研究测试临界值,优化美国境外出生者的潜伏肺结核感染诊断。

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM
Sofia Zavala, Kathryn Winglee, Christine S Ho, April C Pettit, Amina Ahmed, Dolly J Katz, Robert W Belknap, Jason E Stout
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引用次数: 0

摘要

理由:在结核病(TB)高发国家出生并生活在结核病低发国家的人群中检测潜伏结核病感染(LTBI)是在结核病低发国家消除结核病的关键。优化 LTBI 检测对于有针对性地进行治疗至关重要。研究目的比较结核菌素皮试(TST)和两种干扰素-γ释放检测法在不同临界值下的灵敏度和特异性,以及单一检测法和双重检测法的灵敏度和特异性。方法:我们对美国接受过 LTBI 检测的前瞻性队列中的一个子集(N = 14,167)进行了研究。我们纳入了非美国出生、人类免疫缺陷病毒(human immunodeficiency virus)阴性、年龄在 5 岁及以上、具有有效 TST、QuantiFERON-TB Gold-in-Tube (QFT) 和 T-SPOT.TB (TSPOT) 检测结果的人群。根据贝叶斯潜类模型得出的不同检测临界值和检测组合的敏感性/特异性,构建了接收者操作特征曲线(ROC),并评估了每种检测的曲线下面积(AUC)。计算了双重检测的灵敏度/特异性。结果TST ROC 曲线的 AUC 为 0.81(95% 可信区间 (CrI),0.78-0.86),在 5、10 和 15 mm 临界点时的敏感性/特异性分别为 86.5%/61.6%、81.7%/71.3% 和 55.6%/88.0%。QFT ROC 曲线的 AUC 为 0.89(95% CrI,0.86-0.93),在 0.35、0.7 和 1.0 IU/mL 临界点时的敏感性/特异性分别为 77.7%/98.3%、66.9%/99.1% 和 61.5%/99.4%。TSPOT ROC 曲线的 AUC 为 0.92(95% CrI,0.88-0.96),5、6、7 和 8 个点的敏感性/特异性分别为 79.2%/96.7%、76.8%/97.7%、74.0%/98.6% 和 71.8%/99.5%。TST-QFT、TST-TSPOT 和 QFT-TSPOT 在标准临界值下的敏感性/特异性分别为 73.1%/99.4%、64.8%/99.8% 和 65.3%/100%。结论与 TST 相比,干扰素-γ 释放测定对 LTBI 高危人群的预测能力更强。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States.

Rationale: Detection of latent tuberculosis infection (LTBI) in persons born in high tuberculosis (TB) incidence countries living in low TB incidence countries is key to TB elimination in low-incidence countries. Optimizing LTBI tests is critical to targeting treatment. Objectives: To compare the sensitivity and specificity of tuberculin skin test (TST) and two interferon-γ release assays at different cutoffs and of a single test versus dual testing. Methods: We examined a subset (N = 14,167) of a prospective cohort of people in the United States tested for LTBI. We included non-U.S.-born, human immunodeficiency virus-seronegative people ages 5 years and older with valid TST, QuantiFERON-TB Gold-in-Tube (QFT), and T-SPOT.TB (TSPOT) results. The sensitivity/specificity of different test cutoffs and test combinations, obtained from a Bayesian latent class model, were used to construct receiver operating characteristic (ROC) curves and assess the area under the curve (AUC) for each test. The sensitivity/specificity of dual testing was calculated. Results: The AUC of the TST ROC curve was 0.81 (95% credible interval (CrI), 0.78-0.86), with sensitivity/specificity at cutoffs of 5, 10, and 15 mm of 86.5%/61.6%, 81.7%/71.3%, and 55.6%/88.0%, respectively. The AUC of the QFT ROC curve was 0.89 (95% CrI, 0.86-0.93), with sensitivity/specificity at cutoffs of 0.35, 0.7, and 1.0 IU/mL of 77.7%/98.3%, 66.9%/99.1%, and 61.5%/99.4%. The AUC of the TSPOT ROC curve was 0.92 (95% CrI, 0.88-0.96) with sensitivity/specificity for five, six, seven, and eight spots of 79.2%/96.7%, 76.8%/97.7%, 74.0%/98.6%, and 71.8%/99.5%. Sensitivity/specificity of TST-QFT, TST-TSPOT, and QFT-TSPOT at standard cutoffs were 73.1%/99.4%, 64.8%/99.8%, and 65.3%/100%. Conclusion: Interferon-γ release assays have a better predictive ability than TST in people at high risk of LTBI.

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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
发文量
0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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