γ-干扰素释放试验在结核病专科门诊诊断儿童活动性结核病的效能

目的 评价γ-干扰素释放试验(interferon-gamma release assay, IGRA)在结核病专科门诊诊断儿童活动性结核病的效能。方法 回顾性分析2019年1月至2021年12月就诊于西安市胸科医院结核病门诊的268例疑似结核病患儿为研究对象，采用area under the ROC curve (AUC)评估在不同年龄阶段，有无卡痕，有无结核病密切接触史患儿中IGRA诊断活动性结核病的效能。结果 在结核病专科门诊，IGRA诊断儿童活动性结核的敏感度、特异度、阴性预测值、阳性预测值、AUC分别为80.6%、63.6%、48.6%、88.5%、0.74。IGRA诊断儿童结核病AUC(95%CI值),在年龄≤5岁患儿中为0.71(0.62～0.80),低于6～14岁组的0.75(0.70～0.81),两组差异无统计学意义(Z=-0.848,P=0.40);在可见卡痕患儿中为0.72 (0.67～0.78),与未见卡痕组的0.72(0.61～0.83)无统计学差异(Z=0.067,P=0.946);在有密接史组为0.83(0.75～0.91),高于无密接史组的0.72(0....     

γ-干扰素释放试验应用于结核病诊断的研究进展

结核病是我国重点控制的重大传染病之一,早期发现、早期治疗结核病患者是减少传播、控制结核病疫情的关键环节。近年来,结核感染的实验室诊断不断取得进展,尤以γ-干扰素为基础的免疫学诊断研究最为广泛。本文就γ-干扰素释放试验的产生、发展以及在结核病诊断中的研究进展进行了综述。     

γ-干扰素释放试验在活动性结核病中的诊断价值

在活动性结核病（ATB）患者中,菌阴肺结核患者约占40％～60％。由于缺乏诊断的“金标准”,菌阴肺结核以及肺外结核病成为诊断与鉴别诊断中的难点,也是造成误诊、漏诊、过诊、延迟诊断的重要原因。目前,活动性结核病的辅助诊断指标主要是血清或体液腺苷脱氨酶（ADA）、痰或血聚合酶链反应（PCR）、血清抗结核抗体（LAM）、皮肤结核菌素试验（TST）等,然而,这些指标的敏感性或佴口特异性较低,     

γ-干扰素释放试验在基层门诊肺结核筛查中的应用及评价

目的 通过对γ-干扰素释放试验(interferon-γ release assay,IGRA)在基层门诊肺结核筛查中的的临床应用,评价其应用效果和影响因素,为临床正确合理的使用提供参考意见。方法 选取2021年1月至2022年12月深圳市龙华区慢性病防治中心接诊的3073例疑似初诊肺结核患者,收集患者痰液标本采用痰涂片抗酸染色(acid-fast Stain,AFS)、BACTEC-MGIT 960液体培养法、交叉引物恒温扩增技术(crossing-primer amplification,CPA)对抗结核治疗前痰液标本进行结核分枝杆菌(mycobacterium tuberculosis,MTB)检测,采集患者外周血进行IGRA,以临床诊断作为确诊依据,评价IGRA与其他方法对结核感染的检测效能。结果 不同年龄患者IGRA阳性检出率存在明显统计学差异,30～40岁组阳性检出率最高,0～10岁组最低,且男性高于女性(P <0.01)。痰培养和CPA的总体诊断准确率分别为77.62%和66.88%,明显优于IGRA。IGRA的敏感度和特异度分别为72.89%和40.96%,总体诊...     

Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis.

OBJECTIVE: Interferon-gamma release assays (IGRA) are now available alternatives to tuberculin skin testing (TST) for detection of latent tuberculosis infection (LTBI). We compared the cost-effectiveness of TST and IGRA in different populations and clinical situations, and with variation of a number of parameters. METHODS: Markov modelling was used to compare expected TB cases and costs over 20 years following screening for TB with different strategies among hypothetical cohorts of foreign-born entrants to Canada, or contacts of TB cases. The less expensive commercial IGRA, Quanti-FERON-TB Gold (QFT), was examined. Model inputs were derived from published literature. RESULTS: For entering immigrants, screening with chest radiograph (CXR) would be the most and QFT the least cost-effective. Sequential screening with TST then QFT was more cost-effective than QFT alone in all scenarios, and more cost-effective than TST alone in selected subgroups. Among close and casual contacts, screening with TST or QFT would be cost saving; savings with TST would be greater than with QFT, except in contacts who were bacille Calmette-Guérin (BCG) vaccinated after infancy. CONCLUSIONS: Screening for LTBI, with TST or QFT, is cost-effective only if the risk of disease is high. The most cost-effective use of QFT is to test TST-positive persons.     

