Department of Rheumatology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France.
Int J Tuberc Lung Dis. 2012 Oct;16(10):1307-14. doi: 10.5588/ijtld.12.0111. Epub 2012 Aug 3.
Screening for latent tuberculosis infection (LTBI) using a protocol comprising chest X-ray and tuberculin skin test (TST) interpreted with medical history, Sc1, reduces LTBI reactivation on treatment with anti-tumour necrosis factor-alpha (anti-TNF-α). In the district of Seine-Saint-Denis, France, where tuberculosis (TB) incidence ranges from 30 to >100/100 000 person-years, however, Sc1 might be insensitive as a screening tool. We adopted another protocol, Sc2, comprising Sc1 plus two additional tests: the QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) and chest computed tomography (CT).
We screened 123 consecutive patients with inflammatory rheumatic diseases (IRDs), candidates for anti-TNF-α treatment, and evaluated the impact of Sc2 vs. Sc1 on the prescription of prophylactic anti-tuberculosis treatment.
Sc2 led to a diagnosis of LTBI in 69 patients vs. 59 when using Sc1: eight were QFT-GIT-positive. Diagnosis was based on CT findings in two patients. QFT-GIT had higher diagnostic accuracy than TST, but no single diagnostic test could detect all patients at high risk for LTBI reactivation (respectively 30.2% and 37.5% of patients positive with only TST or QFT-GIT). CT detected TB sequelae in 3/46 rheumatoid arthritis patients who were negative to all tests.
Testing with both TST and QFT-GIT seems the safest strategy for detecting LTBI in patients with IRD from populations with high incidence of TB. Systematic screening with CT warrants further evaluation.
采用包括胸部 X 光和结核菌素皮肤试验（TST）在内的方案，并结合病史进行解读（Sc1）筛查潜伏性结核感染（LTBI），可降低使用抗肿瘤坏死因子-α（anti-TNF-α）治疗时 LTBI 的再激活率。然而，在法国塞纳-圣但尼区，结核病（TB）发病率在 30 至＞100/100000 人年之间，Sc1 作为筛查工具可能不够敏感。我们采用了另一种方案（Sc2），包括 Sc1 加两项附加测试：QuantiFERON（®）-TB Gold In-Tube（QFT-GIT）和胸部计算机断层扫描（CT）。
我们对 123 例连续的炎症性风湿病（IRDs）患者进行了筛查，这些患者是抗 TNF-α 治疗的候选者，并评估了 Sc2 与 Sc1 对预防性抗结核治疗处方的影响。
Sc2 导致 69 例患者被诊断为 LTBI，而 Sc1 则为 59 例：8 例 QFT-GIT 阳性。有两例患者的诊断基于 CT 发现。QFT-GIT 的诊断准确性高于 TST，但没有任何一种单一的诊断测试可以检测出所有 LTBI 再激活风险高的患者（仅 TST 或 QFT-GIT 阳性的患者分别为 30.2%和 37.5%）。CT 在 46 例类风湿关节炎患者中发现了 3 例，这些患者的所有测试均为阴性。
在来自 TB 发病率高的人群的 IRD 患者中，同时进行 TST 和 QFT-GIT 检测似乎是检测 LTBI 的最安全策略。对 CT 的系统筛查需要进一步评估。
