Interferon-γ Release Assays and Tuberculin Skin Testing for Diagnosis of Latent Tuberculosis Infection in Healthcare Workers in the United States
Interferon-γ Release Assays and Tuberculin Skin Testing for Diagnosis of Latent Tuberculosis Infection in Healthcare Workers in the United States
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DOI：
10.1164/rccm.201302-0365oc
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发表时间：
2014-01-01
影响因子：
24.7
通讯作者：
Daley, Charles L.
中科院分区：
文献类型：
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作者：
Dorman, Susan E.;Belknap, Robert;Daley, Charles L.
原理：IFN-γ释放试验（IGRAs）是结核菌素皮肤试验（TST）的替代方法，用于诊断潜伏性结核感染。有限的数据表明，IGRAs可能没有表现良好的连续测试的医护人员（HCWs.Objectives：确定的性能特点IGRAs与TST的连续测试HCWs.Methods：一项纵向研究，涉及2,563 HCWs进行职业性结核病筛查在四个医疗机构在美国，平均肺结核病例率范围从4至9每10万人。QuantiFERON-TB Gold In-Tube（QFT-GIT），T-SPOT。方法：2008年2月至2011年3月，共对2,418名医务人员进行基线TST、QFT-GIT和T-SPOT检测，其中TST阳性125例（5.2%），QFT-GIT阳性118例（4.9%），T-SPOT阳性144例（6.0%）。基线TST阳性伴IGRA阴性与卡介苗（BCG）接种相关（比值比：25.1 [95%置信区间：15.5，40.5] vs.无BCG）。在研究期间，2，263名参与者中有138名（6.1%）接受了QFT-GIT，177名（8.3%）接受了T-SPOT，2，293名（0.9%）接受了TST（QFT-GIT与TST和T-SPOT与TST的P < 0.001; QFT-GIT与T-SPOT的P = 0.005）。在QFT-GIT和T-SPOT转换器中，分别有81/106（76.4%）和91/118（77.1%）在6个月后重新测试时呈阴性。有15的170（8.8%）的QFT-GIT和19的151（12.6%）的T-SPOT参与者的负/正不一致时，血液被抽2 weeks later.Conclusions：大多数转换HCWs之间的低TB发病率设置出现假阳性，这些发生6至9倍更频繁与IGRA比TST;重复测试的明显转换器是必要的。
Rationale: IFN-gamma release assays (IGRAs) are alternatives to tuberculin skin testing (TST) for diagnosis of latent tuberculosis infection. Limited data suggest IGRAs may not perform well for serial testing of healthcare workers (HCWs).Objectives: Determine the performance characteristics of IGRAs versus TST for serial testing of HCWs.Methods: A longitudinal study involving 2,563 HCWs undergoing occupational tuberculosis screening at four healthcare institutions in the United States, where the average tuberculosis case rate ranged from 4 to 9 per 100,000 persons. QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT. TB (T-SPOT), and TST were performed at baseline and every 6 months for 18 months between February 2008 and March 2011.Measurements and Main Results: A total of 2,418 HCWs completed baseline testing, which was positive for 125 (5.2%) by TST, 118 (4.9%) by QFT-GIT, and 144 (6.0%) by T-SPOT. A baseline positive TST with negative IGRAs was associated with bacillus Calmette-Guerin (BCG) vaccination (odds ratio: 25.1 [95% confidence interval: 15.5, 40.5] vs. no BCG). Proportions of participants with test conversion during the study period were 138 of 2,263 (6.1%) for QFT-GIT, 177 of 2,137 (8.3%) for T-SPOT, and 21 of 2,293 (0.9%) for TST (P < 0.001 for QFT-GIT vs. TST and for T-SPOT vs. TST; P = 0.005 for QFT-GIT vs. T-SPOT). Of the QFT-GIT and T-SPOT converters, 81 of 106 (76.4%) and 91 of 118 (77.1%), respectively, were negative when retested 6 months later. There was negative/positive discordance for 15 of 170 (8.8%) participants by QFT-GIT and for 19 of 151 (12.6%) by T-SPOT when blood was drawn 2 weeks later.Conclusions: Most conversions among HCWs in low TB incidence settings appear to be false positives, and these occurred six to nine times more frequently with IGRAs than TST; repeat testing of apparent converters is warranted.