Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.
Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain.
J Crohns Colitis. 2017 Jul 1;11(7):792-800. doi: 10.1093/ecco-jcc/jjx022.
Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage.
In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression.
We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004].
The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
结核菌素皮肤试验[TST]在筛查潜伏性结核感染[LTBI]中的敏感性受类固醇和/或免疫抑制剂治疗的影响。本研究的目的是比较两步 TST 在炎症性肠病患者开始使用抗肿瘤坏死因子[TNF]治疗前（作为 LTBI 常规筛查的一部分）与控制患者（当 TST 在早期进行时）的表现。
在这项多中心前瞻性对照研究中，我们评估了 5mm 阈值的两步 TST 的性能。通过逻辑回归确定 TST 结果相关的因素。
我们评估了 243 名候选抗 TNF 治疗患者和 337 名对照患者。总体而言，105 名患者[18.1%]的第一次 TST 或 TST 复测时硬结≥5mm。TST 复测诊断 LTBI 占 25%的患者。28 名[11.5%]抗 TNF 组患者与 77 名[22.8%]对照患者 TST 阳性（比值比[OR]0.44，95%置信区间[CI]0.28-0.70；P<0.001）。在多变量分析中，TST 阳性与年龄较大[OR 2.63，95%CI 1.21-5.72；P<0.001]和 5-氨基水杨酸治疗[OR 1.86，95%CI 1.14-3.05；P=0.013]相关。TST 阴性与类固醇治疗[OR 0.36，95%CI 0.16-0.83；P=0.016]、免疫抑制剂治疗[OR 0.36，95%CI 0.21-0.62；P<0.001]或类固醇+免疫抑制剂治疗[OR 0.20，95%CI 0.07-0.59；P=0.004]相关。
在开始使用抗 TNF 治疗前进行常规 TST 的敏感性较低。在早期进行 TST 可以在没有免疫抑制治疗的情况下进行筛查，从而最大限度地提高 TST 检测 LTBI 的诊断效果。
