结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析

doi:10.3969/j.issn.1000-6621.2014.02.008

中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (2): 121-125.doi: 10.3969/j.issn.1000-6621.2014.02.008

结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析

耿梦杰宋渝丹熊勇超赵飞胡冬梅李萌侯月云成君何广学

102206 北京，中国疾病预防控制中心结核病预防控制中心［耿梦杰(中国疾病预防控制中心在读研究生)、宋渝丹(北京协和医学院公共卫生学院在读研究生)、赵飞、胡冬梅、李萌、成君］，政策研究中心（熊勇超），科技处（何广学）；北京市通州区妇幼保健院（侯月云）

收稿日期:2013-05-29 出版日期:2014-02-10 发布日期:2014-04-10
通信作者: 何广学；赵飞 E-mail:heguangxue@chinatb.org；zhaofei@chinatb.org
基金资助:
“十一五”国家重大科技专项(2009ZX10004-714)；全球基金结核病防治项目（TB12-0010）

Comparison and analysis of TST and IGRAs for testing tuberculosis infection of health care workers

GENG Meng-jie, SONG Yu-dan, XIONG Yong-chao, ZHAO Fei, HU Dong-mei, LI Meng, HOU Yue-yun, CHENG Jun, HE Guang-xue

National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

Received:2013-05-29 Online:2014-02-10 Published:2014-04-10
Contact: HE Guang-xue；ZHAO Fei E-mail:heguangxue@chinatb.org；zhaofei@chinatb.org

摘要/Abstract

摘要： 目的比较分析结核菌素皮肤试验和γ干扰素释放试验检测医务人员结核分枝杆菌感染结果的一致性。方法 2010年4月至8月，于内蒙古自治区一家大型传染病医院和一家综合医院，纳入1005名医务人员。通过调查问卷方法，了解一般人口学信息、卡介苗接种史等。共发放问卷1005份，收回合格问卷952份（完成问卷人数、TST和QFT-GIT检测的医务人员分别为952名、924名和999名）,三项调查均完成者为923名，排除6名QFT-GIT检测结果不确定的医务人员，有917名医务人员纳入分析。采用结核菌素皮肤试验和γ干扰素释放试验中的QuantiFERON-TB Gold In-Tube (QFT-GIT)方法检测医务人员结核分枝杆菌的感染情况，TST硬结平均直径分别以5、10和15 mm为阳性临界值，使用Kappa统计量评价两种检测方法的一致性。结果纳入分析的917名医务人员中，TST 5、10和15 mm临界值阳性率分别为68.92%（632/917）、47.87%（439/917）和25.08%（230/917）；QFT-GIT阳性率为69.57%（638/917）。TST硬结平均直径以5 mm为阳性临界值时，两种检测结果均阳性者483名，均阴性者130名，TST和QFT-GIT一致率为66.85%（613/917）；TST硬结平均直径以10 mm为阳性临界值时，两种检测结果均阳性者350名，均阴性者190名，TST和QFT-GIT一致率为58.89%（540/917）；TST硬结平均直径以15 mm为阳性临界值时，两种检测结果均阳性者181名，均阴性者230名，TST和QFT-GIT一致率为44.82%（411/917），两种检测方法的Kappa值分别为0.22、0.19、0.08， 95%CI值分别为0.16～0.29、0.13～0.25、0.04～0.12。结论 TST和QFT-GIT检测结果的一致性较差。

