重组结核分枝杆菌融合蛋白皮肤试验与TST在学校结核潜伏感染筛查中的比较  

Comparison of recombinant Mycobacterium tuberculosis fusion protein skin test and tuberculin skin test for screening latent tuberculosis infection in school students

作　　者：苏倩 汪清雅 张婷 刘英 SU Qian;WANG Qing-ya;ZHANG Ting;LIU Ying(District and County Department,Chongqing Municipal Institution of Tuberculosis,Chongqing 400050,China;Medical Education Department,Chongqing Municipal Institution of Tuberculosis,Chongqing 400050,China)

机构地区：[1]重庆市结核病防治所区县科,重庆400050 [2]重庆市结核病防治所医教科,重庆400050

出　　处：《中国感染控制杂志》2023年第5期547-551,共5页Chinese Journal of Infection Control

基　　金：重庆市科卫联合医学科研项目(2022MSXM018);重庆市首批公共卫生重点学科项目(结核病防控)。

摘　　要：目的 比较重组结核分枝杆菌融合蛋白皮肤试验(EC)与结核菌素皮肤试验(TST)两种检测方法的筛查效能及成本效益,探讨更适合学校结核潜伏感染的筛查方法。方法 选取2021年9月重庆市某中学高一新生共计283名,采用整群随机抽样方法分为EC组(138名)和TST组(145名),分别于左前臂皮内注射0.1 mL EC或0.1 mL TST,观察注射72 h后皮肤反应。皮肤试验前采集283名学生的静脉血,进行体外γ-干扰素释放试验(IGRA)检测,以IGRA检测结果为标准,分别计算EC、TST试验结果的灵敏度、特异度、漏诊率、一致率,并分析三者的成本效益。结果 EC的灵敏度、特异度、漏诊率、一致率分别为54.55%、93.70%、45.45%、90.58%;TST的灵敏度、特异度、漏诊率、一致率分别为61.11%、81.10%、38.89%、78.62%。每检出1例结核分枝杆菌感染者,TST、EC、IGRA的检测成本分别为124.29、492.86、4 879.31元。结论 EC与IGRA检测结果一致性较好,较TST的特异度和一致率更高,检测成本效益较高,简便易行,有望成为学校结核分枝杆菌潜伏感染新的筛查方法。Objective To compare the effectiveness and cost-effectiveness of the recombinant Mycobacterium tuberculosis fusion protein skin test(EC)and the tuberculin skin test(TST)for detecting latent tuberculosis infection(LTBI),and to explore a more suitable screening method for LTBI in school students.Methods 283 high school freshmen enrolled in September 2021 in Chongqing City were divided into EC group(n=138)and TST group(n=145)by cluster random sampling.Each student was intracutaneously injected with 0.1 mL of either EC or TST into the left forearm,and skin reactions were observed 72 hours after injection.Before skin test,venous blood of all 283 students was collected for in vitro interferon-γrelease assay(IGRA).Taking the IGRA test result as the standard,the sensitivity,specificity,misdiagnosis rate,and consistency between EC/TST and IGRA were calculated respectively.Cost-effectiveness of the three methods were compared.Results The sensitivity,specificity,misdiagnosis rate,and consistency rate of EC were 54.55%,93.70%,45.45%,and 90.58%respectively,while those of TST were 61.11%,81.10%,38.89%,and 78.62%respectively.The detection cost for detecting one tuberculosis infection case using TST,EC,and IGRA were 124.29 Yuan,492.86 Yuan and 4879.31 Yuan,respectively.Conclusion The consistency between EC and IGRA is good,and the specificity,consistency and cost-effectiveness of EC are higher than TST.EC is also easy to perform,making it a potential new screening method for LTBI among school students.

关 键 词：重组结核分枝杆菌融合蛋白 结核感染 肺结核 结核菌素纯蛋白衍生物 Γ-干扰素释放试验 结核菌素皮肤试验 

分 类 号：R181.32[医药卫生—流行病学] R521[医药卫生—公共卫生与预防医学]