TY -的T1 -是干扰素-γ释放化验使用ful for diagnosing active tuberculosis in a high-burden setting? JF - European Respiratory Journal JO - Eur Respir J SP - 649 LP - 656 DO - 10.1183/09031936.00181610 VL - 38 IS - 3 AU - Ling, D.I. AU - Pai, M. AU - Davids, V. AU - Brunet, L. AU - Lenders, L. AU - Meldau, R. AU - Calligaro, G. AU - Allwood, B. AU - van Zyl-Smit, R. AU - Peter, J. AU - Bateman, E. AU - Dawson, R. AU - Dheda, K. Y1 - 2011/09/01 UR - //www.qdcxjkg.com/content/38/3/649.abstract N2 - Although interferon-γ release assays (IGRAs) are intended for diagnosing latent tuberculosis (TB), we hypothesised that in a high-burden setting: 1) the magnitude of the response when using IGRAs can distinguish active TB from other diagnoses; 2) IGRAs may aid in the diagnosis of smear-negative TB; and 3) IGRAs could be useful as rule-out tests for active TB. We evaluated the accuracy of two IGRAs (QuantiFERON®-TB Gold In-tube (QFT-GIT) and T-SPOT®.TB) in 395 patients (27% HIV-infected) with suspected TB in Cape Town, South Africa. IGRA sensitivity and specificity (95% CI) were 76% (68–83%) and 42% (36–49%) for QFT-GIT and 84% (77–90%) and 47% (40–53%) for T-SPOT®.TB, respectively. Although interferon-γ responses were significantly higher in the TB versus non-TB groups (p<0.0001), varying the cut-offs did not improve discriminatory ability. In culture-negative patients, depending on whether those with clinically diagnosed TB were included or excluded from the analysis, the negative predictive value (NPV) of QFT-GIT, T-SPOT®.TB and chest radiograph in smear-negative patients varied between 85 and 89, 87 and 92, and 98% (for chest radiograph), respectively. Overall accuracy was independent of HIV status and CD4 count. In a high-burden setting, IGRAs alone do not have value as rule-in or -out tests for active TB. In smear-negative patients, chest radiography had better NPV even in HIV-infected patients. ER -