Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
Clin Exp Rheumatol. 2011 Sep-Oct;29(5):790-4. Epub 2011 Oct 31.
There is little information regarding the reliability of repeat tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs) in detecting latent tuberculosis infection (LTBI) in people on anti-tumour necrosis factor (TNF) medication.
We conducted a prospective, observational study of patients referred to the Saskatoon Tuberculosis (TB) Clinic prior to starting anti-TNF medication. A chest x-ray (CXR), 2-step TST and IGRA (QuantiFERON-TB Gold In-Tube Method) were performed at baseline. Those patients with a baseline TST ≥10 mm and/or a positive IGRA were followed with a clinic visit, CXR, TST and IGRA at 3 and 6 months after starting anti-TNF medication.
Of 106 potential patients, 91 consented to participate. Twenty-six patients had a positive (≥ 10 mm) TST or IGRA at baseline; twelve started and stayed on anti-TNF medication through the 6-month follow-up and completed both planned follow-up visits. The baseline mean TST measurement for the 12 participants was 13.9 mm (SD 11.4), increasing to a mean of 16.8 mm (SD 9.3) post-booster. At 3 months post-anti-TNF initiation, there was an overall decrease in TST measurement (mean=10.0 mm; SD 9.3; p=0.013), with measurements <5 mm in 3 of the 12 patients. By the 6-month TST, a response recovery was observed with a mean TST measurement of 14.5 mm (SD 7.7), with 11/12 ≥5 mm. The IGRA was unchanged throughout the study period in all patients. The overall agreement between TST and IGRA was poor (kappa coefficient = 0.180, p=0.020).
We demonstrated a transient but significant decrease in TST response in the first six months of anti-TNF therapy.
关于肿瘤坏死因子（TNF）抑制剂治疗患者中重复结核菌素皮肤试验（TST）和γ干扰素释放试验（IGRA）检测潜伏性结核感染（LTBI）的可靠性，相关信息较少。
我们进行了一项前瞻性、观察性研究，纳入了在开始 TNF 抑制剂治疗前到萨斯卡通结核（TB）诊所就诊的患者。在基线时进行了胸部 X 光（CXR）、两步 TST 和 IGRA（QuantiFERON-TB Gold In-Tube 法）检查。对于基线 TST≥10mm 和/或 IGRA 阳性的患者，在开始 TNF 抑制剂治疗后 3 和 6 个月时进行临床访视、CXR、TST 和 IGRA。
在 106 名潜在患者中，91 名同意参加。26 名患者基线时 TST 或 IGRA 阳性（≥10mm）；12 名患者开始并继续接受 TNF 抑制剂治疗至 6 个月随访期，并完成了两次计划随访。12 名参与者的基线 TST 平均测量值为 13.9mm（SD 11.4），在加强针后增加到 16.8mm（SD 9.3）。在开始抗 TNF 治疗后 3 个月时，TST 测量值总体下降（平均值=10.0mm；SD 9.3；p=0.013），12 名患者中有 3 名的测量值<5mm。在 6 个月的 TST 时，观察到反应恢复，平均 TST 测量值为 14.5mm（SD 7.7），12 名患者中有 11 名≥5mm。在整个研究期间，所有患者的 IGRA 均无变化。TST 和 IGRA 之间的总体一致性较差（kappa 系数=0.180，p=0.020）。
我们在 TNF 抑制剂治疗的前 6 个月中观察到 TST 反应短暂但显著下降。
