Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Tuberculin Skin Test and QuantiFERON-TB Gold Assay before and after Treatment for Latent Tuberculosis Infection among Health Care Workers in Local Tertiary Hospital

일개 병원의 의료인에서 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 이용한 잠복결핵의 진단과 치료 전후의 변화

  • Lee, Seung Jun (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Kim, Hyeon Sik (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Ma, Jung Eun (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Sang Min (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Ham, HyunSeok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Cho, Yu Ji (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Jeong, Yi Yeong (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Kim, Ho Cheol (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Jong Deok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Kim, Sun-Joo (Department of Laboratory Medicine, College of Medicine, Gyeongsang National University) ;
  • Hwang, Young Sil (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
  • 이승준 (경상대학교 의과대학 내과학교실) ;
  • 김현식 (경상대학교 의과대학 내과학교실) ;
  • 마정은 (경상대학교 의과대학 내과학교실) ;
  • 이상민 (경상대학교 의과대학 내과학교실) ;
  • 함현석 (경상대학교 의과대학 내과학교실) ;
  • 조유지 (경상대학교 의과대학 내과학교실) ;
  • 정이영 (경상대학교 의과대학 내과학교실) ;
  • 김호철 (경상대학교 의과대학 내과학교실) ;
  • 이종덕 (경상대학교 의과대학 내과학교실) ;
  • 김선주 (경상대학교 의과대학 진단검사의학과교실) ;
  • 황영실 (경상대학교 의과대학 내과학교실)
  • Received : 2007.01.23
  • Accepted : 2007.03.29
  • Published : 2007.04.30
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Abstract

The QuantiFERON-TB Gold assay and tuberculin skin test (TST) have been useful test for diagnosing latent tuberculosis infections (LTBI). However, there are few reports on the efficacy of the QuantiFERON-TB Gold assay and TST in evaluating the response after the treatment of LTBI. This study examined the changes in the TST and QuantiFERON-TB Gold assay before and after a treatment for latent tuberculosis in health care workers (HCWs) at a local tertiary hospital. Methods: A cohort of volunteers working as nurses and doctors who underwent a TST and QuantiFERON-TB Gold assay was established. The volunteers positive for the QuantiFERON-TB Gold assay had been treated with 3 months of isoniazid (INH) and rifampin (RFP). After completing treatment, the TST and QuantiFERON-TB Gold assay were repeated. Results: Of the 48 participants (14 doctors, 34 nurses, M: F=11:37, mean $age=29.9{\pm}5.5$ years, mean employment $period=74.9{\pm}64.3$ months), 19 (39.6%) tested positive to the TST (mean induration=$19.1{\pm}9.7mm$) and 8 (16.7%) were QuantiFERON-TB Gold assay. Among them, one had active pulmonary tuberculosis. Seven volunteers were consistently positive to both the TST and QuantiFERON-TB Gold assay after being medicated with INH and RFP for 3 months. Conclusion: TST and QuantiFERON-TB Gold assay are unsuitable for evaluating the treatment response of LTBI because they were consistently positive both before and after the anti-tuberculosis medication.

배 경: 결핵의 완전 퇴치를 위해서는 잠복결핵의 진단 및 치료를 통해 활동성 결핵으로 진행되는 것을 예방하는 것이 중요하다. 최근 QuantiFERON-TB Gold 검사가 잠복결핵의 진단을 위한 방법으로 승인되어 사용되고 있다. 본 연구에서는 지역 3차 종합병원에 근무하는 의료인을 대상으로 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 통해 잠복결핵을 진단하고, 잠복결핵을 치료한 후 투베르쿨린 검사와 QuantiFERON-TB Gold 검사의 변화를 알아보고자 하였다. 방 법: 2006년 경상대학교 병원에 근무중인 의료인 중 48명의 지원자(의사 14명, 간호사 34명, 남:여 =11:37, 평균연령=$29.9{\pm}5.5$세, 평균근무기간=$74.9{\pm}64.3$개월)를 대상으로 하였다. QuantiFERON-TB Gold 검사와 투베르쿨린 검사를 시행하여 의료인에서 잠복 결핵을 진단하고 두 검사의 일치율을 알아보았다. 그리고 QuantiFERON-TB Gold 검사가 양성인 지원자를 대상으로 Isoniazid(INH, 300 mg/day)와 Rifampin( RFP, 600 mg/day)을 3개월간 투약한 후 다시 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 시행하여 잠복결핵 치료 전후 두 검사의 변화를 확인하고 경결의 양성 기준에 따른 투베르쿨린 검사와 Quanti FERON-TB Gold 검사의 일치율을 알아보았다. 결 과: 48명의 지원자 중 투베르쿨린 검사는 경결 양성 기준을 10 mm 이상으로 하였을 때 19명(39.6%) 에서 양성, QuantiFERON-TB Gold 검사는 8명 (16.7%)에서 양성이었으며 두 검사의 일치율은 77.1%, ${\kappa}$값은 0.468이었고, 투베르쿨린 검사의 경결 양성 기준을 15 mm로 설정하면 두 검사의 일치율은 83.3%, ${\kappa}$값은 0.500이었다. 1명의 활동성 결핵 환자를 제외한 QuantiFERON-TB Gold 검사가 양성인 7명의 지원자에서 잠복결핵 치료 후에도 투베르쿨린 검사와 QuantiFERON-TB Gold 검사는 계속 양성이었다. 이들에게서 시행한 투베르쿨린 검사의 평균 경결은 잠복결핵 치료 전 $19.1{\pm}9.7mm$, 치료 후 $43.6{\pm}25.1mm$이었다. 결 론: 이번 연구의 결론으로는 투베르쿨린 검사와 QuantiFERON-TB Gold 검사로 잠복결핵의 치료 반응을 평가하는 것은 부적절하다고 판단되며 향후 이에 대한 더 많은 연구가 필요할 것으로 사료된다.

Keywords

References

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