结核菌素皮肤试验和γ干扰素释放试验检测917名医务人员结核分枝杆菌感染一致性的比较分析

Comparison and analysis of TST and IGRAs for testing tuberculosis infection of health care workers

目的比较分析结核菌素皮肤试验和γ干扰素释放试验检测医务人员结核分枝杆菌感染结果的一致性。方法2010年4月至8月，于内蒙古自治区一家大型传染病医院和一家综合医院，纳入1005名医务人员。通过调查问卷方法，了解一般人口学信息、卡介苗接种史等。共发放问卷1005份，收回合格问卷952份（完成问卷人数、TST和QFT-GIT检测的医务人员分别为952名、924名和999名），三项调查均完成者为923名，排除6名QFTGIT检测结果不确定的医务人员，有917名医务人员纳入分析。采用结核菌素皮肤试验和γ干扰素释放试验中的QuantiFERON-TB Gold In-Tube（QFT-GIT）方法检测医务人员结核分枝杆菌的感染情况，TST硬结平均直径分别以5、10和15ranl为阳性临界值，使用Kappa统计量评价两种检测方法的一致性。结果纳入分析的917名医务人员中，TST5、10和15mm临界值阳性率分别为68．92％（632／917）、47．87％（439／917）和25．08％（230／917）；QFTGIT阳性率为69．57％（638／917）。TST硬结平均直径以5mm为阳性临界值时，两种检测结果均阳性者483名，均阴性者130名，TsT和QFT-GIT一致率为66．85％（613／917）；TST硬结平均直径以10mm为阳性临界值时，两种检测结果均阳性者350名，均阴性者190名，TST和QFT-GIT～致率为58．89％（540／917）；TST硬结平均直径以15mm为阳性临界值时，两种检测结果均阳性者181名，均阴性者230名，TST和QFT-GIT一致率为4乱82％（411／917），两种检测方法的Kappa值分别为0．22、0．19、0．08，95％CI值分别为0．16～0．29、0．13～0．25、0．04～0．12。结论TST和QFT-GIT检测结果的一致性较差。

Objective To compare and analyze the agreement of tuberculosis （TB） infection results of health care workers with tuberculin skin test （TST） and interferon 7 release assays （IGRAs）. Methods Between April to August 2010, 1005 health care workers in an infectious disease hospital and a general medical hospital in Inner Mongolia were enrolled. Questionnaire was used to get the general demographic information, the history of BCG vaccina tlon and so on. 1005 questionnaires were sent out, and 952 qualified questionnaires were taken back （the number of medical staff completed questionnaires, received TST and QFT - GIT test was 952, 924 and 999 respectively）,923 subjects completes all of the three inquiries, excluding 6 with not-sure QFT-GIT results, there were 917 health care workers in the analysis. We applied TST and one of IGRAs namely QuantiFERON TB Gold In Tube （QFT-GIT） assay to test tuberculosis infection of health care workers, and assessed the agreement of the two tests with Kappa coefficients with the 5 ram, 10 mm and 15 mm as the positive cut-off of TST. Results Of the 917 health care workers included in the analysis, the TST positive rates were 68. 92% （632/917）, 47.87% （439/917） and 25.08% （230/917） respectively with the different positive cut-off of 5 ram, 10 mm and 15 ram. With 5 mm as the positive cut-off, there were 483 medical staff got positive results and 130 got negative results of the two tests, and the agreement rate was 66. 85%（613/917）. With 10 mm as the positive cut-off, there were 350 medical staff got positive results and 190 got negative results of the two tests, and the agreement rate was 58.89%（540/917）. With 15 mm as the positive cut-off, there were 181 medical staff got positive results and 230 got negative results of the two tests, and the agreement rate was 44.82%（411/917）. The kappa value （95%CI） between the tests were 0.22 （0. 16-0.29）, 0.19（0.13-0. 25） and 0.08 （0.04 0.12） respectively, the agreement was poor. Conclusion The agree ment between TST and QFT GIT was low.