Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Comparison of a whole blood Interferon-γ assay and A tuberculin skin test for detecting latent tuberculosis infection in children

소아 잠복 결핵 감염 진단에 있어서 투베르쿨린 피부반응 검사와 결핵 특이항원 자극 Interferon-γ 분비능 측정의 비교

  • Chun, Jin-Kyong (Department of Pediatrics, College of Medicine Yonsei University) ;
  • Kim, Chang Ki (Department of Laboratory Medicine, College of Medicine Yonsei University) ;
  • Kim, Hyun Sook (Department of Laboratory Medicine, College of Medicine Yonsei University) ;
  • Jung, Ghee Young (Sowha Childrens Hospital) ;
  • Linton, John A. (Department of Family Medicine, College of Medicine Yonsei University) ;
  • Kim, Ki Hwan (Department of Pediatrics, College of Medicine Yonsei University) ;
  • Lee, Taek Jin (Department of Pediatrics, College of Medicine Yonsei University) ;
  • Jeon, Ji Hyun (Department of Pediatrics, College of Medicine Yonsei University) ;
  • Kim, Dong Soo (Department of Pediatrics, College of Medicine Yonsei University)
  • 전진경 (연세대학교 의과대학 소아과학교실) ;
  • 김창기 (연세대학교 의과대학 진단검사의학교실) ;
  • 김현숙 (연세대학교 의과대학 진단검사의학교실) ;
  • 정귀영 (소화아동병원) ;
  • 인요한 (연세대학교 의과대학 가정의학교실) ;
  • 김기환 (연세대학교 의과대학 소아과학교실) ;
  • 이택진 (연세대학교 의과대학 소아과학교실) ;
  • 전지현 (연세대학교 의과대학 소아과학교실) ;
  • 김동수 (연세대학교 의과대학 소아과학교실)
  • Received : 2007.10.25
  • Accepted : 2008.08.05
  • Published : 2008.09.15
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Abstract

Purpose : Surveillance for detecting and managing latent tuberculosis infection (LTBI) is a key component of tuberculosis control. The classic surveillance tool, the tuberculin skin test (TST), may have some limitations when used in the Bacillus Calmette-$Gu{\acute{e}}rin$ (BCG)-vaccinated population. The object was to perform a blood test $QuantiFERON^{(R)}$-TB Gold In Tube (QFT-G IT) based on the detection of interferon-$\gamma$ ($IFN-{\gamma}$) released by T cells in response to Mycobacterium tuberculosis-specific antigens, and to compare the efficacy of this new diagnostic tool for LTBI with that of TST. Methods : For six months, between October 1, 2006 and April 30, 2007, data were collected from 111 patients under 15 years of age at Severance Children's Hospital. TST and QFT-G IT tests were performed with children with or without contact histories of tuberculosis. In addition to these tests, we examined comparative data from 29 adults who had tuberculosis, to detect false negative rates in the QFT-G IT method. Results : Thirty-three children had household contact histories. In this group, 15% and 42% of cases were found to be positive using the QFT-G IT assay and TST, respectively. Agreement was low between these two tests (${\kappa}=0.39$). In the adult active tuberculosis group, the QFT-G IT false negative rate defined as a positive culture and a negative QFT-G IT result was 12.5%. Conclusion : In diagnosing LTBI in children, the usefulness of a whole-blood $IFN-{\gamma}$ assay employing TB-specific antigens will be revealed only by examining additional longitudinal clinical data; this study serves as a starting point in that process.

목 적 : 결핵 감염 관리에 있어서 잠복 결핵 감염을 찾아 내어 예방적 화학요법을 시행하는 것은 주요 핵심이다. 결핵에 노출된 소아에서 잠복 결핵 감염 진단을 위해 투베르쿨린 피부반응과 최근 널리 쓰이기 시작한 체외 검사법으로 결핵 특이항원 자극에 의한 T 세포의 $IFN-{\gamma}$ 분비능 측정 (QFT-G IT)이 있다. 잠복 결핵 감염 진단에 있어 두 검사법의 차이를 알아보고자 본 연구를 진행하였다. 방 법 : 2006년 10월 1일부터 2007년 4월 30일까지 6개월 간 총 111명의 소아를 대상으로 투베르쿨린 반응과 QFT-G IT 검사를 시행하였고, 동일 기간 내인 2개월 간 진단 된 성인 결핵 환자 29명에서 동일한 검사 결과를 후향적으로 알아보았다. 결 과 : 결핵 환자와의 가까운 접촉력을 주소로 내원한 무증상의 환자 33명 중 15% (5명)에서 QFT-G IT 검사 양성 소견을 보였고, 투베르쿨린 피부반응은 42% (14명)에서 양성결과를 보여 두 검사 간의 일치율은 낮았다(${\kappa}=0.39$). 성인 결핵 환자에서 QFT-G IT 양성율은 86.2%였고, 결핵균 배양 검사 양성율은 48.2%였다. 배양검사 양성이면서 QFT-G IT 음성이었던 환자는 12.5%였다. 결 론 : 소아에서 잠복 결핵 감염을 진단함에 있어 가족력을 근저에 둔 투베르쿨린 피부반응 검사를 시행하되 접촉력이 불분명하거나 지속적이지 않았을 경우 혹은 BCG 접종 효과로 의심되는 경우 결핵균 특이항원 자극 $IFN-{\gamma}$ 분비능 측정이 보조적 수단으로 사용 될 수 있을 지는 아직 확실하지 않으며 향후 수년 간 다 기관 연구가 필요하다.

Keywords

References

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