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1 DOI : /trd ISSN : (Print)/ (Online) Tuberc Respir Dis 2009;66:13-19 CopyrightC2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. 활동성결핵의진단에서혈청인터페론감마측정법의유용성 1 성균관대학교의과대학삼성서울병원내과학교실호흡기내과, 한림대학교의과대학 2 내과학교실호흡기내과, 3 진단검사의학과 박소영 1, 박용범 2, 최정희 2, 이재영 2, 김재석 3, 모은경 2 The Diagnostic Value of Interferon-γ Assay in Patients with Active Tuberculosis So Young Park, M.D. 1, Yong Bum Park, M.D. 2, Jeong Hee Choi, M.D. 2, Jae Young Lee, M.D. 2, Jae-Seok Kim, M.D. 3, Eun Kyung Mo, M.D. 2 1 Division of Pulmonary & Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Departments of 2 Internal Medicine, 3 Laboratory Medicine, College of Medicine, Hallym University, Seoul, Korea Background: The interferon-gamma assay is reported to have high sensitivity and specificity for making the diagnosis of latent tuberculosis infection. The clinical usefulness of this essay for detecting active tuberculosis has not fully defined. We evaluated the diagnostic value of the commercial interferon-gamma assay kit (QuantiFERON- TB GOLD) for patients with suspected tuberculosis. Methods: From January to August 2007, we recruited 52 patients with suspected tuberculosis infection. We performed chest X-ray, sputum smear, culture, PCR and the QuantiFERON-TB GOLD test. Pleural fluid analysis and pleural biopsy were also done for the patients with pleural effusion. Results: Of the 52 patients we studied, 30 patients had a positive QuantiFERON-TB GOLD test result. 35 patients were finally diagnosed with active tuberculosis: twenty-five with a positive QuantiFERON-TB GOLD test and 10 with a negative QuantiFERON-TB GOLD test. The sensitivity of the QuantiFERON-TB GOLD test was 71.4% and the specificity was 64.7%. The positive predictive value was 0.83 and the negative predictive value was There was no significant difference of any of the clinical and laboratory characteristics between the two groups of patients except the C-reactive protein (CRP) level. The CRP level was 29.2±27.3 mg/dl in the pulmonary tuberculosis patients with a positive QuantiFERON-TB GOLD test and 72.9±67.9 mg/dl in the