使用印度本土净化蛋白衍生物 (PPD) 的结核素测试显示,与国际标准的PPD仅有中等的一致性
Devasahayam J Christopher1, N Priya1, Deepa Shankar1
1Department of Pulmonary Medicine, Christian Medical College Vellore Ranipet Campus, Kilminnal Village, Ranipet District, Tamil Nadu, Pin Code 632 517, India.
概括
印度的TST-Arkray与TST-Tubersol在潜在结核病感染 (LTBI) 诊断方面显示出适度的一致性. 然而,这两种结核素皮肤测试 (TST) 与QFT-Plus血液测试的一致性很差,表明LTBI检测的潜在变异性.
科学领域:
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
- 公共卫生 公共卫生
背景情况:
- 潜伏结核病感染 (LTBI) 影响印度约40%的人口.
- 基于纯化蛋白衍生物 (PPD) 的结核素皮肤测试 (TST) 用于LTBI诊断,但像TST-Arkray (印度) 和TST-Tubersol (国际) 这样的配方可能会产生不同的结果.
- 与国际公认的结核素和干扰素释试验 (IGRA) 进行的TST-Arkray的比较性能,如QFT-Plus,尚未得到充分证实.
研究的目的:
- 为了评估TST-Arkray和TST-Tubersol的诊断性能,与Quantiferon-Gold Plus (QFT-Plus) 试验进行比较.
- 评估两个TST和一个IGRA在印度人口中检测LTBI之间的协议.
主要方法:
- 纳入了512名参与者的队列,包括医疗保健专业人员和结核病家庭接触者.
- 参与者接受了使用TST-Arkray,TST-Tubersol和QFT-Plus的测试.
- TST涉及皮内注射,在48小时后读取强度;QFT-Plus使用血液样本.
主要成果:
- 在27%的参与者中,TST-Tubersol产生了积极结果,而TST-Arkray在40.1%的参与者中产生了积极结果.
- 在TST-Arkray和TST-Tubersol之间观察到适度的协议 (kappa=0.58).
- 这两种TST都与QFT-Plus表现出很差的一致性 (Tubersol的kappa=0.19,Arkray的0.17). 当QFT-Plus是参考标准时,TST-Arkray显示出较高的灵敏度 (60.6%),但与TST-Tubersol相比 (64%) 的特异性较低 (46.8%的灵敏度,76.3%的特异性).
结论:
- 印度的TST-Arkray与国际公认的TST-Tubersol在LTBI查方面表现出适度的协议.
- 在TST和QFT-Plus IGRA之间存在显著的不一致,这表明LTBI检测能力的潜在差异.
- 需要进一步的研究,以澄清在印度的TST的最佳使用情况,考虑到它们相对于IGRA的性能.
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