Malaviya Anand N, Kapoor Sanjiv, Garg Shriram, Rawat Roopa, Shankar Subramanian, Nagpal Savita, Khanna Dinesh, Furst Daniel E
Joint Disease Clinic, Indian Spinal Injuries Centre Superspeciality Hospital and Clinic for Arthritis and Rheumatism, New Delhi, India.
J Rheumatol. 2009 Jul;36(7):1414-20. doi: 10.3899/jrheum.081042. Epub 2009 Jun 1.
To test the efficacies of a strategy for preventing tuberculosis (TB) in Indian patients with inflammatory rheumatic diseases (IRD) treated with tumor necrosis factor-alpha (TNF-alpha) inhibitor.
The screening strategy included tuberculosis skin test (TST), QuantiFERON-TB Gold (QTG) test, standard chest radiograph, and contrast enhanced-computerized tomography of the chest (CT).
Among 53 patients screened, 17 (32%) had >or= 1 test positive, with 5 (9.4%) patients having TB infection (clinical, CT, biopsy). The remaining 12 patients showed latent TB; 1 additional patient with negative screening tests was diagnosed with latent TB retrospectively for he developed TB disease within a few weeks of receiving infliximab. The remaining 35 patients tested negative with all tests. The combination of 4 screening tests gave a sensitivity of 0.83, specificity of 0.74, positive predictive value (PPV) 0.29, and negative predictive value (NPV) 0.97. Only 22 patients could afford treatment with TNF-alpha inhibitors; 19 of them were negative in the screening tests. Three patients who were positive on TST and/or QTG received prophylactic treatment with TNF-alpha inhibitor. Since implementation of the screening strategy, only 1 of 22 (4.5%) patients given TNF-alpha inhibitor developed probable TB disease.
With the use of these 4 TB screening tests in India, where TB is highly prevalent, TB could be excluded with a high degree of certainty (NPV 0.97). However, as even this combination of tests has only moderate sensitivity and specificity and poor PPV for detecting TB, vigilance may be advisable even if only one of the tests is positive.
测试一种预防策略对接受肿瘤坏死因子-α（TNF-α）抑制剂治疗的印度炎性风湿性疾病（IRD）患者预防结核病（TB）的疗效。
筛查策略包括结核菌素皮肤试验（TST）、结核感染T细胞检测（QTG）、标准胸部X线片以及胸部增强计算机断层扫描（CT）。
在53例接受筛查的患者中，17例（32%）一项或多项检查呈阳性，5例（9.4%）患者患有结核感染（临床、CT、活检确诊）。其余12例患者显示为潜伏性结核；另外1例筛查试验阴性的患者在接受英夫利昔单抗治疗几周内发生结核病，故回顾性诊断为潜伏性结核。其余35例患者所有检查均为阴性。四项筛查试验联合使用时，灵敏度为0.83，特异度为0.74，阳性预测值（PPV）为0.29，阴性预测值（NPV）为0.97。只有22例患者能够负担TNF-α抑制剂治疗；其中19例筛查试验为阴性。3例TST和/或QTG呈阳性的患者接受了TNF-α抑制剂预防性治疗。自实施筛查策略以来，在接受TNF-α抑制剂治疗的22例患者中，仅1例（4.5%）发生可能的结核病。
在结核病高度流行的印度，使用这四项结核病筛查试验，可以高度确定地排除结核病（NPV为0.97）。然而，即使是这种联合检查，检测结核病的灵敏度和特异度也仅为中等，PPV较差，因此即使只有一项检查呈阳性，也建议保持警惕。
