Song Dong Juan, Tong Jin Lu, Peng Jiang Chen, Cai Chen Wen, Xu Xi Tao, Zhu Ming Ming, Ran Zhi Hua, Zheng Qing
Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Institute of Digestive Disease, Shanghai, China.
J Dig Dis. 2017 Jan;18(1):23-30. doi: 10.1111/1751-2980.12437.
To assess the prevalence and potential risk factors of latent tuberculosis infection (LTBI) in Chinese patients with inflammatory bowel disease (IBD) and to evaluate the role of chest computed tomography (CT) in the screening of LTBI.
A single-center retrospective study was conducted and all IBD patients who had been screened for LTBI by T-SPOT.TB between December 2011 and January 2016 were enrolled in the study. Both inpatient and outpatient records were collected and comprehensively reviewed.
Altogether 534 IBD patients were included. The positivity rate of T-SPOT.TB was 18.0% overall, 31.9% in IBD unclassified, 22.5% in ulcerative colitis and 13.0% in Crohn's disease patients, respectively. Age, history of TB and the administration of immunosuppressants were significantly associated with T-SPOT.TB positivity. Among 123 patients who underwent serial testing, the conversion and reversion rate of T-SPOT.TB was 10.2% and 42.9%, respectively. Furthermore, 102 of 447 (22.8%) patients who underwent chest computed tomography (CT) were found with abnormal CT findings suggestive of LTBI. The concordance rate was 75% between the T-SPOT.TB and chest CT with a kappa value of 0.25 (95% CI 0.15-0.35).
The prevalence of LTBI in IBD patients is high in China. Chest CT is recommended as an alternative to IGRA for screening LTBI of IBD patients before commencing immunosuppressive therapy in high-prevalence regions.
评估中国炎症性肠病（IBD）患者中潜伏性结核感染（LTBI）的患病率及潜在危险因素，并评估胸部计算机断层扫描（CT）在LTBI筛查中的作用。
进行一项单中心回顾性研究，纳入2011年12月至2016年1月期间通过T-SPOT.TB筛查LTBI的所有IBD患者。收集并全面审查住院和门诊记录。
共纳入534例IBD患者。T-SPOT.TB总体阳性率为18.0%，未分类IBD患者中为31.9%，溃疡性结肠炎患者中为22.5%，克罗恩病患者中为13.0%。年龄、结核病史和免疫抑制剂的使用与T-SPOT.TB阳性显著相关。在123例接受系列检测的患者中，T-SPOT.TB的转换率和逆转率分别为10.2%和42.9%。此外，447例接受胸部计算机断层扫描（CT）的患者中有102例（22.8%）CT检查发现异常，提示LTBI。T-SPOT.TB与胸部CT的一致性率为75%，kappa值为0.25（95%CI 0.15 - 0.35）。
中国IBD患者中LTBI的患病率较高。在高流行地区，建议在开始免疫抑制治疗前，将胸部CT作为IBD患者LTBI筛查的IGRA替代方法。
