Analysis of screening of latent tuberculosis infection in hospitalized children

doi:10.3969/j.issn.1000-6621.2021.07.003

Abstract

Abstract: Objective To analyze the screening of latent tuberculosis infection (LTBI) in children with diseases of different systems. Methods Clinical information of 19093 children hospitalized in Beijing Children’s Hospital, Capital Medical University and tested by tuberculin skin test (TST) or interferon-gamma release assay (IGRA) between January 2013 and December 2015 were retrospectively analyzed. The diseases were classified according to clinical diagnosis, including respiratory diseases, rheumatic and immune diseases, hematologic/tumor diseases and renal diseases. The positive rate, consistency and the risk factors of the consistency of TST and IGRA were analyzed in children with diseases of different systems. Results Among children with diseases of different systems, when using TST to screen LTBI, the positive rates were 4.56% (205/4492), 3.01% (41/1361), 2.82% (170/6039) and 1.78% (19/1070) in children with rheumatic and immune diseases, renal diseases, respiratory diseases and hematologic/tumor diseases, respectively, the difference was statistically significant (χ ²=34.383, P<0.01). When using IGRA to screen LTBI, the positive rates were 1.13% (36/3191), 1.06% (66/6215), 0.93% (19/2039) and 0.90% (69/7648) in children with hematologic/tumor systemic diseases, rheumatic and immune diseases, renal diseases and respiratory diseases, respectively. However, the difference was not statistically significant (χ ²=1.608, P=0.658). The consistency between test results of TST and IGRA was poor in children with diseases of different systems (respiratory diseases: consistency rate was 96.92% (5853/6039), Kappa=0.193; rheumatic and immune diseases: consistency rate was 95.19% (4276/4492),Kappa=0.165; hematologic/tumor systemic diseases: consistency rate was 97.48% (1043/1070), Kappa=0.169;renal diseases: consistency rate was 96.77% (1317/1361), Kappa=0.173). Conclusion Compared to children with respiratory diseases, the rates of LTBI and the inconsistent results of TST and IGRA were higher in children with rheumatic and immune diseases, renal diseases and hematologic/tumor diseases. The combination of TST and IGRA was suggested to be used to screen LTBI in children with respiratory diseases.

Key words: Child, Mycobacterium tuberculosis, Infectious disease incubation period, Diagnostic techniques and procedures

QI Xue, WU Xi-rong, GUO Ya-jie, WANG Yong-hong, MA Qi, CHEN Yu-ying, SUN Lin, SHEN A-dong. Analysis of screening of latent tuberculosis infection in hospitalized children[J]. Chinese Journal of Antituberculosis, 2021, 43(7): 653-658. doi: 10.3969/j.issn.1000-6621.2021.07.003

Figures/Tables 5

References 17

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临床特征	呼吸系统疾病	泌尿系统疾病	风湿免疫系统疾病	血液系统/肿瘤疾病	合计
性别
男性	4615(60.34)	1370(67.19)	3343(53.79)	1901(59.57)	11229(58.81)
女性	3033(39.66)	669(32.81)	2872(46.21)	1290(40.43)	7864(41.19)
年龄组(岁)
<5	4285(56.03)	787(38.60)	896(14.42)	1956(61.30)	7924(41.50)
≥5	3363(43.97)	1252(61.40)	5319(85.58)	1235(38.70)	11169(58.50)
卡痕
有	7245(94.73)	1968(96.52)	5756(92.61)	3112(97.52)	18081(94.70)
无	403(5.27)	71(3.48)	459(7.39)	79(2.48)	1012(5.30)
肺结核接触史
有	237(3.10)	32(1.57)	105(1.69)	40(1.25)	414(2.17)
无	7411(96.90)	2007(98.43)	6110(98.31)	3151(98.75)	18679(97.83)
应用激素或免疫抑制剂
是	411(5.37)	317(15.55)	905(14.56)	377(11.81)	2010(10.53)
否	7237(94.63)	1722(84.45)	5310(85.44)	2814(88.19)	17083(89.47)
合计	7648(40.06)	2039(10.68)	6215(32.55)	3191(16.71)	19093(100.00)

TST	IGRA		一致性 (%)	Kappa值
TST	阳性(例)	阴性(例)	一致性 (%)	Kappa值
呼吸系统疾病			96.92	0.193
阳性	24	146
阴性	40	5829
泌尿系统疾病			96.77	0.173
阳性	5	36
阴性	8	1312
风湿免疫系统疾病			95.19	0.165
阳性	24	181
阴性	35	4252
血液系统/肿瘤疾病			97.48	0.169
阳性	3	16
阴性	11	1040

影响因素	TST(+)/IGRA(+)和 TST(-)/IGRA(-)	TST(+)/IGRA(-)和 TST(-)/IGRA(+)	χ²值	P值
性别			0.591	0.442
男性	7298(96.46)	268(3.54)
女性	5191(96.20)	205(3.80)
年龄组(岁)			17.460	<0.01
<5	4860(97.22)	139(2.78)
≥5	7629(95.81)	334(4.19)
卡痕			2.906	0.088
有	11785(96.28)	455(3.72)
无	704(97.51)	18(2.49)
肺结核接触史			14.215	<0.01
有	293(92.43)	24(7.57)
无	12196(96.45)	449(3.55)

影响因素	TST(+)/IGRA(+)和 TST(-)/IGRA(-)	TST(+)/IGRA(-)和 TST(-)/IGRA(+)	χ²值	P值
应用激素或免疫抑制剂			2.509	0.113
是	1313(97.12)	39(2.88)
否	11176(96.26)	434(3.74)
疾病分类			27.265	<0.01
呼吸系统疾病	5853(96.92)	186(3.08)
泌尿系统疾病	1317(96.77)	44(3.23)
风湿免疫系统疾病	4276(95.19)	216(4.81)
血液系统/肿瘤疾病	1043(97.48)	27(2.52)