Division of General Medicine and Primary Care, St. Vincent's University Hospital/University College Dublin, Ireland.
Inflamm Bowel Dis. 2012 Jun;18(6):1057-63. doi: 10.1002/ibd.21824. Epub 2011 Sep 26.
Since the introduction of infliximab, anti-tumor necrosis factor alpha (anti-TNF-α) agents have been used with increasing frequency for the treatment of inflammatory bowel disease (IBD). Reactivation of latent Mycobacterium tuberculosis (TB) soon became recognized as a complication of therapy. More recently, reactivation of hepatitis B while on anti-TNF therapy has been documented. The aim of this study was to assess the adherence to screening for latent TB and hepatitis B by gastroenterologists prior to initiation of an anti-TNF.
This is a retrospective analysis of all patients with IBD treated with an anti-TNF at a large urban academic hospital. In our population, 65% of patients were screened for latent TB prior to the initiation of anti-TNF therapy, while 25% of patients were screened for hepatitis B.
Failure to screen for latent TB was strongly correlated with prior exposure to an anti-TNF (odds ratio [OR]: 5.3; P < 0.0001) and initiation of treatment prior to 2006 (OR: 5.8; P < 0.0001). Failure to screen for hepatitis B was associated with lack of an abnormal alanine aminotransferase (OR: 2.6; P = 0.005) and treatment prior to 2010 (OR: 3.3; P = 0.02). Providers who had been in practice longer were less likely screen for TB or hepatitis B.
The rate of screening for both latent TB and hepatitis B in this study was inadequate. While the rate of screening is increasing, further systems improvements and physician education is needed.
自英夫利昔单抗问世以来，越来越多的人将抗肿瘤坏死因子α（anti-TNF-α）药物用于治疗炎症性肠病（IBD）。很快就认识到潜伏性结核分枝杆菌（TB）的再激活是治疗的一种并发症。最近，在使用抗 TNF 治疗时乙型肝炎的再激活也有记录。本研究旨在评估在开始使用抗 TNF 之前，胃肠病学家对潜伏性 TB 和乙型肝炎进行筛查的依从性。
这是对在一家大型城市学术医院接受抗 TNF 治疗的所有 IBD 患者的回顾性分析。在我们的人群中，65%的患者在开始抗 TNF 治疗前接受了潜伏性 TB 的筛查，而 25%的患者接受了乙型肝炎的筛查。
未筛查潜伏性 TB 与先前暴露于抗 TNF（比值比 [OR]：5.3；P < 0.0001）和 2006 年前开始治疗（OR：5.8；P < 0.0001）强烈相关。未筛查乙型肝炎与丙氨酸氨基转移酶异常（OR：2.6；P = 0.005）和 2010 年前治疗（OR：3.3；P = 0.02）有关。从业时间较长的医生不太可能筛查 TB 或乙型肝炎。
本研究中筛查潜伏性 TB 和乙型肝炎的比例不足。虽然筛查率在增加，但仍需要进一步的系统改进和医生教育。
