Bartalesi F, Vicidomini S, Goletti D, Fiorelli C, Fiori G, Melchiorre D, Tortoli E, Mantella A, Benucci M, Girardi E, Cerinic M M, Bartoloni A
Infectious and Tropical Diseases Unit, Careggi Hospital, University of Florence, Florence, Italy.
Eur Respir J. 2009 Mar;33(3):586-93. doi: 10.1183/09031936.00107608. Epub 2008 Dec 1.
Screening for active tuberculosis (TB) and latent TB infection (LTBI) is mandatory prior to the initiation of tumour necrosis factor-alpha inhibitor therapy. However, no agreement exists on the best strategy for detecting LTBI in this population. The aim of the present study was to analyse the performance of the tuberculin skin test (TST) and QuantiFERON-TB Gold in-tube (QFT-GIT) on LTBI detection in subjects with immunomediated inflammatory diseases (IMID). The TST and QFT-GIT were prospectively performed in 398 consecutive IMID subjects, 310 (78%) on immunosuppressive therapy and only 16 (4%) had been bacillus Calmette-Guérin (BCG) vaccinated. Indeterminate results to QFT-GIT were found in five (1.2%) subjects. Overall, 74 (19%) out of 393 subjects were TST-positive and 52 (13%) were QFT-GIT-positive. Concordance between TST and QFT-GIT results was good (87.7%): 13 were QFT-GIT-positive/TST-negative and 35 QFT-GIT-negative/TST-positive. By multivariate analysis both tests were significantly associated with older age. Only the TST was associated with BCG vaccination and radiological lesions of past TB. Use of immunosuppressive drugs differently modulated QFT-GIT or TST scoring. Use of the QuantiFERON-TB Gold in-tube, as a screening tool for latent tuberculosis among immunomediated inflammatory disease subjects, is feasible. Until further data will elucidate discordant tuberculin skin test/QuantiFERON-TB Gold in-tube results, a strategy of simultaneous tuberculin skin and QuantiFERON-TB Gold in-tube testing in a low prevalence bacillus Calmette-Guérin vaccinated population, should maximise potentials of latent tuberculosis diagnosis.
在开始使用肿瘤坏死因子-α抑制剂治疗之前，必须对活动性肺结核（TB）和潜伏性结核感染（LTBI）进行筛查。然而，对于在该人群中检测LTBI的最佳策略尚无共识。本研究的目的是分析结核菌素皮肤试验（TST）和全血γ-干扰素释放试验（QFT-GIT）在免疫介导的炎症性疾病（IMID）患者中检测LTBI的性能。对398例连续的IMID患者前瞻性地进行了TST和QFT-GIT检测，其中310例（78%）接受免疫抑制治疗，仅16例（4%）接种过卡介苗（BCG）。5例（1.2%）患者的QFT-GIT结果不确定。总体而言，393例患者中有74例（19%）TST阳性，52例（13%）QFT-GIT阳性。TST和QFT-GIT结果之间的一致性良好（87.7%）：13例QFT-GIT阳性/TST阴性，35例QFT-GIT阴性/TST阳性。多因素分析显示，两种检测均与年龄较大显著相关。仅TST与BCG接种和既往结核的放射学病变相关。免疫抑制药物的使用对QFT-GIT或TST评分有不同的调节作用。将全血γ-干扰素释放试验用作免疫介导的炎症性疾病患者潜伏性结核的筛查工具是可行的。在进一步的数据阐明结核菌素皮肤试验/全血γ-干扰素释放试验结果不一致之前，在卡介苗接种率低的人群中同时进行结核菌素皮肤试验和全血γ-干扰素释放试验的策略，应能最大限度地提高潜伏性结核诊断的潜力。