patients with a negative QuantiFERON-TB GOLD test (p<0.05). Conclusion: The sensitivity and specificity of the QuantiFERON-TB GOLD test were inadequate for making the diagnosis of active tuberculosis. We suggest that the QuantiFERON-TB GOLD test should not be used by itself to exclude the diagnosis of active tuberculosis. The relationship of the QuantiFERON-TB GOLD test and the CRP level in patients with TB would be further investigated. Key Words: Active tuberculosis, QuantiFERON-TB GOLD, C-reactive protein 서 론 Address for correspondence: Eun Kyung Mo, M.D. Division of Pulmonology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, 445, Gil-dong, Gangdonggu, Seoul , Korea Phone: , Fax: ekmo@hallym.or.kr Received: Dec. 17, 2008 Accepted: Jan. 15, 2009 결핵은인류의역사만큼이나오래된질환이고이를퇴치하려는노력은수세기동안지속되어왔으나아직도전세계적으로매년 920만명 (10만명당 139명 ) 의결핵환자가새롭게발생하고, 사망자수는 158 만명 (10 만명당 24명 ) 에이른다 1,2. 결핵의발병률이낮은국가에서는잠복결핵의진단및치료가결핵관리의기본이된다 3. 그러 13

2 SY Park et al: The diagnostic value of interferon-γ assay in patients with active tuberculosis 나매년 10만명당 92명의결핵환자가발생하여결핵의발병률이중등도에속하는우리나라에서는 BCG 접종과활동성결핵의치료가결핵조절정책의근간이되고있다 4. 그러므로우리나라의경우에는정확하고신속한결핵의진단이결핵감염을조절하는데가장중요한수단이된다. 활동성결핵의진단법은객담배양으로결핵균을확인하는것이가장정확한방법으로알려져있으나이는시간이오래걸린다는단점이있고객담도말검사의경우활동성폐결핵환자에서양성이나올확률은 50 60% 에지나지않는다 5. 또한객담도말이나배양검사가음성이라하더라도잠재적으로전염성이있거나중증도가높은환자는임상소견, 방사선검사소견만으로진단하여야하는경우도많은데이로써진단된결핵은결핵이아니거나치료를요하지않는비활동성병변일수있으므로신중을기해야한다. 따라서객담도말검사나배양검사외에신속히활동성폐결핵을진단할수있는진단도구의개발이결핵의치료에중요한역할을할것으로생각된다. 최근에등장한 Interferon-gamma release assay 는잠복결핵의진단에투베르쿨린피부반응검사를대신할수있을만한중요한검사방법으로주목받고있으며 6-9 활동성결핵의진단에도이용될가능성이제시되고있으나아직이에대한보고가불충분하다 7-9. 최근발표된메타분석에서는결핵환자에서투베르쿨린피부반응검사의경우에는 BCG 접종여부에따라민감도나특이도가다양한분포를보이나 QuantiFERON-TB GOLD 의경우에는민감도 78%, 특이도 99% 를보여투베르쿨린피부반응검사보다정확한것으로보고하였다 10. 그러나한국인을대상으로한연구에서는활동성결핵의진단에있어 Interferongamma release assay의민감도는 70 90%, 특이도는 50 85% 로다양한분포를나타내고있어 4,11, 결핵의발병률이중등도인우리나라의실정을감안할때 Interferongamma release assay 검사를활동성결핵을진단하는방법으로사용하는문제에대해서는여러가지의견이있는실정이다. 따라서본연구에서는활동성결핵이의심되는환자를대상으로 QuantiFERON-TB GOLD 검사를시행하고객담도말검사, 객담배양검사, 및조직검사결과와비교함으로써, 활동성결핵진단에서 QuantiFERON-TB GOLD 검사의유용성을알아보고자하였다. 대상및방법 1. 대상환자본연구는 2007년 1월부터 8월까지강동성심병원에입원한환자중임상양상과흉부방사선검사에서활동성결핵이의심되는환자 52명을대상으로하였다. 