Service d'Ophtalmologie, CHNO des Quinze-Vingts, Paris, France.
Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
Am J Ophthalmol. 2011 Sep;152(3):433-440.e1. doi: 10.1016/j.ajo.2011.02.006. Epub 2011 Jun 8.
To evaluate the accuracy of QuantiFERON-TB Gold testing in patients with presumptive tuberculosis-ocular inflammation.
Prospective nonrandomized case series and clinical laboratory investigation.
Ninety-six consecutive patients presenting with ocular inflammation between January and October 2007 were tested using QuantiFERON-TB Gold. Positive patients received a 6-month anti-tuberculosis treatment. Patient follow-up ranged from 12 months to 24 months. Treatment was considered effective at the end of follow-up, in cases of no or a 2-point decrease of ocular inflammation (SUN criteria) and systemic corticosteroids stopped or tapered to 10 mg/day.
Mean age was 51 ± 17 years. Types of ocular inflammation included scleritis (n = 7), panuveitis (n = 34), and posterior (n = 15), intermediate (n = 14), and anterior uveitis (n = 15). QuantiFERON-TB Gold was positive in 42 cases (44%), negative in 51 cases (53%), and undetermined in 3 cases (3%). Among positive QuantiFERON-TB Gold patients, 25 received a full anti-tuberculosis treatment, which was effective in 15 cases (60%). Associated systemic steroids were given to 6 patients and tapered to 10 mg/day or less in all cases. Median QuantiFERON-TB Gold value was significantly higher in the group with a successful therapeutic response (7.67 IU/mL [0.46 to 33.37]) compared to the group with treatment failure (1.22 IU/mL [0.61 to 4.4]), P = .026.
Results of anti-tuberculosis treatment were encouraging in QuantiFERON-TB Gold-positive ocular inflammation, especially with values over 2 IU/mL in our study, suggesting that a higher cut-off value than that given by the manufacturer should be considered to better identify ocular inflammation that can benefit from full anti-tuberculosis treatment.
评估结核菌素 QFT 检测在疑似结核-眼炎症患者中的准确性。
前瞻性非随机病例系列和临床实验室研究。
2007 年 1 月至 10 月期间，96 例连续出现眼部炎症的患者接受了结核菌素 QFT 检测。阳性患者接受了 6 个月的抗结核治疗。患者的随访时间为 12 个月至 24 个月。在随访结束时，根据眼部炎症（SUN 标准）无或减少 2 个等级，以及全身皮质类固醇激素停药或减少至 10mg/天，判断治疗是否有效。
平均年龄为 51 ± 17 岁。眼部炎症的类型包括巩膜炎（n = 7）、全葡萄膜炎（n = 34）、后葡萄膜炎（n = 15）、中间葡萄膜炎（n = 14）和前葡萄膜炎（n = 15）。结核菌素 QFT 阳性 42 例（44%），阴性 51 例（53%），未确定 3 例（3%）。在结核菌素 QFT 阳性患者中，25 例接受了完整的抗结核治疗，其中 15 例（60%）有效。所有患者均给予全身皮质类固醇激素治疗，且均减少至 10mg/天或以下。治疗反应良好的患者结核菌素 QFT 值中位数（7.67IU/mL [0.46 至 33.37]）明显高于治疗失败的患者（1.22IU/mL [0.61 至 4.4]），P =.026。
结核菌素 QFT 阳性的眼部炎症患者抗结核治疗的效果令人鼓舞，尤其是本研究中 QFT 值大于 2IU/mL 的患者，提示应考虑高于制造商提供的截止值，以更好地识别可受益于完整抗结核治疗的眼部炎症。
