Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver BC, Canada.
Inflamm Bowel Dis. 2012 Nov;18(11):2034-42. doi: 10.1002/ibd.22901. Epub 2012 Jan 31.
Guidelines mandate screening for latent tuberculosis infection (LTBI) prior to anti-tumor necrosis factor (anti-TNF) therapy in patients with inflammatory bowel disease (IBD). However, many are already on immunosuppressive therapy (IST) that may affect the precision of the Tuberculin skin test (TST). Our aim was to assess the performance of the new interferon-gamma release assays (IGRAs) to detect LTBI in patients with IBD.
MEDLINE and EMBASE were searched (up to June 2011) to identify studies evaluating the performance of IGRAs (QuantiFERON-TB Gold [QFT-2G], QuantiFERON-TB Gold In-Tube [QFT-3G] and T-SPOT.TB) in individuals with IBD. Forest plots and pooled estimates using random effects models were created where applicable.
Nine unique studies encompassing 1309 patients with IBD were included for analysis. The pooled concordance between the TST and QFT-2G/QFT-3G was 85% (95% confidence interval [CI] 77%-90%). The concordance of the TST and TSPOT.TB was 72% (95% CI 64%-78%). Studies assessing agreement reported more IGRA-/TST+ results versus IGRA+/TST- results. The pooled percentage of indeterminate results was 5% (95% CI 2%-9%) for QFT-2G/QFT-3G. TSPOT.TB showed similar results. Both positive QFT-2G/QFT-3G results (pooled odds ratio [OR] 0.37, 95% CI 0.16-0.87) and positive TST results (pooled OR 0.28, 95% CI 0.10-0.80) were significantly influenced by IST (both P = 0.02).
While it remains difficult to determine superiority between the IGRAs and the TST, both are negatively affected by IST. Therefore, screening prior to initiation of IST should be considered. Nevertheless, it is imperative that all patients receive screening prior to anti-TNF therapy.
指南要求在接受抗肿瘤坏死因子（anti-TNF）治疗前对炎症性肠病（IBD）患者进行潜伏性结核感染（LTBI）筛查。然而，许多患者已经在接受免疫抑制治疗（IST），这可能会影响结核菌素皮肤试验（TST）的准确性。我们的目的是评估新型干扰素释放分析（IGRAs）在 IBD 患者中检测 LTBI 的性能。
我们在 MEDLINE 和 EMBASE 上进行了检索（截至 2011 年 6 月），以确定评估 IGRAs（QuantiFERON-TB Gold [QFT-2G]、QuantiFERON-TB Gold In-Tube [QFT-3G]和 T-SPOT.TB）在 IBD 患者中的性能的研究。在适用的情况下，创建了森林图和使用随机效应模型进行的汇总估计。
纳入了 9 项包含 1309 例 IBD 患者的独特研究进行分析。TST 和 QFT-2G/QFT-3G 之间的总体一致性为 85%（95%置信区间 [CI] 77%-90%）。TST 和 TSPOT.TB 的一致性为 72%（95%CI 64%-78%）。评估一致性的研究报告说，IGRA-/TST+结果比 IGRA+/TST-结果更多。QFT-2G/QFT-3G 的不确定结果百分比为 5%（95%CI 2%-9%）。TSPOT.TB 显示出相似的结果。阳性 QFT-2G/QFT-3G 结果（汇总优势比 [OR] 0.37，95%CI 0.16-0.87）和阳性 TST 结果（汇总 OR 0.28，95%CI 0.10-0.80）均受到 IST 的显著影响（均 P = 0.02）。
虽然尚难以确定 IGRAs 和 TST 之间的优势，但两者均受 IST 的负面影响。因此，应考虑在开始 IST 之前进行筛查。然而，至关重要的是，所有患者在接受抗 TNF 治疗前都应进行筛查。