활동성결핵환자군에는임상적증상이나방사선학적검사에서결핵이의심되는환자로서객담도말검사에서양성이고, 핵산증폭검사가양성인환자, 객담배양검사에서결핵균이배양된환자, 조직검사에서건락괴사가동반된육아종성병변이있는환자가포함되었다 5. 단, 결핵성흉막염의경우에는상기진단기준을만족시키지못하여도흉수검사결과 Adenosine deaminase 가 40 IU/L 이상인림프구우세삼출액이면서결핵약투여후에방사선소견이호전되는경우도포함시켰다. 대조군에는폐렴, 폐암, 심부전, 판막질환, 간질성폐렴환자등이포함되었다. 2. 연구방법입원당시, 임상양상및흉부방사선검사에서활동성폐결핵이나결핵성흉막염이의심되었던환자를대상으로 QuantiFERON-TB GOLD (Cellestis Limited, Carnegie, Victoria, Australia) 검사를시행하고객담에서결핵균도말검사와결핵균배양검사, 핵산증폭검사를시행하였으며결핵성흉막염의경우에는흉수검사및흉막조직검사를시행하였다. 대상환자의혈액에서백혈구, 혈색소, 간효소수치, 혈당, 크레아티닌, C 반응성단백 (C reactive protein, CRP), 적혈구침강계수를측정하여 QuantiFERON-TB GOLD 검사결과와비교분석하였다. 3. QuantiFERON-TB GOLD 검사방법 QuantiFERON-TB GOLD 검사는환자의전혈을채취하여배양용기에각각 1 ml씩분주하고각 well에결핵균특이항원 (ESAT-6, CFP-10) 과양성 (mitogen) 대조항원, 음성 (nil) 대조항원을첨가하여 20시간동안배양후상층액을모아 Interferon-gamma 를 ELISA 방법으로측정하여판독하였다. QuantiFERON-TB GOLD 검사에서특이항원인 ESAT- 6>0.35 IU/mL 또는 CFP10>0.35 IU/mL 를만족하는경우를양성으로판정하였다. 단, 환자의면역상태를나타내는 mitogen 이 0.5 IU/mL 이하인경우에는중등도반응으로해석하였다 6. 14

3 Tuberculosis and Respiratory Diseases Vol. 66. No. 1, Jan 자료의분석자료의결과는평균과표준편차로표시하였고Quanti- FERON-TB GOLD 검사와임상적으로진단된결핵과의관계는 t-test 를이용하여나타내었고 p<0.05를유의한것으로간주하였다. 통계분석은 SPSS version 13.0 (SPSS Inc., Chicago, IL, USA) 을사용하였다. 결과 1. 대상환자군의비교본연구는임상적으로활동성결핵이의심되는환자 52 명을대상으로하였고, 이중활동성결핵으로확진된환자는 35명으로폐결핵환자 18명, 기관지결핵환자 2명, 속립성결핵환자 2명, 결핵성늑막염환자 11명, 결핵성농흉환자 2명이포함되었다. 평균연령은 세였고남자가 23명, 여자가 12명이었다. 이중 8명의환자가당뇨로, 3명의환자가고혈압치료를받고있었고과거에악성종양으로치료를받은환자는 2명 ( 갑상선암 1명, 대장암 1명 ), 관상동맥질환및신부전으로투석치료중인환자가각각 1명씩이었으며, HIV 감염증이있는환자는없었다. 객담도말검사가양성인환자는 14명, 배양검사가양성인환자는 11명, 핵산증폭검사가양성인환자는 17 명이었다. 객담도말검사와배양검사가동시에양성인환자는 7명이었고, 그중에서 6명의환자는핵산증폭검사도양성의결과를보였다. 결핵성흉막염환자중 4명은흉막조직검사에서건락성괴사를동반한육아종성병변이관찰되었다. 객담배양검사에서비결핵항산균이나온환자는없었다. 활동성결핵환자중 33명은 isoniazid, rifampin, ethambutol, pyrazinamide를투여하였고, 1명은약제부작용으로 pyrazinamide 대신 levofloxacin 을투여하였으며 1명은다제내성결핵환자로 moxifloxacin, streptomycin, cycloserine, prothionamide, para-aminosalicyclic acid 를투여하였다. 초치료환자는 32명, 재치료환자는 3명이었고, 재치료환자중 1명은다제내성결핵환자였다. 대조군에는폐렴 8명, 폐암 4명 ( 연구기간에진단받은경우로선암 3명, 소세포암 1명 ), 심부전으로인한폐부종 3명, 승모판협착에의한객혈환자 1명, 간질성폐렴환자가 2명포함되었다. 이환자군의평균연령은 51.9세, 남자가 9명, 여자가 8명이었다. 당뇨환자 4명, 고혈압환자가 3명있었다. 과거에악성종양으로치료를받은환자는 1명 ( 갑상선암 1명 ), 관상동맥질환및신부전으로투석치료중인환자, HIV 감염증이있는환자는없었다. 