关键词: 结核菌素试验, &, gamma, 干扰素释放试验, 分枝杆菌, 结核, 疾病传播, 卫生人员至病人

Abstract: Objective To compare and analyze the agreement of tuberculosis (TB) infection results of health care workers with tuberculin skin test (TST) and interferon γ release assays (IGRAs). Methods Between April to August 2010, 1005 health care workers in an infectious disease hospital and a general medical hospital in Inner Mongolia were enrolled. Questionnaire was used to get the general demographic information, the history of BCG vaccination and so on. 1005 questionnaires were sent out, and 952 qualified questionnaires were taken back (the number of medical staff completed questionnaires, received TST and QFT - GIT test was 952, 924 and 999 respectively),923 subjects completes all of the three inquiries, excluding 6 with not-sure QFT-GIT results, there were 917 health care workers in the analysis. We applied TST and one of IGRAs namely QuantiFERON-TB Gold In-Tube (QFT-GIT) assay to test tuberculosis infection of health care workers, and assessed the agreement of the two tests with Kappa coefficients with the 5 mm, 10 mm and 15 mm as the positive cut-off of TST. Results Of the 917 health care wor-kers included in the analysis, the TST positive rates were 68.92% (632/917), 47.87% (439/917) and 25.08% (230/917) respectively with the different positive cut-off of 5 mm, 10 mm and 15 mm. With 5 mm as the positive cut-off, there were 483 medical staff got positive results and 130 got negative results of the two tests, and the agreement rate was 66.85% (613/917). With 10 mm as the positive cut-off, there were 350 medical staff got positive results and 190 got negative results of the two tests, and the agreement rate was 58.89% (540/917). With 15 mm as the positive cut-off, there were 181 medical staff got positive results and 230 got negative results of the two tests, and the agreement rate was 44.82% (411/917).The Kappa value (95%CI) between the tests were 0.22 (0.16-0.29), 0.19(0.13-0.25) and 0.08 (0.04-0.12) respectively, the agreement was poor. Conclusion The agreement between TST and QFT-GIT was low.

Key words: Tuberculin test, Interferon-gamma release tests, Mycobacterium tuberculosis, Disease transmission, professional-to-patient

耿梦杰，宋渝丹，熊勇超，赵飞，胡冬梅，李萌，侯月云，成君，何广学. 结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析[J]. 中国防痨杂志, 2014, 36(2): 121-125. doi: 10.3969/j.issn.1000-6621.2014.02.008

GENG Meng-jie, SONG Yu-dan, XIONG Yong-chao, ZHAO Fei, HU Dong-mei, LI Meng, HOU Yue-yun, CHENG Jun, HE Guang-xue. Comparison and analysis of TST and IGRAs for testing tuberculosis infection of health care workers[J]. Chinese Journal of Antituberculosis, 2014, 36(2): 121-125. doi: 10.3969/j.issn.1000-6621.2014.02.008

参考文献

［1］陈友鹏,黄思敏.潜伏结核感染的研究新进展.新医学,2008,39（12）:820-821,812.
［2］Sterling TR, Bethel J, Goldberg S, et al. The scope and impact of treatment of latent tuberculosis infection in the United States and Canada. Am J Respir Crit Care Med, 2006, 173（8):927-931.
［3］Farhat M, Greenaway C, Pai M, et al. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria.Int J Tuberc Lung Dis, 2006, 10(11):1192-1204.
［4］Pai M, Gokhale K, Joshi R, et al. Mycobacterium tuberculosis infection in health care workers in rural India:comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA, 2005, 293(22):2746-2755.
［5］Food and Drug Administration. QuantiFERON-TB-P010033［G/OL］(2013-09-05). ［2013-12-19］. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceAppro-valsandClearances/Recently-ApprovedDevices/ucm084025.htm.
［6］Mazurek GH, Jereb J, Lobue P，et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep，2005,54(RR-15):49-55.
［7］Food and Drug Administration. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection-United States, 2010［2013-12-19］.http://www.fda.gov/downloads/advisorycommittees/committeesmee-tingmaterials/medicaldevices/medicaldevicesadvisorycommittee/microbiologydevicespanel/ucm260832.pdf.
［8］Food and Drug Administration. SUMMARY OF SAFETY AND EFFECTIVENESS.2008［2013-12-19］. http://www.accessdata.fda.gov/cdrh_docs/pdf7/P070006b.pdf.
［9］中华人民共和国卫生部.WS 288-2008 肺结核诊断标准.北京:人民卫生出版社，2008.
［10］全国结核病流行病学抽样调查技术指导组.第四次全国结核病流行病学抽样调查报告.中华结核和呼吸杂志,2002,25(1): 3-7.
［11］Casas I, Latorre I, Esteve M, et al. Evaluation of interferon-gamma release assays in the diagnosis of recent tuberculosis infection in health care workers. PLoS One, 2009，4(8):e6686.
［12］Zwerling A, van den Hof S, Scholten J, et al. Interferon-gamma release assays for tuberculosis screnning of healthcare workers:a systematic review. Thorax，2012,67（1）：62-70.
［13］Talebi-Taher M, Javad-Moosavi SA, Entezari AH, et al.Comparing the performance of QuantiFERON-TB Gold and Mantoux test in detecting latent tuberculosis infection among Iranian health care workers. Int J Occup Med Environ Health, 2011,24(4):359-366.
［14］Ringshausen FC, Schablon A, Nienhaus A. Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review. J Occup Med Toxicol， 2012，7(1):6.
［15］Bugiani M, Borracino A, Migliore E, et al. Tuberculin reactivity in adult BCG-vaccinated subjects: a cross-sectional study. Int J Tuberc Lung Dis,2003，7（4）: 320-326.
［16］Mazurek GH, Jereb J, Vernon A, et al. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection-United States, 2010. MMWR Recomm Rep, 2010,59(RR-5):1-25.

