关键词: 血液透析；结核；&gamma, 干扰素释放试验；结核菌素皮试试验

Abstract: Objective　To study the diagnostic and prognostic values of quantification ELISA interferon-γ release test（QFT） and tuberculosis skin test（TST） for patients with tuberculosis〔including both latent tuberculosis infection（LTBI） and tuberculosis（TB）〕 undergoing maintenance hemodialysis（MHD） in areas with high prevalence of tuberculosis.Methods　Totaled 198 patients who underwent MHD in Blood Purification Center，Hainan General Hospital，for more than 3 months during 2013—2015 were enrolled.All of them were given a 3-year follow-up.Baseline clinical data were collected.The results of QFT and TST were also obtained and their values in the diagnosis and prediction of the prognosis of these patients were evaluated.Multivariate Logistic regression analysis was performed to investigate the influencing factors for positive results of QFT and TST.The prognosis of patients in 3 years was observed，and survival curves were drawn.Cox proportional hazards regression analysis was carried out to explore the factors associated with the prognosis.Results　156 cases who completed the study were included in the final analysis，including 109 males and 47 females，with an average age of（54.4±16.6）years and an average hemodialysis duration of（1.9±0.4） years.The prevalences of positive QFT，positive TST were 34.6%（54/156），67.9%（106/156），respectively.The results of TST and QFT in identifying TB showed no consistency（Kappa=0.053，P=0.405）.Multivariate Logistic regression analysis revealed that，after adjusting for other factors，sex〔OR=0.345，95%CI（0.144，0.828），P=0.017〕and no BCG vaccine scar〔OR=0.345，95%CI（0.144，0.828），P=0.017〕were risk factors for having a positive QFT result，the sex 〔OR=2.836，95%CI（1.120，7.177），P=0.028〕and the total lymphocyte count〔OR=3.573，95%CI（1.410，12.295），P=0.043〕were risk factors for having a positive TST result.Of the 37 patients identified with LTBI，11（29.7%） developed TB.The 3-year prevalence of TB in these patients was 42 948.7/100 000.The 1-，2-，3- year survival rates were 89.7%，77.6%，and 69.9%，respectively.Crud death rate was（CDR）301.3/1 000.Multivariate Cox proportional hazard regression analysis found that positive QFT results and elevated C-reactive protein（CRP） were unfavorable prognostic factors for the overall survival，while anti-TB treatment and elevated prealbumin were favorable prognostic factors for the overall survival（P<0.05）.Conclusion　In areas with high prevalence of tuberculosis in Hainan Province，among the CKD patients undergoing MHD，males were more likely to have a positive QFT result.The results of TST and QFT in diagnosing TB demonstrated no consistency.Positive QFT results and elevated CRP were unfavorable factors whereas anti-TB treatment and elevated prealbumin were favorable prognostic factors for the overall survival.In this population，the diagnosis of LTBI or TB should be based on epidemiologic data，past medical history，predisposing factors of TB，lung imaging data，exclusion of other infections and results of experimental anti-TB treatment.In addition，diagnostic measures such as histopathological examination and determination of bronchoalveolar lavage fluid concentration should be promoted vigorously.

Key words: Hemodialysis；Tuberculosis；Interferon-&gamma, release assays；Tuberculosis skin test