투베르쿨린 검사가 결핵에 대한 체외 IFN-γ 검사 결과에 미치는 영향
Effect of Tuberculin Skin Test on Ex-vivo Interferon-gamma Assay for Latent Tuberculosis Infection
오연목 (울산대학교)
이상도 (울산대학교)
심태선 (울산대학교)
김우성 (울산대학교)
김동순 (울산대학교)
김원동 (울산대학교)
조상래 (연세대학교)
최희진 (아산생명과학연구소)
박이내 (울산대학교 의과대학 서울아산병원)
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초록
연구배경 : 최근 말초혈액을 결핵균 특이 항원으로 자극후 분비되는 IFN-γ 를 측정하는 QuantiFERON??-TB Gold (QFT) 와 T SPOT-TB?? (SPOT) 검사가 임상에서 잠복결핵의 진단에 상품화되어 사용되고 있다. 그러나 이전에 시행한 투베르쿨린 검사가 상기 체외 IFN-γ 검사의 위양성을 유발할 수 있는 가능성에 대해서는 아직 발표된 자료가 없다. 방 법 :과거 결핵치료력 또는 환자 접촉력이 없는 46명의 15세 남자 고등학생을 대상으로 하였다. 혈액을 채취하여 IFN-γ 검사를 시행하고, 이단계 TST를 시행하였다. 첫 번째 검사에서 IFN-γ 검사와 TST가 모두 음성인 학생을 대상으로 하여 2개월 째에 TST, 2개월, 4개월 째에 QFT, 그리고 2개월 째에 SPOT 검사가 반복 시행되었다.
- keywords
- Latent tuberculosis infection, Interferon-gamma assay, Tuberculin skin test, Purified Protein Derivative, Latent tuberculosis infection, Interferon-gamma assay, Tuberculin skin test, Purified Protein Derivative
Abstract
Background : Recently, two commercialized whole-blood assays, QuantiFERON-TB Gold (QFT) and T SPOT-TB (SPOT), which measure the IFN-γ released in the whole blood after being incubation with mycobacterial antigens, were approved for the diagnosis of a latent tuberculosis infection (LTBI). However, there is data on whether or not the previously used PPD skin tests (TST) have any influence on the diagnostic ability of these ex-vivo IFN-γ assays. Methods : Forty-six 15 year-old students who did not appear to be infected with Mycobacterium tuberculosis were enrolled in this study. The peripheral blood was collected and used for two IFN-γ assays. The IFN-γ assays and TST were performed at the baseline (1st). The TST was repeated two months later (2nd), and the IFN-γ assays were repeated two (2nd) and four months (3rd) later only in those subjects who had negative results at the baseline in both the IFN-γ assays and TST. An induration size > 10 mm was considered to be positive in the TST. Results : The mean TST value was 3.1 ± 5.4 mm (range: 0-20). Of the 46 subjects examined, 13 subjects (28.3%) showed positive results in the two-step TST. Nine (19.6%) were SPOT-positive and only one (2.2%) was QFT-positive. The 2nd and 3rd QFT were carried out in 23 and 25 all-negative subjects, respectively, and all showed negative results. The 2nd SPOT was performed in 23 subjects and only one (4.3%) showed a weak-positive result. Conclusion : Even though there were some discrepancies in the results of the two ex-vivo IFN-γ assays, it appears that their results were not influenced by a previous TST carried out in two or four months earlier. (Tuberc Respir Dis 2005; 59: 406-412)
- keywords
- Latent tuberculosis infection, Interferon-gamma assay, Tuberculin skin test, Purified Protein Derivative, Latent tuberculosis infection, Interferon-gamma assay, Tuberculin skin test, Purified Protein Derivative
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