Predictors of Discordant Tuberculin Skin Test and QuantiFERON-TB Gold In-tube Results in Eastern China: A Population-based, Cohort Study
Predictors of Discordant Tuberculin Skin Test and QuantiFERON-TB Gold In-tube Results in Eastern China: A Population-based, Cohort Study
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DOI：
10.1093/cid/ciaa519
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发表时间：
2021-06-01
影响因子：
11.8
通讯作者：
Lu, Wei
中科院分区：
文献类型：
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作者：
Lu, Peng;Liu, Qiao;Lu, Wei
背景QuantiFERON-TB Gold In-tube（QFT）和结核菌素皮肤试验（TST）之间的不一致性尚不清楚。我们的目的是确定在中等结核病（TB）负担设置下，TST和QFT与TST（+）QFT（+）或TST（-）QFT（-）结果相比不一致的因素。我们在中国东部进行了一项基于人群的研究，并对参与者进行了TST和QFT。我们在构建多变量逻辑回归模型时计算kappa值，以评估检验不一致性的预测因子。我们分析了6年随访中不一致和一致检测结果对结核病进展的预测价值。总体而言，5405例受试者入组; 2043例（37.8%）和1104例（20.4%）分别为TST和QFT阳性。TST和QFT之间存在公平的一致性（在不同的TST截止值下，kappa值在0.30-0.39之间）。接种卡介苗的参与者之间的一致性较低（BCG; kappa值为0.17，未接种疫苗的参与者为0.47）。TST（+）QFT（-）结果与年龄降低、吸烟、未确诊的糖尿病和卡介苗接种相关（校正比值比，1.45; 95%置信区间[CI]，1.11-1.90）。TST（-）QFT（+）结果与年龄增加、男性、吸烟和诊断的糖尿病相关。与TST（-）QFT（-）结果的参与者相比，QFT（+）和TST（+）QFT（+）参与者进展为TB的可能性分别为6.3（95%CI，1.9-20.4）和7.5（95%CI，2.3-25.1）倍。在这项基于人群的研究中，来自中等结核病负担地区的5000多名参与者，QFT和TST之间的测试一致性总体上是公平的，我们发现了多个不一致的QFT/TST结果的新预测因子。QFT在这些人群中提供了TST的实质性改善，并且在预测TB进展方面更好。
Background. Discordance between the QuantiFERON-TB Gold In-tube (QFT) and tuberculin skin test (TST) is not well understood. We aimed to identify the factors that determine discordance between the TST and QFT when compared to either TST(+)QFT(+) or TST(-)QFT(-) results in a medium tuberculosis (TB) burden setting.Methods. We conducted a population-based study in Eastern China and administered TSTs and QFTs to participants. We calculated kappa values while constructing multivariable logistic regression models to evaluate predictors of test discordance. We analyzed the predictive value of discordant and concordant test results for progression to TB over 6 years of follow-up.Results. Overall, 5405 participants were enrolled; 2043 (37.8%) and 1104 (20.4%) were TST and QFT positive, respectively. There was fair agreement between the TST and the QFT (kappa values between 0.30-0.39 at different TST cutoffs). Agreement was lower among participants vaccinated with Bacillus Calmette-Guerin (BCG; kappa, 0.17 versus 0.47 in nonvaccinated participants). TST(+)QFT(-) results were associated with decreasing age, smoking, undiagnosed diabetes, and BCG vaccination (adjusted odds ratio, 1.45; 95% confidence interval [CI], 1.11-1.90). TST(-)QFT(+) results were associated with increasing age, male sex, smoking, and diagnosed diabetes. Compared to participants with TST(-)QFT(-) results, QFT(+) and TST(+)QFT(+) participants were 6.3 (95% CI, 1.9-20.4) and 7.5 (95%CI, 2.3-25.1) times more likely to progress to TB, respectively.Conclusions. In this population-based study of over 5000 participants from a medium TB burden region, the test agreement between QFT and TST was fair overall and we found multiple novel predictors of discordant QFT/TST results. QFT provides a substantial improvement to the TST among these populations and was multi-fold better at predicting progression to TB.