Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, ON, Canada.
J Rheumatol. 2011 Jul;38(7):1234-43. doi: 10.3899/jrheum.100623. Epub 2011 Apr 1.
Reactivation of latent tuberculosis infection (LTBI) is well recognized as an adverse event associated with anti-tumor necrosis factor-α (anti-TNF-α) therapy. The strengths and weaknesses of current techniques for detecting LTBI in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) and psoriasis have not been fully examined. T cell hyporesponsiveness due to immunosuppression caused by illness or drugs, referred to as anergy, may produce false-negative tuberculin skin test (TST) and interferon-γ release assay (IGRA) results. The literature suggests that anergy may influence screening performance of TST and IGRA tests in candidates for anti-TNF-α therapy. Conversely, the potential for false-positive TST and IGRA results must be considered, as treatment for LTBI may be associated with significant morbidity. This review examines the reliability issues related to LTBI diagnostic testing and provides practical direction to help prevent LTBI reactivation and facilitate successful anti-TNF-α treatment.
潜伏性结核感染（LTBI）的再激活被认为是与抗肿瘤坏死因子-α（anti-TNF-α）治疗相关的不良事件。目前用于检测慢性炎症性疾病（如类风湿关节炎[RA]和银屑病）患者 LTBI 的技术的优缺点尚未得到充分研究。由于疾病或药物引起的免疫抑制导致的 T 细胞低反应性，称为无反应性，可能导致结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）结果出现假阴性。文献表明，无反应性可能会影响抗 TNF-α治疗候选者的 TST 和 IGRA 检测的筛查性能。相反，必须考虑到 TST 和 IGRA 结果出现假阳性的可能性，因为 LTBI 的治疗可能会导致严重的发病率。本综述检查了与 LTBI 诊断检测相关的可靠性问题，并提供了实用的指导，以帮助预防 LTBI 再激活并促进成功的抗 TNF-α治疗。
