일개 병원의 의료인에서 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 이용한 잠복결핵의 진단과 치료
Tuberculin Skin Test and QuantiFERON-TB Gold Assay before and after Treatment for Latent Tuberculosis Infection among Health Care Workers in Local Tertiary Hospital
정이영 (경상대학교)
김호철 (경상대학교)
이종덕 (경상대학교)
김선주 (경상대학교)
황영실 (경상대학교)
김현식 (한국체육대학교)
마정은 (경상의대)
이상민 (경상의대)
함현석 (경상의대)
조유지 (경상의대)
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초록
배 경: 결핵의 완전 퇴치를 위해서는 잠복결핵의 진단 및 치료를 통해 활동성 결핵으로 진행되는 것을 예방하는 것이 중요하다. 최근 QuantiFERON-TB Gold 검사가 잠복결핵의 진단을 위한 방법으로 승인되어 사용되고 있다. 본 연구에서는 지역 3차 종합병원에 근무하는 의료인을 대상으로 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 통해 잠복결핵을 진단하고, 잠복결핵을 치료한 후 투베르쿨린 검사와 QuantiFERON-TB Gold 검사의 변화를 알아보고자 하였다.방 법: 2006년 경상대학교 병원에 근무중인 의료인 중 48명의 지원자(의사 14명, 간호사 34명, 남:여=11:37, 평균연령=29.9±5.5세, 평균근무기간=74.9±64.3개월)를 대상으로 하였다. QuantiFERON-TB Gold 검사와 투베르쿨린 검사를 시행하여 의료인에서 잠복결핵을 진단하고 두 검사의 일치율을 알아보았다. 그리고 QuantiFERON-TB Gold 검사가 양성인 지원자를 대상으로 Isoniazid(INH, 300 mg/day)와 Rifampin(RFP, 600 mg/day)을 3개월간 투약한 후 다시 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 시행하여 잠복결핵 치료 전후 두 검사의 변화를 확인하고 경결의 양성 기준에 따른 투베르쿨린 검사와 Quanti FERON-TB Gold 검사의 일치율을 알아보았다.결 과: 48명의 지원자 중 투베르쿨린 검사는 경결 양성 기준을 10 mm 이상으로 하였을 때 19명(39.6%)에서 양성, QuantiFERON-TB Gold 검사는 8명(16.7%)에서 양성이었으며 두 검사의 일치율은 77.1%, κ값은 0.468이었고, 투베르쿨린 검사의 경결 양성 기준을 15 mm로 설정하면 두 검사의 일치율은 83.3%, κ값은 0.500이었다. 1명의 활동성 결핵 환자를 제외한 QuantiFERON-TB Gold 검사가 양성인 7명의 지원자에서 잠복결핵 치료 후에도 투베르쿨린 검사와 QuantiFERON-TB Gold 검사는 계속 양성이었다. 이들에게서 시행한 투베르쿨린 검사의 평균 경결은 잠복결핵 치료 전 19.1±9.7 mm, 치료 후 43.6±25.1 mm이었다.
- keywords
- Latent tuberculosis infection (LTBI), Treatment, Tuberculin skin test (TST), QuantiFERON-TB Gold assay, Health care workers., Latent tuberculosis infection (LTBI), Treatment, Tuberculin skin test (TST), QuantiFERON-TB Gold assay, Health care workers.
Abstract
Background: The QuantiFERON-TB Gold assay and tuberculin skin test (TST) have been useful test for diagnosing latent tuberculosis infections (LTBI). However, there are few reports on the efficacy of the QuantiFERON-TB Gold assay and TST in evaluating the response after the treatment of LTBI. This study examined the changes in the TST and QuantiFERON-TB Gold assay before and after a treatment for latent tuberculosis in health care workers (HCWs) at a local tertiary hospital. Methods: A cohort of volunteers working as nurses and doctors who underwent a TST and QuantiFERON-TB Gold assay was established. The volunteers positive for the QuantiFERON-TB Gold assay had been treated with 3 months of isoniazid (INH) and rifampin (RFP). After completing treatment, the TST and QuantiFERON-TB Gold assay were repeated. Results: Of the 48 participants (14 doctors, 34 nurses, M: F=11:37, mean age=29.9±5.5 years, mean employment period=74.9±64.3 months), 19 (39.6%) tested positive to the TST (mean induration=19.1±9.7 mm) and 8 (16.7%) were QuantiFERON-TB Gold assay. Among them, one had active pulmonary tuberculosis. Seven volunteers were consistently positive to both the TST and QuantiFERON-TB Gold assay after being medicated with INH and RFP for 3 months. Conclusion: TST and QuantiFERON-TB Gold assay are unsuitable for evaluating the treatment response of LTBI because they were consistently positive both before and after the anti-tuberculosis medication. (Tuberc Respir Dis 2007; 62: 270-275)
- keywords
- Latent tuberculosis infection (LTBI), Treatment, Tuberculin skin test (TST), QuantiFERON-TB Gold assay, Health care workers., Latent tuberculosis infection (LTBI), Treatment, Tuberculin skin test (TST), QuantiFERON-TB Gold assay, Health care workers.
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