Yamamoto Shotaro, Nagatani Katsuya, Sato Takeo, Iwamoto Masahiro, Takatori Shino, Minota Seiji
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Int J Rheum Dis. 2017 May;20(5):584-588. doi: 10.1111/1756-185X.13101. Epub 2017 May 19.
The tuberculin skin test (TST) is used to diagnose tuberculosis; however, the influence of tumor necrosis factor (TNF) inhibitors on the test is unclear. This study investigated whether therapy with TNF inhibitors suppresses the TST reaction due to immunosuppression or whether the TST reaction increases due to reactivation of latent Mycobacterium tuberculosis infection.
Ninety-one patients with rheumatoid arthritis receiving TNF inhibitors (40 using infliximab and 51 using etanercept) were studied. The TST was performed before starting TNF inhibitors (T1) and more than 1 year after starting them (T2).
At T1, the reaction was negative in 45 patients, weakly positive in 21 patients, moderately positive in 18 patients and strongly positive in seven patients, while the numbers at T2 were 44, 20, 16 and 11, respectively. There were no significant differences of the TST reaction between T1 and T2 in all patients (P = 0.657), patients using infliximab (P = 0.462) or patients using etanercept (P = 1.00). No patients with a strongly positive TST reaction at T1 became negative at T2. However, two patients who were negative at T1 became strongly positive at T2. Although they had no signs of M. tuberculosis infection, isoniazid prophylaxis was given.
The TST reaction was not suppressed after more than 1 year of therapy with TNF inhibitors. Patients in whom the TST reaction changes from negative to strongly positive may need appropriate prophylaxis.
结核菌素皮肤试验（TST）用于诊断结核病；然而，肿瘤坏死因子（TNF）抑制剂对该试验的影响尚不清楚。本研究调查了TNF抑制剂治疗是由于免疫抑制而抑制TST反应，还是由于潜伏性结核分枝杆菌感染的重新激活而使TST反应增强。
对91例接受TNF抑制剂治疗的类风湿性关节炎患者进行研究（40例使用英夫利昔单抗，51例使用依那西普）。在开始使用TNF抑制剂之前（T1）和开始使用超过1年后（T2）进行TST。
在T1时，45例患者反应为阴性，21例为弱阳性，18例为中度阳性，7例为强阳性，而在T2时的数字分别为44、20、16和11。所有患者、使用英夫利昔单抗的患者（P = 0.462）或使用依那西普的患者（P = 1.00）中，T1和T2之间的TST反应无显著差异。T1时TST反应强阳性的患者在T2时无变为阴性的情况。然而，2例T1时为阴性的患者在T2时变为强阳性。尽管他们没有结核分枝杆菌感染的迹象，但给予了异烟肼预防性治疗。
TNF抑制剂治疗1年以上后，TST反应未受抑制。TST反应从阴性变为强阳性的患者可能需要适当的预防性治疗。
