소아에서 Interferon-γ 검사와 투베르쿨린 검사와의 비교
Comparison of Interferon-γ Assays with the Tuberculin Skin Test in Children
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초록
목 적:BCG 예방접종이 잠복결핵 진단에 이용되는 투베르쿨린 피부반응검사 결과에 영향을 미칠 수 있으므로 최근 잠복결핵을 진단하는 새로운 검사법이 개발되었다. 그러나 이 검사법을 이용한 결과는 주로 성인을 대상으로 보고 되었고 국내에서는 이 검사법을 이용한 소아에 대한 보고는 미약한 실정이다. 이에 본 연구자들은 이러한 새로운 검사방법 결과와 기존에 사용되고 있는 투베르쿨린 피부반응검사 결과와의 일치율을 알아보고자 하였다. 방 법:2007년 7월 1일부터 2009년 ５월 31일까지 부모 혹은 거주자가 활동성 결핵으로 본원에서 진단 받아 잠복결핵 감염 유무를 확인하고자 본원 소아청소년과를 방문한 소아 82명을 대상으로 흉부 방사선 검사,투베르쿨린 피부반응검사, QuantiFERON-TB Gold 검사를 시행하였다, QuantiFERON-TB Gold 검사 결과 양성이거나 투베르쿨린 피부반응검사 결과 양성인 소아들은 isoniazide를 소아 체중에 맞추어 6개월간 투여하였고 이 중 약물 투여 6개월 후 QuantiFERON-TB Gold 검사 양성인 환아들 중 지원자에 한해 QuantiFERON-TB Gold 검사를 다시 실시하였다. 결 과:82명의 소아 중 27명에서 QuantiFERON-TB Gold 검사 결과가 양성이었고 투베르쿨린 피부반응검사 결과 양성을 경결 크기 10 mm이상으로 하는 경우에 26명에서 양성이었고 투베르쿨린 피부반응검사 결과 양성을 경결 크기 15 mm이상으로 하는 경우에 14명에서 양성이었다. 투베르쿨린 피부반응검사 결과 양성을 경결 크기 10 mm이상으로 하는 경우에 투베르쿨린 피부반응검사와 Quanti FERON-TB Gold 검사의 일치율은 86.8%였고 투베르쿨린 피부반응검사 양성을 경결 크기 15 mm이상으로 하는 경우에는 두 검사 간의 일치율은 74.4%였으며 두 경우 모두에서 P value는 0.05이하로 유의한 일치율을 보였다. QuantiFERON-TB Gold 검사 양성을 보인 소아 중 7명에서 경과 관찰이 가능하였으며 이중 치료 6개월 후 4명에서는 음성으로 변화 하였으나 3명은 양성이었다. 결 론:본 연구에서 QuantiFERON-TB Gold 검사와 투베르쿨린 피부반응검사 결과 사이에 높은 일치율을 보였으며 향후 잠복결핵 진단에 있어서 QuantiFERON-TB Gold 검사가 투베르쿨린 피부반응검사를 대체 가능할 것으로 생각되나 보다 많은 연구가 필요하다.
Abstract
Purpose:In vitro interferon-γ assays have emerged as alternatives to the tuberculin skin test for the diagnosis of latent tuberculosis infection. These assays have been performed on adults, especially in foreign countries. The aim of this study was to investigate the usefulness of interferon-γ assays in children. Methods:Between July 2007 and May 2009, we recruited 82 children with suspected latent tuberculosis infections. We performed chest radiography, the tuberculin skin test (2 TU) and the QuantiFERON-TB Gold assay. The volunteers who were positive for the QuantiFERON-TB Gold assay treated for 6 months with isoniazid. After treatment, the QuantiFERON-TB Gold assay was repeatedly performed. Results:Of the 82 participants, 27 had positive QuantiFERON-TB Gold assay results. For the tuberculin skin test, 26 participants were positive at a 10-mm cutoff. With a cutoff point of 15 mm, 14 participants had positive tuberculin skin test results. Data on agreement between the tuberculin skin test and the QuantiFERON-TB Gold assay were available for all children. With a cutoff point of 10 mm, agreement was 86.8%, whereas with a cutoff point of 15 mm, it was 74.4%. The QuantiFERON-TB Gold assay was repeatedly performed on 7 participants, 3 of whom had persistently positive QuantiFERON-TB Gold assay results. Conclusion:In our study, it is suggested that the QuantiFERON-TB Gold assay may have good agreement with the tuberculin skin test．Further studies with a larger sample size are needed to evaluate a definitive relationship between the QuantiFERON-TB Gold assay and the tuberculin skin test in children.
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