확진된 소아청소년 결핵에서 인터페론감마 분비검사의 진단적 가치
Evaluation of Interferon-gamma Release Assay in Children with Confirmed Tuberculosis
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목적: 이 연구의 목적은 소아청소년 결핵 질환의 진단에서QuantiFERON-TB Gold In-Tube (QFT-GIT) 검사의 진단적 가치를 평가하는 것이다. 방법: 2006년부터 2017년까지 세브란스 병원에서 QFT-GIT 검사 및 결핵균 배양검사를 같이 시행했던 18세 이하 환아들의 의무기록을 후향적으로 확인하여 분석하였다. 결핵 확진은 결핵균 배양검사 또는 결핵균 핵산증폭검사에서 양성인 경우로 정의하였다. 결과: 분석 대상에 포함된 총 582명 중 결핵 확진 환아는 48명이었고, 결핵 미확진 환아는 534명이었다. 미정 결과를 제외하고 계산된 소아청소년 결핵 질환 진단에서 QFT-GIT 검사의 민감도와 특이도는 각각 85.4%와 95.5%이었다. 결핵 확진 환아들 중 QFT-GIT 음성군은 양성군보다 면역억제 상태의 환자가 더 많았으며(50.0% vs. 5.7%, P=0.010), QFT-GIT 미정군은 양성군보다 나이의 중앙값이 낮고(7세 vs. 17세, P=0.008), 면역억제 상태의 환자가 더 많았다(42.9% vs. 5.7%, P=0.017). 10–18세군은 0–9세군보다 양성 대조군인 mitogen에 대한 인터페론감마 분비 농도가 높았고(P<0.001), 면역정상군은 면역억제군보다 mitogen에 대한 인터페론감마 분비 농도가 높았다(P=0.001). 결론: QFT-GIT 검사 결과는 면역억제 환아나 어린 나이의 소아에서 활동성 결핵이 의심되는 경우 주의 깊게 해석되어야 한다.
Abstract
Purpose: This study aimed to evaluate the diagnostic value of the QuantiFERON-TB Gold In-Tube (QFT-GIT) in children with confirmed tuberculosis (TB). Methods: We retrospectively reviewed the medical records of children aged ≤18 years who underwent both QFT-GIT and Mycobacterium tuberculosis culture between 2006 and 2017. Confirmed TB was defined as the presence of at least one positive specimen for M. tuberculosis on culture or a nucleic acid amplification test. Results: Of the 582 patients included in the analysis, 48 were confirmed to have TB. The sensitivity and specificity of QFT-GIT for the diagnosis of confirmed TB were 85.4% and 95.5%, respectively. Among children with confirmed TB, the proportion in the immunocompromised state was higher in the QFT-GIT negative group than in the QFT-GIT positive group (50.0% vs. 5.7%, P=0.010). The median age at sampling was lower in the QFT-GIT indeterminate group than in the QFT-GIT positive group (7 years vs. 17 years, P=0.008), and the proportion of immunosuppression was higher in the QFT-GIT indeterminate group than in the QFT-GIT positive group (42.9% vs. 5.7%, P=0.017). The interferon gamma response to mitogen control was significantly higher in the 10–18 years group than in the 0–9 years group (P<0.001), and was significantly higher in the immunocompetent group than in the immunocompromised group (P=0.001). Conclusion: The QFT-GIT results should be interpreted carefully in immunocompromised or younger children suspected of having TB.
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