Comparison of two interferon gamma release assays in the diagnosis of Mycobacterium tuberculosis infection and disease in The Gambia
Comparison of two interferon gamma release assays in the diagnosis of Mycobacterium tuberculosis infection and disease in The Gambia
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DOI：
10.1186/1471-2334-7-122
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发表时间：
2007-10-25
影响因子：
3.7
通讯作者：
Hill, Philip C.
中科院分区：
文献类型：
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作者：
Adetifa, Ifedayo M. O.;Lugos, Moses D.;Hill, Philip C.
背景：IFN-γ 释放测定 (IGRA) 已被许可用于诊断潜伏结核分枝杆菌感染 (LTBI)。它们的性能可能取决于检测形式，并且可能因人群和环境而异。我们比较了冈比亚内部 T 细胞和商用全血 IGRA 在诊断 LTBI 和结核病方面的诊断性能。方法：招募了新诊断的痰涂片阳性病例及其家庭接触者。对病例和接触者进行 IGRA 抽血，并对接触者进行 Mantoux 皮肤测试。我们评估了测试之间的一致性和不一致，并根据接触者相对于病例的睡眠地点（同一房间、同一房屋或不同房屋）对接触者的结核分枝杆菌暴露水平进行了分类。我们通过多元逻辑回归评估了暴露与检测结果之间的关系。结果：在 80 例新诊断的结核病病例中，ELISPOT 的敏感性为 78.7%，QFT-GIT 的敏感性为 64.0%（p = 0.047）。在 194 名家庭接触者中，ELISPOT 和 QFT-GIT 检测结果分别为 57.1% 和 58.8%。两个 IGRA 之间关于接触者 LTBI 的总体一致性为 71.4%，并且没有显着不一致 (p = 0.29)。 IGRA 和 TST 之间存在显着不一致。 IGRA 和 TST 均未发现因卡介苗 (BCG) 疫苗接种而出现假阳性结果的证据。然而，QFT-GIT 和 TST 之间的一致性以及 IGRA 和 TST 之间的不一致都与 BCG 疫苗接种有关。两种 IGRA 均对结核分枝杆菌暴露梯度有反应，并且与 TST 硬结的增加呈正相关（ELISPOT 的 p = 0.003，QFT-GIT 的 p = 0.001）。 结论：对于诊断结核病，ELISPOT 测试比 QFT-GIT 更敏感。这两种测试在诊断结核病接触者的 LTBI 方面表现相似。两个 IGRA 之间以及每个 IGRA 与 TST 之间的显着不一致在很大程度上仍然无法解释。
Background: IFN-gamma Release Assays (IGRAs) have been licensed for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Their performance may depend on assay format and may vary across populations and settings. We compared the diagnostic performance of an in-house T-cell and commercial whole blood-based IGRAs for the diagnosis of LTBI and TB disease in The Gambia.Methods: Newly diagnosed sputum smear positive cases and their household contacts were recruited. Cases and contacts were bled for IGRA and contacts had a Mantoux skin test. We assessed agreement and discordance between the tests and categorized a contact's level of M. tuberculosis exposure according to where s/he slept relative to a case: the same room, same house or a different house. We assessed the relationship between exposure and test results by multiple logistic regression.Results: In 80 newly diagnosed TB cases, the sensitivity of ELISPOT was 78.7% and for QFT-GIT was 64.0% (p = 0.047). Of 194 household contacts 57.1% and 58.8% were positive for ELISPOT and QFT-GIT respectively. The overall agreement between both IGRAs for LTBI in contacts was 71.4% and there was no significant discordance (p = 0.29). There was significant discordance between the IGRAs and TST. Neither IGRA nor TST had evidence of false positive results because of Bacille Calmette Guerin (BCG) vaccination. However, agreement between QFT-GIT and TST as well as discordance between both IGRAs and TST were associated with BCG vaccination. Both IGRAs responded to the M. tuberculosis exposure gradient and were positively associated with increasing TST induration (p = 0.003 for ELISPOT and p = 0.001 for QFT-GIT).Conclusion: The ELISPOT test is more sensitive than the QFT-GIT for diagnosing TB disease. The two tests perform similarly in the diagnosis of LTBI in TB contacts. Significant discordance between the two IGRAs and between each and the TST remain largely unexplained.