Application value of two-step detection of Mycobacterium tuberculosis infection screening in schools

doi:10.19982/j.issn.1000-6621.20220096

Abstract

Abstract:

Objective: To evaluate the application value of tuberculin skin test (TST) combined with interferon-gamma release assays (IGRA)(shorter form“two-step”) screening Mycobacterium tuberculosis (MTB) infection and active tuberculosis in students’ physical examination. Methods: A cross-sectional study was conducted in 74358 students in Guangdong during 2017—2021, 50701 (68.18%) were treated with chest X-ray and 74148 (99.72%) were tested with TST. And then, 9702 (13.08%) students positive in TST test received IGRA test (two-step approach). Finally, the students with abnormal chest X-ray and those who were positive in TST and IGRA tests (double positive) should be further examined to clarify the diagnosis of pulmonary tuberculosis. Results: Using the IGRA test results as the reference standard,taking the mean diameter of induration detected by TST of 5, 10 and 15 mm as the positive threshold, the consistency rates of MTB infection detected by TST and IGRA were 15.97% (1549/9702), 26.63% (2584/9702) and 81.11% (7869/9702), respectively, with the Kappa values of 0.014, 0.014 and 0.112, respectively. The rate of MTB infection detected by TST was significantly higher than that of the two-step method (11.67% (8652/74148) vs. 1.02% (759/74148), χ²=7068.423,P<0.001). The detection rate of pulmonary tuberculosis among students with moderate and strongly positive TST was significantly lower than that among students with double positive (0.29% (15/5219) vs. 1.84% (14/759), χ²=30.133,P<0.001). Conclusion: The consistency of detecting MTB infection by TST and IGRA is poor. The “two-step method” can significantly improve the detection rate of MTB infection and the screening efficiency of pulmonary tuberculosis in schools.

Key words: Mycobacterium tuberculosis, Tuberculin test, Multiphasic screening, School

CLC Number:

R521
R181.2

Dong Xiaowei, Guo Huixin, Zhang Chenchen, Wang Jiawen, He Junlei, Li Guanhai, Li Jianwei, Wen Wenpei. Application value of two-step detection of Mycobacterium tuberculosis infection screening in schools[J]. Chinese Journal of Antituberculosis, 2022, 44(8): 802-807. doi: 10.19982/j.issn.1000-6621.20220096

Figures/Tables 5

References 21

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学校类型	TST检测[名(比率,%)]					IGRA检测[名/例(比率,%)]
学校类型	检查人数	强阳性	中度阳性	一般阳性	阴性	检查人数	阳性	阴性
初中	15365	340(2.21)	2502(16.28)	5489(35.73)	7034(45.78)	2793	146(5.23)	2647(94.77)
职高、高中等	40796	793(1.94)	3467(8.50)	7077(17.35)	29459(72.21)	4930	487(9.88)	4443(90.12)
大专、大学等	17987	408(2.27)	1142(6.35)	1816(10.09)	14621(81.29)	1979	254(12.83)	1725(87.17)

TST检测阳性临界值	IGRA		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	一致率 (%)	Kappa(95%CI)值
TST检测阳性临界值	阳性(例)	阴性(名)	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	一致率 (%)	Kappa(95%CI)值
5mm~			99.55	7.56	9.78	99.40	15.97	0.014(0.012~0.016)
阳性	883	8149
阴性	4	666
10mm~			85.57	20.70	9.79	93.45	26.63	0.014(0.008~0.020)
阳性	759	6990
阴性	128	1825
15mm~			27.85	86.47	17.15	92.25	81.11	0.112(0.088~0.136)
阳性	247	1193
阴性	640	7622

指标	TST检测			两步法检测			χ²值	P值
指标	TST中阳	TST强阳	小计	TST中阳+ IGRA阳	TST强阳+ IGRA阳	小计	χ²值	P值
MTB感染例数	7111	1541	8652	512	247	759	7068.423	<0.001
感染率(%)	9.59	2.08	11.67	0.69	0.33	1.02

指标	TST筛查			两步法
指标	TST中阳	TST强阳	小计	TST中阳+IGRA阳	TST强阳+IGRA阳	小计
检查学生人数	4014	1205	5219	512	247	759
肺结核患者例数	7	8	15	7	7	14
检出率(%)	0.17	0.66	0.29	1.37	2.83	1.84