结核菌素皮肤试验和γ干扰素释放试验诊断高危人群潜伏性结核感染的影响因素分析
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摘要
目的探讨结核菌素皮肤试验(tuberculin skin test,TST)和γ干扰素释放试验(interferon gamma release assays,IGRAs)诊断高危人群潜伏性结核感染(latent tuberculosis infection,LTBI)的影响因素。方法选择我院2016年1—7月住院肺结核患者的陪护人员138例(密切接触组)、结核科医务人员89例(医务人员组)及健康体检者50例(对照组),3组分别进行TST和IGRAs试验,比较各组检测结果;同时行问卷调查了解密切接触组和医务人员组结核病接触与结核病预防接种等相关信息,分析TST和IGRAs试验阳性的相关影响因素。结果密切接触组、医务人员组TST试验阳性率均显著高于对照组(P<0.05),密切接触组IGRAs试验阳性率显著高于医务人员组和对照组(P<0.05)。是否接种卡介苗、与接触者关系和接触时间为密切接触组TST试验阳性的影响因素,接触时间和是否营养不良为密切接触组IGRAs试验阳性的影响因素。结论在高危人群中应用TST和IGRAs试验诊断LTBI需排除相关影响因素的干扰。
Objective To analyze the influencing factors of two kinds of trials in the diagnosis of latent tuberculosis infection( LTBI) in high-risk population by tuberculosis bacterium screening in the medical staff at risk for tuberculosis infection. Methods A total of 138 caregivers in close contact with TB patients( close contact group),89 tuberculosis professionals( tuberculosis professional group),and 50 healthy persons( control group) were enrolled in our hospital from January 2016 to July 2016. The three groups underwent tuberculin skin test( TST) and interferon-gamma release test( IGRAs) respectively,and a questionnaire survey was conducted to collect the information on tuberculosis contact and vaccination. Results The positive rate of TST was significantly higher in close contact group and tuberculosis professional group than in control group( P < 0.05). The positive rate of IGRAs was remarkably higher in close contact group than in both tuberculosis professional group and control group( P < 0. 05).BCG vaccination,relationship with the contacts and length of contact were influencing factors of positive reaction in TST in close contact group,as with length of contact and malnutrition in IGRAs in this group. Conclusion In terms of diagnosis of LTBI by TST and IGRAs in high risk population,the influencing factors should be excluded.
Objective To analyze the influencing factors of two kinds of trials in the diagnosis of latent tuberculosis infection( LTBI) in high-risk population by tuberculosis bacterium screening in the medical staff at risk for tuberculosis infection. Methods A total of 138 caregivers in close contact with TB patients( close contact group),89 tuberculosis professionals( tuberculosis professional group),and 50 healthy persons( control group) were enrolled in our hospital from January 2016 to July 2016. The three groups underwent tuberculin skin test( TST) and interferon-gamma release test( IGRAs) respectively,and a questionnaire survey was conducted to collect the information on tuberculosis contact and vaccination. Results The positive rate of TST was significantly higher in close contact group and tuberculosis professional group than in control group( P < 0.05). The positive rate of IGRAs was remarkably higher in close contact group than in both tuberculosis professional group and control group( P < 0. 05).BCG vaccination,relationship with the contacts and length of contact were influencing factors of positive reaction in TST in close contact group,as with length of contact and malnutrition in IGRAs in this group. Conclusion In terms of diagnosis of LTBI by TST and IGRAs in high risk population,the influencing factors should be excluded.
引文
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[10]荣兰香,马淑红,艾清,等.T.SPOT-TB试验与PPD试验对结核病患者诊断价值相关性比较[J].中国实验诊断学,2013,17(8):1475-1476.
[11]监士宁,瞿介明.T-SPOT.TB在结核病诊断中的应用价值[J].国际呼吸杂志,2012,32(6):439-442.
[12]赵鲜丽,李小龙,周枫,等.传染病医院医务人员结核感染状况[J].中国感染控制杂志,2016,15(2):93-96.
[13]杜凤娇,张宏,黄海荣,等.涂阳肺结核患者密切接触者结核感染及危险因素分析[J].临床肺科杂志,2016,21(1):3-6.
[14]张向东,郑蓉蓉,何水珍,等.TB-IGRA与TST检测菌培阳性肺结核患者比较[J].中国人兽共患病学报,2012,28(5):464-466
[15]Takenami I,Loureiro C,Machado A Jr,et al.Blood Cells and Interferon-Gamma Levels Correlation in Latent Tuberculosis Infection[J].ISRN Pulmonol,2013,2013:256148.
[16]Sridhar S,Pollock K,Lalvani A.Redefining latent tuberculosis[J].Future Microbiol,2011,6(9):1021-1035.
[2]沈洪波,陈维政.结核分枝杆菌潜伏感染的免疫机制及免疫干预研究进展[J].中华结核和呼吸杂志,2016,39(1):47-51.
[3]张忠顺,楼海,肖和平,等.结核病专业人员及密切接触者结核潜伏感染的研究[J].中国防痨杂志,2011,33(1):36-40.
[4]肖东楼,张贺秋,赵雁林,等.现代结核病诊断技术[M].北京:人民卫生出版社,2013:20-21.
[5]李卫彬,侯琰,程新征,等.结核菌素试验的临床应用进展[J].临床肺科杂志,2014,19(4):737-739.
[6]刘荣梅,马丽萍,张立群,等.γ干扰素释放分析试验在肺结核病中的诊断价值[J].北京医学,2015(2):112-114.
[7]全国结核病流行病学抽样调查技术指导组.2000年全国结核病流行病学抽样调查报告[J].中国防痨杂志,2002,24(2):65-66.
[8]沈科书,张淑芹,王峰,等.结核潜伏感染的新型诊断方法研究进展[J].中国老年学杂志,2015,35(7):2004-2007.
[9]李静玫,卢巍,王东亮,等.医务人员感染结核危险性的探讨[J].中华医院感染学杂志,2006,16(7):745-747.
[10]荣兰香,马淑红,艾清,等.T.SPOT-TB试验与PPD试验对结核病患者诊断价值相关性比较[J].中国实验诊断学,2013,17(8):1475-1476.
[11]监士宁,瞿介明.T-SPOT.TB在结核病诊断中的应用价值[J].国际呼吸杂志,2012,32(6):439-442.
[12]赵鲜丽,李小龙,周枫,等.传染病医院医务人员结核感染状况[J].中国感染控制杂志,2016,15(2):93-96.
[13]杜凤娇,张宏,黄海荣,等.涂阳肺结核患者密切接触者结核感染及危险因素分析[J].临床肺科杂志,2016,21(1):3-6.
[14]张向东,郑蓉蓉,何水珍,等.TB-IGRA与TST检测菌培阳性肺结核患者比较[J].中国人兽共患病学报,2012,28(5):464-466
[15]Takenami I,Loureiro C,Machado A Jr,et al.Blood Cells and Interferon-Gamma Levels Correlation in Latent Tuberculosis Infection[J].ISRN Pulmonol,2013,2013:256148.
[16]Sridhar S,Pollock K,Lalvani A.Redefining latent tuberculosis[J].Future Microbiol,2011,6(9):1021-1035.