Stratification by interferon- release assay level predicts risk of incident TB
Stratification by interferon- release assay level predicts risk of incident TB
复制标题
DOI：
10.1136/thoraxjnl-2017-211147
复制
发表时间：
2018-07-01
期刊：
影响因子：
10
通讯作者：
Kran, Anne Marte Bakken
中科院分区：
文献类型：
--
作者：
Winje, Brita Askeland;White, Richard;Kran, Anne Marte Bakken
对潜伏性结核感染（LTBI）进行有针对性的检测和治疗是全球卫生议程上的优先事项，但LTBI管理仍然具有挑战性。我们的目的是评价QuantiFERON TB-Gold（QFT）检测在结核病低发病率环境中应用于常规实践时对结核病事件的预后价值，重点关注干扰素（IFN）水平。（2009年1月1日至2014年6月30日）（挪威传染病监测系统，挪威处方数据库，挪威患者登记处和挪威统计局）评估QFT对新发结核病的预后价值。参与者随访至2016年6月30日。我们使用限制性三次样条模型IFN-水平和TB之间的非线性关系，并将这些研究结果的竞争风险model.Results的前瞻性分析包括50 389 QFT结果从44 875个人，其中257开发TB。总体而言，22%（n=9878）的QFT结果为阳性。TB风险随着IFN水平的升高而升高，直至达到平台水平，高于平台水平进一步升高与额外的预后信息无关。TB的HR分别为8.8（95% CI 4.7至16.5）、19.2（95% CI 11.6至31.6）和31.3（95% CI 19.8至49.5）倍，IFN-γ水平为0.35至100 mg/kg。
Introduction Targeted testing and treatment of latent TB infection (LTBI) are priorities on the global health agenda, but LTBI management remains challenging. We aimed to evaluate the prognostic value of the QuantiFERON TB-Gold (QFT) test for incident TB, focusing on the interferon (IFN)- level, when applied in routine practice in a low TB incidence setting.Methods In this large population-based prospective cohort, we linked QFT results in Norway (1 January 2009-30 June 2014) with national registry data (Norwegian Surveillance System for Infectious Diseases, Norwegian Prescription Database, Norwegian Patient Registry and Statistics Norway) to assess the prognostic value of QFT for incident TB. Participants were followed until 30 June 2016. We used restricted cubic splines to model non-linear relationships between IFN- levels and TB, and applied these findings to a competing risk model.Results The prospective analyses included 50 389 QFT results from 44 875 individuals, of whom 257 developed TB. Overall, 22% (n=9878) of QFT results were positive. TB risk increased with the IFN- level until a plateau level, above which further increase was not associated with additional prognostic information. The HRs for TB were 8.8 (95% CI 4.7 to 16.5), 19.2 (95% CI 11.6 to 31.6) and 31.3 (95% CI 19.8 to 49.5) times higher with IFN- levels of 0.35 to