활동성결핵환자군과대조군에서연령, 성별, 과거력의차이는없었다. 2. QuantiFERON-TB GOLD 결과에따른환자군의비교 52명의환자중 QuantiFERON-TB GOLD 검사결과양성이나온경우는 30명, 음성이나온경우는 22명으로평균연령은각각 47.1±21.2세, 50.0±19.4세였고, 남녀비율은양성이나온경우가남자 18명, 여자 12명이었고, 음성이나온경우는남자 14명, 여자 8명이었다. 중등도반응을보이는환자는없었다. 환자중 2명이 1개월내에가족내활동성결핵환자와접촉한기왕력이있었고, 그중 1명은 QuantiFERON-TB GOLD 검사가양성인활동성결핵환자였고, 1명은 QuantiFERON-TB GOLD 검사결과가음성인폐렴환자였다. 활동성결핵환자 3명에서투베르쿨린검사를시행하였고, 이들은투베르쿨린검사는모두음성으로, QuantiFERON-TB GOLD 검사는모두양성으로나타났다. QuantiFERON-TB GOLD 검사가양성인환자군과음성인환자군의특성중통계적으로의미있는차이를보이는부분은없었다 (Table 1, 2). 대조군 17명중 QuantiFERON-TB GOLD 검사양성인환자는 6명 (35%), 음성인환자는 11명 (65%) 이었고, 활동성결핵환자 35명중 QuantiFERON-TB GOLD 검사양성인환자는 25명 (71%), 음성인환자는 10(29%) 명이었다. 활동성결핵환자에서활동성결핵환자군과대조군사이의 QuantiFERON-TB GOLD 검사결과로 t-test를시행한결과, p-value 는 0.01 이하로의미있는수치를보였으나활동성폐결핵진단에대한 QuantiFERON-TB GOLD 검사 Table 1. Demographic characteristics of 52 patients QuantiFERON QuantiFERON p-value (n=30) (n=22) Age (year) 47.1± ±19.4 NS M:F (ratio) 18:12 14:8 NS Smoking 8 (26%) 11 (50%) NS Alcohol 9 (30%) 9 (41%) NS DM 9 (30%) 3 (13.5%) NS HTN 1 (3.3%) 3 (13.5%) NS Cancer 2 (6.6%) 1 (4.5%) NS M: male; F: female; DM: diabetes mellitus; HTN: hypertension; TB: tuberculosis; NS: not significant. 15

4 SY Park et al: The diagnostic value of interferon-γ assay in patients with active tuberculosis Table 2. Laboratory characteristics of 52 patients QuantiFERON QuantiFERON p-value AST (U/L) 27.6± ±56.3 NS ALT (U/L) 24.9± ±26 NS CRP (mg/dl) 39.8± ±66.8 NS Cr (mg/dl) 1.3± ±0.2 NS Glucose (mg/dl) 119± ±57.1 NS Albumin (g/dl) 3.4± ±0.5 NS WBC (ul) 8,360±6,990 7,970±6,850 NS Neutrophil (ul) 6,903±665 5,369±3,302 NS Lymphocyte (ul) 3,920±835 1,427±98 NS ESR (mm/hr) 59.6± ±29 NS Cr: creatinine; NS: not significant. Table 3. Demographic characteristics of patients with pulmonary tuberculosis QuantiFERON- QuantiFERON- p-value (n=17) (n=7) Age (year) 47.4± ±15.3 NS M:F (ratio) 10:7 6:1 NS Smoking 7 (41%) 5 (71%) NS Alcohol 4 (23%) 2 (28%) NS Old TB 1 (5.8%) 1(14%) NS DM 5 (29%) 1 (14%) NS HTN 1 (5.8%) 1 (14%) NS Cancer 1 (5.8%) 0 (0%) NS M: male; F: female; DM: diabetes mellitus; HTN: hypertension; TB: tuberculosis; NS: not significant. 의민감도는 71.4%, 특이도는 64.7% 로나타났다. 