[1]	李婷, 何金戈, 苏茜, 李京, 李运葵, 高文凤, 高媛, 杨文. 结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值[J]. 中国防痨杂志, 2020, 42(9): 931-936.
[2]	李春, 郑海伦, 罗萍, 李亚敏, 赵淑娟, 郭金红, 张丽, 徐静, 屠霞. 2010—2019年北京市大兴区某中学高中部青海藏族集体来京学生肺结核疫情处置分析[J]. 中国防痨杂志, 2020, 42(12): 1318-1322.
[3]	房宏霞,章光荣,秦玉宝,解志民,赖铿,黄成章,王艳,何文龙,郑开巧,肖之凯,刘昌伟,梁健平,陈智聪. 封闭社区结核病患者接触者结核感染状况预测模型[J]. 中国防痨杂志, 2019, 41(9): 936-945.
[4]	房宏霞,解志民,秦玉宝,罗志理,赖铿,余秀齐,王艳,郑开巧,刘昌伟,陈智聪. 监测封闭社区结核病患者接触者结核感染状况二年的结果分析[J]. 中国防痨杂志, 2019, 41(8): 887-891.
[5]	都伟欣,赵爱华,王国治,卢锦标. 结核菌素类产品的发展历程概述[J]. 中国防痨杂志, 2019, 41(10): 1080-1083.
[6]	姚利,盛健,王冰,戴希勇. 外周血结核感染T细胞斑点试验对脊柱结核诊断价值的Meta分析[J]. 中国防痨杂志, 2019, 41(10): 1084-1089.
[7]	吴妍，李琦，张宗德. γ-干扰素释放试验对老年肺结核的辅助诊断价值[J]. 中国防痨杂志, 2016, 38(2): 122-128.
[8]	何秀云黄香玉朱传智陈红兵张翠英肖漓高钰孔祥瑞. PstS1-ESAT-6抗原血清学和γ-干扰素释放试验辅助诊断结核病的价值[J]. 中国防痨杂志, 2016, 38(10): 805-812.
[9]	王永红. 对《2008-2014年中国石油大学(北京)新生PPD试验结果与结核发病情况分析》一文的商榷意见的答复[J]. 中国防痨杂志, 2015, 37(9): 1001-1002.
[10]	陈兴年，刘奇栋，王泓，叶志坚，吴妹英. 活动性肺结核患者血清中白细胞介素6、8和肿瘤坏死因子α检测的临床意义[J]. 中国防痨杂志, 2015, 37(4): 344-347.
[11]	万荣，李明武，赖明红，刘永莉. 结核感染T细胞斑点试验在老年肺结核中的诊断价值[J]. 中国防痨杂志, 2015, 37(4): 348-352.
[12]	侯江厚，李琦，张灵霞，王仲元，孙卫国，赵伟杰，操敏. 重组人γ-干扰素在耐多药结核病小鼠治疗作用中的研究[J]. 中国防痨杂志, 2015, 37(3): 295-299.
[13]	陈希，李晓辕，李玲，孟萍，张廷军，赵红梅，李云鹏. 结核感染T细胞斑点试验在结核性胸膜炎诊断中的价值[J]. 中国防痨杂志, 2015, 37(1): 40-46.
[14]	中国防痨协会结核病临床专业委员会. 结核病临床诊治进展年度报告（2013年）（第一部分结核病临床诊断）[J]. 中国防痨杂志, 2014, 36(8): 714-740.
[15]	孟炜丽，罗萍，胡京坤，孙钊，李慧颖，连赫宇. BCG-PPD与TB-PPD皮肤试验在大学生结核病筛查中的差异性分析[J]. 中国防痨杂志, 2014, 36(7): 542-546.

结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析

Comparison and analysis of TST and IGRAs for testing tuberculosis infection of health care workers

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

友情链接