Tuberculosis progression rates in U.S. Immigrants following screening with interferon-gamma release assays.
Tuberculosis progression rates in U.S. Immigrants following screening with interferon-gamma release assays.
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DOI：
10.1186/s12889-016-3519-6
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发表时间：
2016-08-25
影响因子：
4.5
通讯作者：
Nahid P
中科院分区：
文献类型：
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作者：
Blount RJ;Tran MC;Everett CK;Cattamanchi A;Metcalfe JZ;Connor D;Miller CR;Grinsdale J;Higashi J;Nahid P
干扰素-γ释放试验可作为检测结核分枝杆菌感染的结核菌素皮肤试验的替代方法。然而，在移民中使用干扰素-伽马释放分析进行筛查后，活动性结核病的风险并未得到很好的定义。为了解决这些不确定性，我们确定了一组患有B类结核病的高危移民在抵达美国后进行干扰素-伽马释放分析(IGRA)筛查后的活动性结核病发病率。采用回顾性队列设计，我们招募了从2005年1月到2010年12月在旧金山公共卫生部结核病控制诊所接受IGRA(Quantiferon®Gold或Gold In-Tube Assay)筛查的B类结核病新移民。我们审查了结核病控制患者管理数据库和加州公共卫生部结核病病例登记处的记录，以确定截至2015年2月的活动性结核病病例。在1233名符合IGRA筛查基线的移民中，81人(6.6%)在初步评估后被诊断为活动性结核病。在其余1152名基线没有活动性结核病的参与者中，513人检测IGRA阳性，639人检测IGRA阴性。7名参与者在7730人年的随访中患上了事件活动性结核病，发病率为91/10万人年(95%可信区间43-190)。5名IGRA阳性和2名IGRA阴性的参与者患上活动性肺结核(发病率分别为每100,000人年139例(95%可信区间58-335)和48例/100 000人年(95%可信区间12-193))，未调整的发病率比为2.9(95%可信区间为0.5-30，p = 为0.21)。IGRA检测结果的阴性预测值为99.7%，但阳性预测值仅为0.97%。在进入美国时没有活动性结核病的高危移民中，IGRA阳性的参与者比IGRA阴性的参与者进展为活动性结核病的风险更高。然而，这些发现没有达到统计学意义，登记时IGRA阳性对进展为活动性结核病的预测价值较差。还需要进行更多的研究来确定生物标记物，并开发临床算法，以更好地预测美国移民中活动性结核病的进展。
Interferon-gamma release assays may be used as an alternative to the tuberculin skin test for detection of M. tuberculosis infection. However, the risk of active tuberculosis disease following screening using interferon-gamma release assays in immigrants is not well defined. To address these uncertainties, we determined the incidence rates of active tuberculosis disease in a cohort of high-risk immigrants with Class B TB screened with interferon-gamma release assays (IGRAs) upon arrival in the United States. Using a retrospective cohort design, we enrolled recent U.S. immigrants with Class B TB who were screened with an IGRA (QuantiFERON ® Gold or Gold In-Tube Assay) at the San Francisco Department of Public Health Tuberculosis Control Clinic from January 2005 through December 2010. We reviewed records from the Tuberculosis Control Patient Management Database and from the California Department of Public Health Tuberculosis Case Registry to determine incident cases of active tuberculosis disease through February 2015. Of 1233 eligible immigrants with IGRA screening at baseline, 81 (6.6 %) were diagnosed with active tuberculosis disease as a result of their initial evaluation. Of the remaining 1152 participants without active tuberculosis disease at baseline, 513 tested IGRA-positive and 639 tested IGRA-negative. Seven participants developed incident active tuberculosis disease over 7730 person-years of follow-up, for an incidence rate of 91 per 100,000 person-years (95 % CI 43–190). Five IGRA-positive and two IGRA-negative participants developed active tuberculosis disease (incidence rates 139 per 100,000 person-years (95 % CI 58–335) and 48 per 100,000 person-years (95 % CI 12–193), respectively) for an unadjusted incidence rate ratio of 2.9 (95 % CI 0.5–30, p = 0.21). IGRA test results had a negative predictive value of 99.7 % but a positive predictive value of only 0.97 %. Among high-risk immigrants without active tuberculosis disease at the time of entry into the United States, risk of progression to active tuberculosis disease was higher in IGRA-positive participants compared with IGRA-negative participants. However, these findings did not reach statistical significance, and a positive IGRA at enrollment had a poor predictive value for progressing to active tuberculosis disease. Additional research is needed to identify biomarkers and develop clinical algorithms that can better predict progression to active tuberculosis disease among U.S. immigrants.