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Usefulness of Mycobacterium Tuberculosis Antigen-specific Interferon-gamma Release Assay in Diagnosing Active Tuberculosis

Author: FengYun
Tutor: ZhangWenHong
School: Fudan University
Course: Internal Medicine
Keywords: Tuberculosis Extrapulmonary tuberculosis Fever of unknown origin Diagnosis Interferon-γ release test
CLC: R52
Type: Master's thesis
Year: 2010
Downloads: 231
Quote: 0
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Objective: developed in recent years to release test based on the Mycobacterium tuberculosis-specific protein gamma interferon (Interf eron-gamma Release Assay, IGRA) as a novel ELISPOT technology for the diagnosis of tuberculosis provides new technology. With high sensitivity and specificity, the method in foreign countries has become a major technology for diagnosis of tuberculosis infection. Countries, however, the results of applied research on the diagnosis of active tuberculosis is quite different, and the few studies on the diagnosis of extrapulmonary active TB in the international and domestic rare large. In this study, a prospective method selected clinically suspected cases of active TB evaluation Mycobacterium tuberculosis-specific IGRA tests (T SPOT.TB) in the diagnosis of active TB. IGRA (T SPOT. TB) detection methods: In 182 patients with clinically suspected active tuberculosis patients, the tuberculin skin test (a unit or 5 units of tuberculin purified protein derivative) and a history of collection through bacteriology, pathology, and follow-up of more than 3 months and the basis for establishing the diagnosis, the diagnostic value of the evaluation IGRA analysis lead to the IGRA false negative and false positive factors, the diagnostic value of the tuberculin skin test IGRA and differences. In addition, for the admission diagnosis of fever of unknown origin cases, further analysis of the diagnostic value of IGRA tests in identifying clinical manifestations of active TB are more hidden aspects. Results: IGRA (T SPOT.TB) in active tuberculosis sensitivity of 94.7% (95% CI86.9% -98.5%) and negative predictive value of 95.7% (95% CI, 89.5% -98.8%) ; specificity of 84.1% (95% CI 78.5% -90.5%), positive predictive value of 80.7% (95% CI, 70.9% -88.3%). IGRA (T SPOT TB) in active pulmonary tuberculosis and extrapulmonary tuberculosis were higher in sensitivity, amounted to 95.6% (95% CI84.9% -99.5%) and 93.3% (95% CI 77.9% -99.2%); However, IGRA tuberculosis diagnostic specificity of 69.2% ( 95% CI 48.2% -85.7%), high specificity for the diagnosis of extrapulmonary tuberculosis, 88.9% (95% CI, 80.0% -94.8%), the difference was statistically significant (P lt; 0.05). False positive risk factors, age ≥ 46 years of age Multivariate Logistic regression analysis OR = 0.1965 (95% CI 0.0494-0.7819), P lt; 0.05: history of previous tuberculosis Multivariate Logistic regression analysis OR = 0.0994 (95% CI0.0159 -0.6194), P lt; 0.05. The study found no the T SPOT. TB false negatives immunosuppressive factors within January relevance of anti-TB treatment. The sensitivity of the tuberculin skin test (intradermal injection of 5 units), 56.4% (95% CI39.6% -72.2%), specificity of 61.5% (95% CI, for 31.6% of -86.1%), with IGRA (T SPOT . TB) compared to P lt; 0.05; tuberculin skin test (intradermal injection of one unit), sensitivity was 27.8% (95% CI, 9.7% -53.3%), compared with IGRA (T SPOT TB) P lt; 0.05, while specificity was 82.8% (95% CI 70.6% -91.4%), compared with IGRA (T SPOT.TB) P gt; 0.05. Fever of unknown origin in the case group, IGRA (T SPOT.TB) diagnostic specificity was 92.5% (95% CI, 79.6% -53.5%) and negative predictive value of 97.4% (95% CI, 86.2% -99.9%). Conclusion: IGRA (T SPOT.TB) in active TB high sensitivity and negative predictive value, as good except the basis of the diagnosis of active tuberculosis. IGRA in active TB specificity and positive predictive value is also higher in patients highly suspected active tuberculosis infection, help the clinical diagnosis of active tuberculosis. IGRA specificity for the diagnosis of extrapulmonary tuberculosis than tuberculosis. Age ≥ 46 years of age and previous history of tuberculosis was independently associated with false positive TSPOT. TB. ≥ 46 years of age, or a previous history of tuberculosis, the occurrence of false-positive T SPOT.TB is more likely. The study did not found the T SPOT.TB the false negative risk factors. IGRA (T SPOT. TB) are superior in sensitivity and specificity of the tuberculin skin test (intradermal injection of 5 units), better sensitivity than the tuberculin skin test (intradermal injection of 1 unit) . Two tuberculin skin test and the consistency of the T SPOT. TB are poor. Fever of unknown origin in the case group found significant negative T SPOT. TB exclude active tuberculosis significance.

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