Factors Influencing Discrepancies Between the QuantiFERON-TB Gold in Tube Test and the Tuberculin Skin Test in Korean Patients with Rheumatic Diseases

被引:29
作者
Kim, Jae-Hoon [1 ]
Cho, Soo-Kyung [1 ]
Han, Minkyung [1 ]
Choi, Chan-Bum [1 ]
Kim, Tae-Hwan [1 ]
Jun, Jae-Bum [1 ]
Bae, Sang-Cheol [1 ]
Yoo, Dae-Hyun [1 ]
Sung, Yoon-Kyoung [1 ]
机构
[1] Hanyang Univ, Hosp Rheumat Dis, Dept Rheumatol, Seoul 133792, South Korea
关键词
QuantiFERON-TB gold in tube test; tuberculin skin test; latent tuberculosis infection; tumor necrosis factor inhibitor; rheumatic disease; INTERFERON-GAMMA ASSAY; RELEASE ASSAY; INFECTION; ARTHRITIS; RISK; RECOMMENDATIONS; PERFORMANCE; PREVENTION; DIAGNOSIS; AGENTS;
D O I
10.1016/j.semarthrit.2012.07.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 kappa 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 (kappa = 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. (c) 2013 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 42:424-432
引用
收藏
页码:424 / 432
页数:9
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