Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Aliment Pharmacol Ther. 2012 Nov;36(9):858-65. doi: 10.1111/apt.12037.
Patients treated with TNF-α inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (LTB). Prospective studies on monitoring of TB reactivation and/or infection in this risk group are lacking.
To test the conversion and reversion rate of screening tests for latent TB serial tuberculin skin test (TST) and interferon-γ release assay (IGRA) under ongoing TNFi therapy.
We retested consecutive patients with IBD receiving TNFi therapy for a minimum of 5 months for LTB using IGRA and TST. A detailed patient history and concomitant therapy were recorded for each subject.
After a median of 34.9 weeks (20.7–177.7), IGRA was retested in 184/227 patients (81.1%; Crohn's disease n = 139, ulcerative colitis n = 45) still under index TNFi. TST was available in 144/184 subjects (78.2%). The majority of patients were TNFi naïve (147/184, 79.9%). In a subgroup of patients who received isoniazid due to diagnosis of latent TB at baseline (n = 32), 6/13 patients (46.2%) with baseline positive IGRA and 3/22 patients (13.6%) with baseline positive TST reverted to negative at retesting. In patients without diagnosis of LTB at baseline no permanent IGRA conversion was observed, but there were 6/144 (4.2%) TST conversions from negative to positive. No single case of TB reactivation or infection was recorded during the observation period.
During treatment TNF-α inhibitors conversion was observed for tuberculin skin test, but not interferon-γ release assay. As compared with tuberculin skin test, interferon-γ release assay reverted in nearly half of isoniazid-treated patients for latent tuberculosis. However, the fact that patients in whom the interferon-γ release assay test result remained positive did not develop active tuberculosis during follow-up questions the utility of interferon-γ release assay as a monitoring tool during chemoprevention.
接受 TNF-α 抑制剂（TNFi）治疗的患者存在潜伏性结核（LTB）再激活的高风险。缺乏针对该风险人群中结核再激活和/或感染监测的前瞻性研究。
检测在持续 TNFi 治疗下，结核菌素皮肤试验（TST）和干扰素-γ 释放试验（IGRA）系列潜伏性 TB 筛查试验的转化和逆转率。
我们对接受 TNFi 治疗至少 5 个月的连续 IBD 患者进行了 LTB 的 IGRA 和 TST 重新检测。为每位患者记录了详细的病史和伴随治疗。
中位时间 34.9 周（20.7-177.7）后，在 227 例仍在接受索引 TNFi 的患者中（克罗恩病 n=139，溃疡性结肠炎 n=45），184 例（81.1%）接受了 IGRA 复查，144 例（78.2%）有 TST 数据。大多数患者为 TNFi 初治（147/184，79.9%）。在基线时因诊断为潜伏性结核而接受异烟肼治疗的患者亚组中（n=32），基线 IGRA 阳性的 13 例患者中有 6 例（46.2%）和基线 TST 阳性的 22 例患者中有 3 例（13.6%）在复查时转为阴性。在基线无 LTB 诊断的患者中，未观察到 IGRA 永久性转化，但有 144 例患者中有 6 例（4.2%）TST 由阴性转为阳性。在观察期间未记录到任何结核再激活或感染的病例。
在 TNF-α 抑制剂治疗期间，结核菌素皮肤试验发生转化，但干扰素-γ 释放试验未发生转化。与结核菌素皮肤试验相比，在接受异烟肼治疗的患者中，近一半的潜伏性结核患者的干扰素-γ 释放试验结果逆转。然而，在随访期间，干扰素-γ 释放试验结果仍为阳性的患者并未发生活动性结核病，这对干扰素-γ 释放试验作为化学预防监测工具的效用提出了质疑。
