定量干扰素玛释放试验在结核病老年患者的诊断实用性
Yoshikazu Mutoh1,2, Yusuke Minato3, Yuya Kawamoto4
1Department of Infectious Diseases, Tosei General Hospital, Seto, Aichi, Japan.
Microbiology spectrum
|February 10, 2026
概括
定量干扰素释量测试 (IGRA) 对于区分活跃结核病与老年人潜在感染的能力有限. 然而,QuantiFERON-TB Gold Plus和T-SPOT.TB在IGRA阳性病例中显示出适度的诊断改善,有助于风险分层.
科学领域:
- 老年医学 老年医学
- 传染性疾病 传染性疾病
- 诊断免疫学 诊断免疫学
背景情况:
- 结核病 (TB) 在老龄化社会中构成了重大健康挑战,特别影响免疫系统受损的老年人.
- 干扰素-释放试验 (IGRA) 是用于检测结核病感染的标准,但它们在区分活跃结核病 (ATB) 与老年结核病隐藏感染 (LTBI) 的定量价值仍不清楚.
- 在这个人口群体中,对于QuantiFERON-TB Gold Plus (QFT-Plus) 存在有限的大规模数据.
研究的目的:
- 评估定量QFT-Plus和T-SPOT.TB的诊断准确性,以区分日本老年患者 (≥65岁) 的ATB和LTBI.
- 评估IGRA定量值在老年人群中的表现,老年人群具有独特的免疫学考虑.
主要方法:
- 一项回顾性,横截面的诊断准确性研究,涉及10,745名老年患者 (310名ATB,1,158名LTBI) 在2015年至2024年期间进行了测试.
- 在结核病转诊中心 (QFT-Plus和T-SPOT.TB) 和第三级医院 (仅T-SPOT.TB) 进行了测试.
- 用接收器操作特征 (ROC) 曲线分析来评估定量IGRA结果的歧视性性能.
主要成果:
- 在所有患者中,在ATB和LTBI组之间的定量IGRA值中观察到大量的重叠.
- 在两家医院的IGRA阳性子集中,T-SPOT.TB显示了更好的歧视性表现 (AUC从0.607到0.679不等).
- 在IGRA阳性队列中,QFT-Plus也表现出更好的表现 (AUC从0.630到0.645不等),尽管所有患者的整体AUC都很低.
结论:
- 单靠定量IGRA值,在老年人群中区分ATB和LTBI的能力有限.
- 在专注于IGRA阳性个体时,QFT-Plus和T-SPOT.TB都在诊断准确度上提供了适度的改进.
- 定量IGRA结果虽然不是独立的诊断,但可以帮助老年患者的风险分层和临床决策.
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