGRA with the intensity of M. tuberculosis exposure than that obtained using the TST. However, the correlation between tests performed before and after the tuberculin 'window period' (time between infection and when the immunological response becomes measurable) remains to be studied. Methods: A longitudinal prospective analysis was performed in TB contacts. We analyzed the correlation between a commercially available IGRA (QuantiFERON (R)-TB Gold in-Tube, QFT) and the TST before and after the tuberculin window period (2 months). Concordance between both tests was assessed using the Kappa coefficient (kappa). Correlation of both tests with the degree of TB exposure was also analyzed. Results: One hundred and fifty-two TB contacts were included in the study. Agreement between the TST and IGRA was better after the window period (kappa = 0.60 at the first visit and kappa = 0.73 after 2 months), especially for non-BCG vaccinated subjects (kappa = 0.81). Both a positive TST and QFT were correlated, after the window period, with the size of place of contact (the smaller the place of contact, the higher the probability of having a positive test) (p = 0.022 and p = 0.02, respectively) and with the total numbers of hours spent with the index case (p = 0.006 for TST and p = 0.007 for QFT). Conclusions: IGRAs are a good alternative to the TST in contact tracing studies, especially after the tuberculin window period.