Interferon-gamma release assays in tuberculosis diagnostics

Two years ago, CE certified interferon-gamma release assays (IGRA) were launched on the German market (QuantiFERON-TB Gold In-Tube and T-SPOT-TB). Since this time, a multitude of studies have analysed these assays. Guidelines have been elaborated by national expert committees of England, the USA and Switzerland. However, standards of tuberculosis diagnostics and management may vary from country to country. This statement provides practice relevant recommendations for indications, pre-analytics and the interpretation of IGRA test results under different clinical conditions. The IGRA are integrated into existing guidelines for the management of tuberculosis.     

Interferon-gamma release assays are a better tuberculosis screening test for hemodialysis patients: A study and review of the literature

Diagnosing latent tuberculosis (TB) infection (LTBI) in dialysis patients is complicated by poor response to tuberculin skin testing (TST), but the role of interferon-gamma release assays (IGRAs) in the dialysis population remains uncertain. Seventy-nine patients were recruited to compare conventional diagnosis (CD) with the results of two IGRA tests in a dialysis unit. Combining TST, chest x-ray and screening questionnaire results (ie, CD) identified 24 patients as possible LTBI. IGRA testing identified 22 (QuantiFERON Gold IT, Cellestis, USA) and 23 (T-spot.TB, Oxford Immunotec, United Kingdom) LTBI patients. IGRA and CD correlated moderately (κ=0.59). IGRA results correlated with history of TB, TB contact and birth in an endemic country. TST was not helpful in identifying LTBI patients in this population. The tendency for IGRAs to correlate with risk factors for TB, active TB infection and history of TB argues for their superiority over TST in dialysis patients. There was no superiority of one IGRA test over another.     

结核菌素试验阳性的接触者随访期间γ-干扰素释放试验的研究

背景：在进行大规模接触者调查后，对结核菌素试验（TST）阳性个体提供预防性抗结核治疗。目的：研究随访期间异烟肼（INH）的治疗效果和了一干扰素释放试验（IGRA）的时效。设计：在大规模接触者调查期间，TST检测为阳性的对象（n=122例）纳入本研究。在2年里，每6个月抽取一次血标本用来进行两种试验。结果：122例中，36例（29．5％）完成异烟肼预防性治疗，71例（58．2％）每6个月进行一次X线筛查随访，另有15例（12．3％）未完成异烟肼预防性治疗。阳性者的总百分率在2年间保持稳定，大约在45％～50％，但随着时间的推移，个体的反应有变化。大多数初始IGRA低者，随访期间其结果仍然在临界值以下，初始IGRA结果高的仍为阳性，而IGRA初始结果为中等程度者，随访期间有多种动态类型。结论：本研究显示IGRA反应随着时间推移变异较大，提示其在潜伏感染个体随访中的应用价值有限。然而，在那些初始IGRA为中等程度结果的个体表现出不同动态类型的意义，需要进一步研究。     

Interferon-gamma release assays during follow-up of tuberculin skin test-positive contacts

SETTING: Following a large-scale contact investigation, individuals with a positive tuberculin skin test (TST) result were offered preventive tuberculosis treatment. OBJECTIVE: To investigate the effect of isoniazid (INH) treatment and the effect of time on interferon gamma release assay (IGRA) results during follow-up. DESIGN: TST-positive subjects (n = 122) detected during the large-scale contact investigation were included in the study. Blood was obtained every 6 months over 2 years to perform both tests. RESULTS: Preventive INH treatment was completed by 36 of the 122 (29.5%) subjects, 71 (58.2%) were followed up with 6-monthly X-ray screening and 15 (12.3%) did not complete INH treatment. The overall percentage of individuals with a positive result remained stable during the 2 years, at approximately 45-50%, but individual responses varied over time. The majority of initially low IGRA results remained below the cut-off value, initially high IGRA results remained positive, while initially intermediate IGRA results were followed by more dynamic patterns. CONCLUSION: This study showed a highly variable pattern of IGRA responses over time and suggests limited value for their use during follow-up of latently infected individuals. However, the significance of different kinetic patterns observed among subjects with intermediate initial IGRA results warrants further study.