양성예측치는 0.83, 음성예측치는 0.5였다. 3. 폐결핵환자의특징 활동성결핵환자 (35명) 중폐결핵으로진단된환자군 ( 결핵성흉막염환자 11명제외 ) 24명에서 QuantiFERON- TB GOLD 검사결과양성이나온환자는 17명으로 ESAT-6 의평균값은 1.4 IU/mL, CFP-10 의평균값은 5.4 IU/mL 였다. 이환자들의임상증상이나흉부방사선검사는 QuantiFERON-TB GOLD 결과음성인환자들과큰차이를보이지않았다 (Table 3, 4). 다른혈액검사에서는큰차이를보이지않았으나 QuantiFERON-TB GOLD 검사양성군에서음성인군보다 C 반응성단백이낮게측정되었는데 (29.3±27.3 mg/l vs. 72.9±67.9 mg/l), 이는 Table 4. Chest X-ray characteristics of patients with pulmonary tuberculosis QuantiFERON QuantiFERON p-value Minimal 4 (23%) 1 (14%) NS Moderate advanced 7 (42%) 3 (43%) NS Far advanced 6 (35%) 3 (43%) NS NS: not significant. Table 5. Laboratory characteristics of patients with pulmonary tuberculosis QuantiFERON- QuantiFERON- p-value WBC (ul) 8,472±2,799 9,828±4,731.1 NS Neutrophil 6,716±3,886 7,135±3,991 NS Lymphocyte 1,657± ,445±813.6 NS ESR (mm/hr) 56.7± ±20 NS CRP (mg/dl) 29.25± ± AST (U/L) 33.8± ±98.3 NS ALT (U/L) 26.47± ±27 NS Creatine (mg/dl) 1.14± ±0.2 NS Glucose (mg/dl) 132.3± ±77.2 NS Albumin (g/l) 3.4± ±0.6 NS NS: not significant. Table 6. Demographic characteristics of patients with tuberculous pleurisy QuantiFERON QuantiFERON p-value (n=7) (n=4) Age (year) 43.5± ±5.9 NS M:F (ratio) 3:4 3:1 NS Smoking 1 (14%) 1 (25%) NS Alcohol 1 (14%) 1 (25%) NS DM 0 0 NS HTN 1 (14%) 0 NS Cancer 0 0 NS Old TB 0 0 NS M: male; F: female; DM: diabetes mellitus; HTN: hypertension; TB: tuberculosis; NS: not significant. 통계학적으로유의한차이가있었다 (Table 5). 4. 결핵성흉막염환자의특징 QuantiFERON-TB GOLD 결과양성이나온환자는 7 명, 16

5 Tuberculosis and Respiratory Diseases Vol. 66. No. 1, Jan Table 7. Laboratory characteristics of tuberculosis pleurisy QuantiFERON QuantiFERON p-value WBC (ul) 6,711±4,876 6,325±722.8 NS CRP (mg/dl) 72.5± ±57.3 NS AST (U/L) 24±16 13±2.9 NS ALT (U/L) 19±12 17±6.3 NS Creatine (mg/dl) 0.8± ±0.2 NS Glucose (mg/dl) 101.1± ±3.1 NS Albumin (g/l) 3.3± ±0.5 NS ESAT-6 (IU/mL) 1.1± NS CFP-10 (IU-mL) 1.0± ±0.05 NS ADA 95.2± ±18.3 NS ADA: adenosine deaminase; NS: not significant. 음성이나온환자는 4명으로양성인군의 ESAT-6 의평균값은 1.12 IU/mL, CFP-10의평균값은 1.04 IU/mL 였다. 두군간의임상증상이나혈액검사결과및흉부방사선검사에서유의한차이를보이지않았다 (Table 6, 7). 고 객담도말이나배양검사가음성이라하더라도잠재적으로전염성이있거나치명적인환자는주로임상소견, 방사선검사등을통해진단하고치료를시작해야하지만이들을신속하게활동성결핵으로진단하여치료하기는쉽지않다. 