接受抗TNF治疗患者的潜伏性结核感染检测及活动性结核预防：一项意大利全国性调查。

Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey.

作者信息

Cantini Fabrizio, Lubrano Ennio, Marchesoni Antonio, Mathieu Alessandro, Olivieri Ignazio, Salvarani Carlo, Scarpa Raffaele, Spadaro Antonio

机构信息

Division of Rheumatology, Misericordia e Dolce Hospital, Prato, Italy.

Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.

出版信息

Int J Rheum Dis. 2016 Aug;19(8):799-805. doi: 10.1111/1756-185X.12708. Epub 2015 Jul 14.

DOI:10.1111/1756-185X.12708

PMID:26172207

Abstract

AIMS

Primary: to investigate Italian rheumatology practice regarding latent tubercular infection (LTBI) detection and tuberculosis (TB) prevention in patients requiring anti-tumor necrosis factor (anti-TNF) therapy. Secondary: to assess the overall number of TB cases over 10 years and their distribution by drug.

METHODS

An anonymous, 24 multiple-response questionnaire was completed by 393/449 (87.5%) rheumatologists prescribing anti-TNF therapy. Six questions provided setting information, and 18 the compliance with recommendations and the recorded TB cases.

RESULTS

The Italian recommendations were used by 323 (82%) and other sets by 60 (15%). TB specialists were always consulted by 81 (21%) and occasionally by 73 (19%). LTBI screening was made using chest radiograph (CR) by 5%, tuburculin skin test (TST) by 5.3%, CR + TST by 35.6%, interferon-gamma release assay (IGRA) by 7.4%, CR + IGRAs by 26% and CR + TST + IGRA by 20.6%. Isoniazid was initiated in the presence of positivity of TST by 97 (24.7%), TST + IGRA by 101 (25.7%) and IGRA by 195 (49.6%). Anti-TNF starting delay was 1 month in 63.1% of the cases, 3 months in 27.7%, concomitantly in 5.6%. Overall, 317 TB reactivation cases occurred in 39 353 patients, with an incidence rate of 80.5 cases/100 000/year (10 times higher than in the Italian general population). TB occurred during TB prophylaxis in 192 (60.6%). TB cases incidence rate divided by drug was: etanercept (ETN) 51 (16%), 28/100 000/year, adalimumab (ADA) 98 (31%), 89/100 000/year, infliximab (IFX) 137 (43.2%), 211/100 000/year, with a significantly lower frequency in the ETN group compared to ADA and IFX groups (χ(2) = P < 0.001).

CONCLUSION

Italian rheumatologists are highly aware of anti-TNF-related TB risk with variable LTBI screening and TB prevention strategies. TB outcome was significantly lower in the ETN group.

摘要

目的

主要目的：调查意大利风湿病学领域在需要抗肿瘤坏死因子（抗TNF）治疗的患者中进行潜伏性结核感染（LTBI）检测和结核病（TB）预防的实际情况。次要目的：评估10年间TB病例的总数及其药物分布情况。

方法

393/449（87.5%）名开具抗TNF治疗药物的风湿病学家完成了一份匿名的、有24个多项选择题的问卷。6个问题提供了背景信息，18个问题涉及对建议的依从性以及记录的TB病例情况。

结果

323名（82%）医生采用了意大利的建议，60名（15%）采用了其他标准。81名（21%）医生总是会咨询结核病专家，73名（19%）偶尔咨询。采用胸部X线（CR）进行LTBI筛查的占5%，结核菌素皮肤试验（TST）的占5.3%，CR+TST的占35.6%，干扰素-γ释放试验（IGRA）的占7.4%，CR+IGRA的占26%，CR+TST+IGRA的占20.6%。TST呈阳性时开始使用异烟肼的有97名（24.7%），TST+IGRA呈阳性时开始使用的有101名（25.7%），IGRA呈阳性时开始使用的有195名（49.6%）。63.1%的病例抗TNF治疗开始延迟1个月，27.7%延迟3个月，5.6%同时开始。总体而言，39353名患者中发生了317例TB再激活病例，发病率为80.5例/10万/年（比意大利普通人群高10倍）。192例（60.6%）TB发生在预防期间。按药物划分的TB病例发病率为：依那西普（ETN）51例（16%），28/10万/年，阿达木单抗（ADA）98例（31%），89/10万/年，英夫利昔单抗（IFX）137例（43.2%），211/10万/年，ETN组的发病率明显低于ADA组和IFX组（χ(2)=P<0.001）。