Comparison of two interferon-γ assays and tuberculin skin test for tracing tuberculosis contacts
Comparison of two interferon-γ assays and tuberculin skin test for tracing tuberculosis contacts
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DOI：
10.1164/rccm.200608-1099oc
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发表时间：
2007-03-15
影响因子：
24.7
通讯作者：
Bossink, Ailko W. J.
中科院分区：
文献类型：
--
作者：
Arend, Sandra M.;Thijsen, Steven F. T.;Bossink, Ailko W. J.
背景：结核菌素皮肤试验(TST)特异性低。Quantiferon-TB Gold(QFT-G)和T-SPOT.TB是基于干扰素(干扰素)-伽马对结核分枝杆菌特异性抗原的反应。目的：比较TST、QFT-GIT和T-SPOT.TB在未接种卡介苗的接触者中的情况，并将结果与最近的暴露措施相关联。方法：当一名涂阳结核病超市员工感染了最密切的接触者时，对2万多名顾客进行接触调查。我们在服用TST当天随机招募受试者(n=469)，并在TST阅读当天随机招募TST>0 mm的受试者(n=316)。行QFT-GIT和T-SPOT.TB检查。收集了人口统计数据和暴露的衡量标准。TST结果以10 mm或15 mm为分界点进行分析。结果：在785名研究参与者中，TST结果与年龄有关，而干扰素-γ阳性反应与累积购物时间显著相关，其中QFT-GLT最为显著。在TST大于或等于15 mm的受试者中，QFT-GLT和T-SPOT.TB的敏感性分别为42.2%和51.3%。批间一致性为89.6%(kappa=0.59)。根据不同的临界值，以93.6%(kappa=0.71)作为临界值，QFT-GIT和T-SPOTB的临界值分别为0.20IU/ml和13个点。结论：血检结果与暴露有关，而TST与暴露无关。尽管卡介苗疫苗接种状态为阴性，但干扰素-γ检测在检测TST大于或等于15 mm的个体时可能缺乏敏感性，因此需要进一步研究替代的临界值。
Background: The tuberculin skin test (TST) has low specificity. QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB are based on interferon (IFN)-gamma responses to Mycobacterium tuberculosis-specific antigens. A novel in-tube format of QFT-G (QFT-GIT) offers logistical advantages.Objective: To compare TST, QFT-GIT, and T-SPOT.TB in bacillus Calmette-Guerin unvaccinated contacts and correlate results with measures of recent exposure.Methods: When a supermarket employee with smear-positive tuberculosis had infected most close contacts, a contact investigation among more than 20,000 customers was performed. We recruited subjects randomly on the day of TST administration (n = 469) and subjects with TST of more than 0 mm on the day of TST reading (n = 316). QFT-GIT and T-SPOT.TB were performed. Demographic data and measures of exposure were collected. TST results were analyzed at a cutoff of 10 or 15 mm. Blood tests were interpreted following the manufacturers' criteria and by varying cutoff levels.Results: Among 785 study participants, TST results were associated with age, whereas positive IFN-gamma responses were significantly associated with cumulative shopping time, most markedly for QFT-GlT. Among participants with a TST of 15 mm or greater, sensitivity of QFT-GlT and T-SPOT.TB was 42.2 and 51.3%, respectively. Interassay agreement was 89.6% (kappa = 0.59). By varying cutoff values, agreement between the IFN-gamma assays was optimal at 93.6% (kappa = 0.71) using a cutoff of 0.20 IU/ml for QFT-GIT and 13 spots for T-SPOT.TB.Conclusions: Blood test results were associated with exposure, whereas the TST was not. A possible lack of sensitivity of IFN-gamma assays in detecting individuals with TST of 15 mm or greater, despite negative bacillus Calmette-Guerin vaccination status, warrants further investigation into alternative cutoff values.