- 作者：Jae-Hoon Kim ; MD ; Soo-Kyung Cho ; MD ; PhD ; Minkyung Han ; BS ; Chan-Bum Choi ; MD ; PhD ; Tae-Hwan Kim ; MD ; PhD ; Jae-Bum Jun ; MD ; PhD ; Sang-Cheol Bae ; MD ; PhD ; MPH ; Dae-Hyun Yoo ; MD ; PhD ; Yoon-Kyoung Sung ; MD ; PhD ; MPH ; sungyk@hanyang.ac.kr
- 关键词：QuantiFERON-TB gold in tube test ; tuberculin skin test ; latent tuberculosis infection ; tumor necrosis factor inhibitor ; rheumatic disease
- 刊名：Seminars in Arthritis and Rheumatism
- 出版年：2013
- 出版时间：February, 2013
- 年：2013
- 卷：42
- 期：4
- 页码：424-432
- 全文大小：338 K
Objectives
To estimate the positivity and agreement between QuantiFERON-tuberculosis (TB) gold in tube test (QFT-GIT) and tuberculin skin test (TST) according to underlying rheumatic diseases and to identify the influencing factors on discrepancies between the 2 tests.Methods
Among the 757 patients who underwent both QFT-GIT and TST simultaneously from September 2008 to November 2010, patients with indeterminate QFT-GIT results (n = 21), with active (n = 11) or suspicious (n = 1) findings for tuberculosis on a chest radiograph, were excluded. Finally, 724 patients were recruited for this study: 497 patients with rheumatoid arthritis (RA), 198 with ankylosing spondylitis (AS), and 29 with juvenile rheumatoid arthritis (JRA). The agreement between the 2 tests was estimated by Cohen's ¦Ê and factors influencing discrepancies were identified using multivariate analysis.
Results
The positivity of QFT-GIT was higher in RA than AS or JRA (30.2 % , 16.2 % , and 3.4 % , respectively). In contrast, TST positivity was highest in AS compared to RA and JRA (45.5 % , 28.2 % , and 17.2 % , respectively). The agreement between the 2 tests was low in all patients (¦Ê = 0.285). The only predictor of a discrepancy between the 2 tests was older age. Factors associated with discordant QFT-GIT-negative/TST-positive results were female [odds ratio (OR) = 2.33, confidence interval (CI) 1.11 to 4.89] and AS (OR = 3.12, CI 1.44 to 6.79), whereas a discordant QFT-GIT-positive/TST-negative result was associated with glucocorticoid use (OR = 2.44, CI 1.24 to 4.81).
Conclusions
The agreement between the 2 tests is low; therefore, it would be better to perform both tests than to use any 1 test alone for the detection of LTBI in TB-endemic regions. Female and underlying AS are related to being QFT-GIT-negative/TST-positive, and the use of glucocorticoid is associated with being QFT-GIT-positive/TST-negative.