The tuberculin skin test versus QuantiFERON TB Gold® in predicting tuberculosis disease in an adolescent cohort study in South Africa.

The tuberculin skin test versus QuantiFERON TB Gold® in predicting tuberculosis disease in an adolescent cohort study in South Africa.
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DOI:
10.1371/journal.pone.0017984
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发表时间:
2011-03-29
期刊:
影响因子:
3.7
通讯作者:
Hussey GD
Hussey GD
中科院分区:
综合性期刊3区
文献类型:
--
作者:
Mahomed H;Hawkridge T;Verver S;Abrahams D;Geiter L;Hatherill M;Ehrlich R;Hanekom WA;Hussey GD

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这项研究是在南非伍斯特结核病(TB)高负担地区进行的,报告的所有结核病发病率为1400/10万。比较基线结核菌素皮肤试验(TST)和Quantiferon结核金试管试验(QFT)对青少年中随后的微生物确诊的结核病的预测价值。12-18岁的青少年是从研究区的高中招募的。在基线时,抽血进行QFT,并实施TST。参与者被跟踪了长达3.8年的结核病事件(中位数为2.4年)。排除后,对6363名青少年中的5244名(82.4%)进行了分析。基线≥阳性(5 Mm)患者的结核病发病率为0.60例/百人年(95%CI为0.43~0.82),基线QFT阳性患者为0.64例/百人年(95%CI为0.45~0.87)。在基线TST和QFT为负值的人群中,结核病发病率分别为0.22/百年(0.11~0.39)和0.22/百年(0.12~0.38)。TST和QFT对结核病发病的敏感度分别为76.9%和75.0%(p = 为0.81)。TST和QFT的阳性预测值分别为1.4%和1.5%。TST和QFT试验阳性是发展为微生物确认的结核病的中等敏感的预测因子。在这种高负担的环境下,这些测试在青少年中对结核病的预测能力没有显著差异。因此,这些发现不支持在本研究人群中使用QFT而不是TST来预测结核病的风险。
This study was conducted in a high tuberculosis (TB) burden area in Worcester, South Africa, with a notified all TB incidence rate of 1,400/100,000. To compare the predictive value of a baseline tuberculin skin test (TST) with that of the QuantiFERON TB Gold (In-tube) assay (QFT) for subsequent microbiologically confirmed TB disease among adolescents. Adolescents aged 12–18 years were recruited from high schools in the study area. At baseline, blood was drawn for QFT and a TST administered. Participants were followed up for up to 3.8 years for incident TB disease (median 2.4 years). After exclusions, 5244 (82.4%) of 6,363 adolescents enrolled, were analysed. The TB incidence rate was 0.60 cases per 100 person years (pyrs) (95% CI 0.43–0.82) for baseline TST positive (≥5 mm) participants and 0.64 cases per 100 pyrs (95% CI 0.45–0.87) for baseline QFT positive participants. TB incidence rates were 0.22 per 100 pyrs (0.11–0.39) and 0.22 per 100 pyrs (0.12–0.38) among those with a negative baseline TST and QFT respectively. Sensitivity for incident TB disease was 76.9% for TST and 75.0% for QFT (p = 0.81). Positive predictive value was 1.4% for TST and 1.5% for QFT. Positive TST and QFT tests were moderately sensitive predictors of progression to microbiologically confirmed TB disease. There was no significant difference in the predictive ability of these tests for TB disease amongst adolescents in this high burden setting. Therefore, these findings do not support use of QFT in preference to TST to predict the risk of TB disease in this study population.
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