Jung Y J, Lee J Y, Jo K-W, Yoo B, Lee C-K, Kim Y-G, Yang S-K, Byeon J-S, Kim K-J, Ye B D, Lee K-H, Lee S-D, Kim W S, Kim D S, Shim T S
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungju Hospital, School of Medicine, Konkuk University, Seoul, South Korea.
Int J Tuberc Lung Dis. 2014 Apr;18(4):428-34. doi: 10.5588/ijtld.13.0644.
A ttertiary referral centre in South Korea.
The 'either test positive' strategy, incorporating both the tuberculin skin test (TST) and the T-SPOT(®).TB(T-SPOT) assay, was evaluated as a novel method for diagnosing latent tuberculous infection (LTBI) before treatment with anti-tumour necrosis factor (TNF) in patients with immune-mediated inflammatory diseases.
From June 2008 to April 2012, 430 patients received anti-TNF treatment at our institution. TST and T-SPOT were performed simultaneously at baseline. LTBI was defined as a positive TST or a positive T-SPOT result.
The positivity rates for the TST and T-SPOT assays were respectively 19.1% (82/430) and 44.2% (190/430), yielding an LTBI-positive rate of 48.6% (209/430). LTBI treatment was initiated in 46.0% (198/430) of patients and was completed by 89.4% (177/198). During follow-up (median 884 days), 0.9% (4/430) of the patients developed active tuberculosis (TB). All four TB patients were TST-negative at baseline, although two received LTBI treatment based on the baseline positive T-SPOT assay results.
The either test positive strategy is a valid method for diagnosing LTBI before anti-TNF treatment, although it is not clear whether it is superior to other strategies.
韩国的一家三级转诊中心。
评估“任一检测呈阳性”策略，该策略结合结核菌素皮肤试验（TST）和T-SPOT.TB（T-SPOT）检测，作为在免疫介导的炎症性疾病患者接受抗肿瘤坏死因子（TNF）治疗前诊断潜伏性结核感染（LTBI）的一种新方法。
2008年6月至2012年4月，430例患者在我们机构接受抗TNF治疗。在基线时同时进行TST和T-SPOT检测。LTBI定义为TST阳性或T-SPOT结果阳性。
TST和T-SPOT检测的阳性率分别为19.1%（82/430）和44.2%（190/430），LTBI阳性率为48.6%（209/430）。46.0%（198/430）的患者开始了LTBI治疗，89.4%（177/198）的患者完成了治疗。在随访期间（中位时间884天），0.9%（4/430）的患者发生了活动性结核病（TB）。所有4例TB患者在基线时TST均为阴性，尽管其中2例根据基线时T-SPOT检测结果阳性接受了LTBI治疗。
任一检测呈阳性策略是在抗TNF治疗前诊断LTBI的一种有效方法，尽管尚不清楚它是否优于其他策略。
