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소아 결핵 진단에 있어서 결핵 특이항원자극 인터페론 감마 측정검사의 임상적 의의

Clinical Significance of Interferon γ Release Assay for Diagnosis of Tuberculosis in Children

이희우|박화영|손근찬|안영민
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)|2010.12|Pediatric Infection and Vaccine|제17권 제2호|pp. 137-147

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키워드

ChildrenTuberculosisTuberculin skin testInterferon γ release assayQuantiFERON-TB Gold assay

초록

목 적 : 본 연구는 소아에서 QuantiFERON-TB Gold (QTB) 검사의 임상적 유용성과 문제점을 평가하기 위해 시행되었다. 방 법: 2007년 1월부터 2009년 6월까지 본원에서TST와 QTB를 시행 받은 소아청소년 112명의 의무 기록을 후향적으로 조사하였다. 결 과: TST와 QTB의 양성률은 각각 59.8%, 15.2%였고, 두 검사의 일치도는 낮았다(κ=0.209). QTB의 민감도와 특이도는 각각 80.0%, 92.6%였다. QTB 양성율은 임상적 결핵군, 긴밀 접촉군, 일반 접촉군, 비접촉군에서 각각 80%, 14%, 0%, 2% 였으며, 판정보류의 빈도는 9.8%였다. QTB 추적 관찰이 시행된 환자 중, 초기QTB 양성이었던 6명 중 5명은 치료 종료 후 평균 2.2개월까지 양성이 지속되었다. 결 론:소아에서 QTB는 민감도가 낮고, 판정보류의빈도가 높다는 단점이 있으나, 특이도가 높은 장점이 있으므로, TST의 특이도가 낮은 점을 보완하여 결핵의 진단 및 치료 결정에 활용될 수 있을 것으로 생각된다.

Abstract

Purpose : The purpose of this study is to evaluate the usefulness and limitation of QuantiFERON-TB Gold (QTB) for diagnosis of latent tuberculosis in children. Methods : The medical records of 112 children who were tested by tuberculin skin test (TST) and QTB for detection of latent tuberculosis (TB) in Eulji General Hospital during the period from January 2007 to June 2009 were retrospectively reviewed. Results : Of the 112 participants, the clinical TB group included 15 (13.4%), the contact group included 43 (38.4%), and the non-contact group included 54 (48.2%). Positive rates of TST and QTB were 100% and 80% in the clinical TB group, 64%and 14% in the close contact group, 27% and 0% in the casual contact group, and 52% and 2% in the non-contact group,respectively. Sensitivity of QTB was 80.0% and specificity was 92.6%. Agreement between QTB and TST was poor (κ=0.209). We also confirmed that the positive rate of QTB increased as the age of the patient increased (P =0.011). A QTB indeterminate result was observed in 11 (9.8%) subjects. QTB was retested in 15 subjects. In 5 of the 6 subjects who had positive results initially, positive results persisted for a median 2.2 months after termination of treatment. Conclusion : Although QTB was associated with several problems, including low sensitivity and a high rate of indeterminate results, it had clinical importance due to its high specificity. We found good correlation with regard to exposure and QTB positivity, including that of young children under 5 years of age. However, clinical application of interferon-γ releasing assay for young children for diagnosis of active and latent tuberculosis will require additional prospective studies.

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