Pediatric Infection and Vaccine

  • 제23권1호
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  • Pages.18-24
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  • 2016
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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국내 소아 결핵감염 진단에서의 결핵피부반응 검사와 Interferon-gamma Release Assay (IGRA)의 비교 연구

Discordance between Tuberculin Skin Test and Interferon-gamma Release Assays for Diagnosis of Tuberculosis Infection in Korean Children

  • 유리나 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김준일 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김서희 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 이진아 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Yoo, Reenar (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon-Il (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Seohee (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jina (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2015.08.11
  • 심사 : 2015.10.20
  • 발행 : 2016.04.25
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초록

목적: 국내와 같이 결핵의 유병률이 높은 지역에서 결핵을 정확하게 진단하는 것은 중요하다. 본 예비연구는 국내의 소아청소년에서 결핵진단 시 TST 및 2가지 IGRA 검사법 (QFT-G 및 T-SPOT.TB) 간의 일치도를 알아보고자 하였다. 방법: 2014년 1월부터 2015년 4월까지 잠복결핵감염 또는 결핵질환의 진단을 위해 서울아산병원을 방문한 20세 이하 환자 중, TST, T-SPOT.TB 및 QFT-G 검사 중 최소 2가지 이상의 검사를 동시에 시행한 경우를 연구에 포함하였다. 이들의 의무기록을 후향적으로 분석하여 각 검사 간의 일치도를 평가하였다. 결과: 연구에 포함된 총 20명의 연령의 중앙값은 13.3세(범위: 3.8-18.1세)이었고, 이 중 11명은 면역저하와 관련된 기저질환이 있었다. T-SPOT.TB와 QFT-G 결과의 일치도는 90%였으며, TST와 T-SPOT.TB의 일치도는 50%, TST와 QFT-G의 일치도는 42.9%였다. T-SPOT.TB, QFT-G 및 TST의 결핵질환에 대한 특이도는 93.3%, 86.7% 및 58.3%였다. 결론: T-SPOT.TB과 QFT-G 간의 일치도는 높으나 TST와 T-SPOT.TB 또는 QFT-G 간의 일치도는 낮았다. 추후 국내 소아청소년의 정확한 결핵의 진단을 위한 각 검사들의 일치도 및 진단적 유용성에 대한 추가적인 연구가 필요하다.

Purpose: There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT$^{(R)}$.TB and QuantiFERON$^{(R)}$-TB Gold (QFT-G) in Korean children. Method: This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015. Results: A total of 20 patients were included, whose median age was 13.3 years (range, 3.8-18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively. Conclusions: Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.

키워드

참고문헌

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피인용 문헌

  1. Usefulness of flexible bronchoscopy in children with suspected pulmonary tuberculosis who have difficulty in sputum expectoration vol.5, pp.5, 2017, https://doi.org/10.4168/aard.2017.5.5.287
  2. Comparative Results of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold Plus Assays for Detection of Tuberculosis Infection in Clinical Samples vol.58, pp.4, 2020, https://doi.org/10.1128/jcm.01854-19