이연구에서는결핵유병률이중등도인우리나라에서 QuantiFERON-TB GOLD 검사의활동성결핵진단의유용성여부를파악하고자하였다. 2004년 12월미국 FDA에서 QuantiFERON-TB GOLD 검사가잠복결핵감염을진단하는데유용한검사로써인정된이래활동성결핵의진단에사용되는경우에 QuantiFERON-TB GOLD 검사결과의유용성에대해서는서로상반된연구결과들이나왔다 4,6,9, 결핵의유병률이낮은지역에서는 QuantiFERON-TB GOLD 검사가활동성결핵의진단에유용하지만상대적으로결핵의유병률이높은지역에서는 QuantiFERON-TB GOLD 검사가유용하지않다는보고가있었다 4, 년 3월 1일부터 2005년 12월 31일까지미국캘리포니아샌프란시스코에서 242명의결핵이의심되는환자를대상으로시행한연구에서는 QuantiFERON-TB GOLD 검사의민감도가 64% 로활동성결핵을진단하는검사로서유용성이낮은것으로보고하였다 9. 그러나다른연구에서는민감도, 특이도 찰 가높은검사로활동성결핵을진단하거나배제하는데유용성이있다는보고를한바있다 8,10,16. 이와같은차이는두지역의활동성결핵환자수, BCG 접종환자수를포함한결핵의역학이다르기때문에나타난것일수있으며 6,11,17,18 인종에따라같은결핵환자라고해도 Interferon-gamma 의유전자형에따라 Interferon-gamma 의생성능력의차이가있으므로지역마다서로다른결과를가져올수있는원인이될수있다 본연구에서 QuantiFERON-TB GOLD 검사의민감도는 76% 로일본의 89% 보다는낮게나타났으나, 2004년의국내보고와는비슷한결과를보였다 3,14. 본연구에서 QuantiFERON-TB GOLD 검사의특이도는 68% 로 Quanti- FERON-TB GOLD 검사가활동성결핵의진단에단일검사로유용성이크다고볼수는없었다. 우리나라는미국이나유럽과는달리 BCG 접종률이높으며중등도의결핵유병률을보이고있기때문에서구에서발표된 QuantiFERON-TB GOLD 검사의유용성의정도가다를것으로사료된다 6,11,17,18. 국내에서 QuantiFERON-TB GOLD 검사의 cut-off value를현재사용하고있는 0.35 IU/mL 에서 0.13 IU/mL 로전환했을경우민감도는 86.2% 로상승해서국내실정에맞게 cut-off value를조정할경우검사의진단적가치가상승할수있음을제시한연구가있다 4. 그러나본연구에서는양성의기준을 0.13 IU/mL 로낮추었을때민감도가 72% 로 cut-off value에따른차이는없었다. 본연구에서흥미로운결과로는폐결핵환자에서 C 반응성단백값에따라 QuantiFERON-TB GOLD 검사의결과가달라졌다는것이다. 이는활동성결핵환자에서 QuantiFERON-TB GOLD 검사가양성인경우, C 반응성단백의평균이 29.3 mg/l, 음성인경우 C 반응성단백의평균이 72.9 mg/l로차이를보였으며, 통계적으로의미있는상관관계를보였다 (p<0.05). 그러나백혈구나적혈구침강계수와같은다른염증반응을나타내는지수들사이에는유의한차이가없는것으로미루어보아 QuantiFERON-TB GOLD 검사값과이차적감염이나염증의정도와는관련이없는것으로생각된다. 최근한연구에서활동성폐결핵환자에서질병의활동성에따라 Interferon-gamma 분비가달라진다는가설이제시된바있다 23. 이연구에서는결핵의중증도가심할수록 Interferon-gamma 분비가감소된다는결론이얻어졌고이연구를바탕으로한다면본연구에서 QuantiFERON- TB GOLD 검사결과가음성인활동성폐결핵환자의경 17

6 SY Park et al: The diagnostic value of interferon-γ assay in patients with active tuberculosis 우양성인환자보다중증도가심했을가능성이있다. 또하나의가설은최근한연구에서유전자의 phenotype 에따라 Interferon 을분비하는정도의차이가있음이증명되었는데 22, 이를바탕으로추론해본다면이번연구에포함된환자군에서도이런유전자의 phenotype 의차이가있었을가능성이있고 Interferon-gamma를덜분비하는환자군은 QuantiFERON-TB GOLD 검사가음성이나왔을가능성이있다는것이다. 그러나활동성결핵환자에서 C 반응성단백의역할이아직명확하게정립된바는없다. 향후활동성결핵환자에서 C 반응성단백과 QuantiFERON-TB GOLD 검사와의관계에대해서는좀더많은환자를대상으로연구를진행해야할것으로생각된다. 