Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Inflamm Bowel Dis. 2011 Jan;17(1):84-90. doi: 10.1002/ibd.21427. Epub 2010 Aug 18.
Screening for latent tuberculosis (LTB) including chest x-ray, tuberculin skin test (TST), and facultative whole blood interferon-γ assay (IGRA) is part of routine management in inflammatory bowel disease (IBD) patients before starting therapy with tumor necrosis factor (TNF)-α inhibitors. However, in patients with immunomodulators (IM) TST and IGRA might show limitations.
We aimed to evaluate the results from an IGRA (QuantiFERON-TB Gold in Tube) and TST as well as their concordance in 208 consecutive IBD patients with indications for anti-TNF-α therapy. Associations of both tests with risk factors for LTB were determined by logistic regression.
During screening, 149 patients (71.6%) were under IM therapy. In 26 (12.5%) patients TST was positive, whereas 15 (7.2%) patients showed a positive result from IGRA. IGRA failed on samples from 16/208 (7.7%) patients, resulting in 192/208 (92.3%) patients in whom results from both screening tests were available. Correlation between IGRA and TST results was fair (84.9%, κ = 0.21). The presence of risk factors for LTB showed association with positive results of TST (odds ratio [OR] 3.7, 1.5-9.6) and IGRA (OR 3.5, 1.2-11.3). TST was associated furthermore with age (OR 1.06, 1.02-1.10) and signs indicative of LTB in chest x-ray (OR 4.9, 1.1-19.9). The IGRA was negatively influenced by IM therapy (OR 0.3, 0.1-0.9).
Our study reveals that results of IGRA are negatively affected by IM therapy. Thus, current guidelines for TB screening prior anti-TNF-α therapy appear inaccurate in patients under IM. Therefore, LTB screening might be best performed prior to initiation of IM treatment.
在开始使用肿瘤坏死因子（TNF）-α抑制剂治疗之前，炎症性肠病（IBD）患者的常规管理包括筛查潜伏性结核（LTB），包括胸部 X 光、结核菌素皮肤试验（TST）和可选的全血干扰素-γ测定（IGRA）。然而，在接受免疫调节剂（IM）治疗的患者中，TST 和 IGRA 可能存在局限性。
我们旨在评估 208 例有抗 TNF-α治疗适应证的 IBD 患者的 IGRA（QuantiFERON-TB Gold in Tube）和 TST 的结果及其一致性。通过逻辑回归确定两种检测方法与 LTB 危险因素的相关性。
在筛查期间，149 例（71.6%）患者正在接受 IM 治疗。26 例（12.5%）患者 TST 阳性，15 例（7.2%）患者 IGRA 阳性。IGRA 在 16/208（7.7%）患者的样本中失败，导致 192/208（92.3%）患者的两种筛查检测结果均可用。IGRA 与 TST 结果的相关性为中等（84.9%，κ=0.21）。LTB 危险因素的存在与 TST（比值比 [OR] 3.7，1.5-9.6）和 IGRA（OR 3.5，1.2-11.3）阳性结果相关。TST 还与年龄（OR 1.06，1.02-1.10）和胸部 X 光显示的 LTB 迹象（OR 4.9，1.1-19.9）相关。IGRA 受到 IM 治疗的负面影响（OR 0.3，0.1-0.9）。
我们的研究表明，IGRA 的结果受到 IM 治疗的负面影响。因此，当前关于 TNF-α 治疗前抗结核筛查的指南在接受 IM 治疗的患者中似乎不准确。因此，在开始 IM 治疗之前，可能最好进行 LTB 筛查。
