摘要
目的评价QuantiFERON-TB Gold Plus(QFT-Plus)筛查监管人员结核潜伏感染的性能,并分析潜伏感染的相关影响因素,为监管人员的结核潜伏感染筛查工作提供依据。方法收集2022年江苏省新入监人员的基本特征与结核潜伏感染的筛查结果,以QuantiFERON-TB Gold In-Tube(QFT-GIT)检测的结果为金标准,使用kappa值和受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)评价QFT-Plus的检测性能;同时通过Kruskal-Wallis检验比较γ-干扰素(interferon-γ,IFN-γ)的产生差异。建立logistic回归模型分析监管人群结核潜伏感染的影响因素。结果本次共纳入100名有效研究对象,筛查出结核潜伏感染(latent tuberculosis infection,LTBI)共24人。研究对象的年龄中位数为38岁,2组中LTBI年龄中位数为44岁,健康人年龄中位数为37岁。其中文化程度主要集中于大专及以上。进行多种筛查方式一致性检验后发现QFT-Plus与QFT-GIT检测结果符合率最高为0.917,曲线下面积也最大,为0.958。Kruskal-Wallis检验分析出QFT-Plus TB管IFN-γ量显著高于QFT-GIT TB管,且QFT-Plus的IFN-γ变化幅度更大。此外多因素分析显示年龄增长(aOR:1.046,95%CI:1.004~1.089)是监管人群结核潜伏感染的危险因素,大专及以上学历(aOR:0.263,95%CI:0.071~0.972)为保护因素。结论QFT-Plus作为新开发的结核潜伏感染检测方法,与QFT-GIT结果基本一致,且一致性相较其他皮试方式均更高。但由于QFT-Plus中IFN-γ产生量的变化幅度较大,因此仍需进行诊断界值的进一步探索。而在筛查监狱结核潜伏感染时工作重点需着重关注老年人群、文化程度较低等人群。
Objective To evaluate the performance of QuantiFERON-TB Gold Plus(QFT-Plus)in screening the prison population for latent tuberculosis infection(LTBI),and analyze the related influencing factors of latent infection,so as to provide the basis for screening the prison population for latent tuberculosis infection.Methods The basic characteristics and screening results of the newly admitted prison population were collected,using QuantiFERON-TB Gold(QFT-GIT)assay as the gold standard.The kappa value and the area under the ROC curve were used to evaluate the detection performance of QFTPlus.At the same time,Kruskal-Wallis test was used to compare the difference of IFN-γproduction between tubes.A logistic regression model was established to analyze the influencing factors of latent tuberculosis infection in the prison population.Results A total of 100 valid subjects were included in this study,and 24 LTBI patients were screened.The median age of the participants was 38 years,with a median LTBI age of 44 years and a median healthy age of 37 years.In addition,the education level was mainly concentrated in college and above.Consistency checks of various screening methods revealed that the highest coincidence rate of QFT-Plus and QFT-GIT detection results was 0.917,with the largest area under the curve at 0.958.The KW analysis showed that the amount of IFN-γin QFT-Plus TB tube was significantly higher than that in QFT-GIT TB tube,and the variation range of IFN-γin QFT-Plus tube was greater.In addition,multivariate analysis showed that increasing age(aOR:1.046,95%CI:1.004-1.089)was a risk factor for LTBI in the prison population,while having an education level of college or above(aOR:0.263,95%CI:0.071-0.972)was a protective factor.Conclusions QFT-Plus,as a newly developed method for detecting LTBI,showed basic consistency with QFT-GIT,and the consistency was higher than that of other skin test methods.However,due to the large variation of IFN-γproduction in QFT-Plus,it is still necessary to further explore the diagnostic threshold.In the screening of LTBI in prisons,special attention should be given to the elderly population and the population with low education levels.
作者
费心如
王展
李忠奇
虞浩
竺丽梅
刘巧
葛芳
FEI Xinru;WANG Zhan;LI Zhongqi;YU Hao;ZHU Limei;LIU Qiao;GE Fang(Department of Epidemiology,School of Public Health,Nanjing Medical University,Nanjing,Jiangsu 211166,China;Institute of Chronic Infectious Diseases,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing,Jiangsu 210009,China;Jiangsu Prison Administration Central Hospital,Nanjing,Jiangsu 211899,China)
出处
《中国热带医学》
CAS
北大核心
2024年第7期807-813,共7页
China Tropical Medicine
基金
国家自然科学基金项目(No.82003516)
江苏省卫生健康委员会科研面上项目(No.M2020020)。