본연구는몇가지제한점을가지고있다. 첫째, 6개월정도의짧은기간안에입원한환자들만을대상으로하였으므로연구기간과연구대상수가충분하지못했다. 둘째, 본연구에서는투베르쿨린검사대상환자가적어활동성결핵환자에서 QuantiFERON-TB GOLD 검사와투베르쿨린검사와의관계를비교, 분석하지못했다. 향후여러기관에서많은지원자를대상으로 Quanti- FERON-TB GOLD 검사를시행하여우리나라실정에맞는 ESAT-6, CFP-10 값을확인하고투베르쿨린검사와상관관계를파악해야만국내의활동성결핵환자들에대한 QuantiFERON-TB GOLD 검사의유용성이확인될것이라고생각된다. 또한 Interferon-gamma를사용한 Quanti- FERON-TB GOLD 검사는환자개인의특성에따라그반응이다양한것으로되어있고질병의활성도에대한모니터링은확립되어있지않다. 따라서결핵의진단에서 Interferon-gamma를이용한측정법에대한추후연구와함께민감도와특이도가높은검사법이필요할것으로생각된다. 요약연구배경 : Interferon-gamma assay는잠복결핵의진단에서투베르쿨린피부반응검사를대신할수있는검사방법으로주목받고있다. 그러나활동성결핵의진단시 Interferon-gamma assay의유용성에대해서는많은이견이있다. 따라서결핵발병률이중등도인우리나라에서 Interferon-gamma assay의임상적유용성을알아보고자하였다. 방법 : 2007년 1월부터 2007년 8월까지강동성심병원 호흡기내과에내원한환자중활동성결핵이의심되는환자 52명을대상으로흉부방사선검사, 객담도말검사, 객담배양검사, PCR 검사, QuantiFERON-TB GOLD test 를시행하였다. 흉막삼출액이있는환자의경우흉수검사및흉막조직검사를시행하였다. 결과 : 이번연구에포함된 52명의환자중 35명이최종적으로활동성폐결핵으로진단되었고, 이중 25명이 QuantiFERON-TB GOLD 검사양성, 10명이 Quanti- FERON-TB GOLD 검사음성소견을보였다. 본연구에서 QuantiFERON-TB GOLD 검사의민감도는 71.4%, 특이도는 64.7% 였고, 양성예측도는 0.83, 음성예측도는 0.50 였다. QuantiFERON-TB GOLD 검사양성인군과음성인군에서 C 반응성단백값을제외하고두군간에큰차이는보이지않았다. C 반응성단백값은 QuantiFERON-TB GOLD 검사양성인군에서 29.25±27.30 mg/l, Quanti- FERON-TB GOLD 검사음성인군에서 72.90±67.98 mg/l로 QuantiFERON-TB GOLD 검사음성인군에서통계적으로유의하게높게나타났다 (p<0.05). 결론 : 본연구에서는 QuantiFERON-TB GOLD 검사는활동성폐결핵진단에유용성이크지않은것으로나타났다. QuantiFERON-TB GOLD 검사결과와 C 반응성단백값의상관관계는추후연구가더필요할것으로사료된다. 참고문헌 1. Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008;29: Dye C, Watt CJ, Bleed DM, Hosseini SM, Raviglione MC. Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally. JAMA 2005;293: Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med 2002;347: Korean Center for Disease Control and Prevention. Annual report on the notified tuberculosis patients in Korea. Seoul: Korean Center for Disease Control and Prevention, Korean Institute for Tuberculosis; Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July This statement was endorsed 18

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untitled DOI: 10.4046/trd.2009.67.4.331 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2009;67:331-337 CopyrightC2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.