Baričević Denis, Popović Grle Sanja, Morović Vergles Jadranka, Čuković Čavka Silvija, Jakopović Marko, Redžepi Gzim, Boras Zagorka, Baričević Marinka, Samaržija Miroslav
Jordanovac Clinical Department of Respiratory Diseases, Zagreb University Hospital Centre.
Clinical Department of Internal Medicine, Dubrava University Hospital.
Acta Clin Croat. 2017 Jun;56(2):203-209. doi: 10.20471/acc.2017.56.02.02.
The aim of this study was to investigate the role of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) in detecting latent tuberculosis in immunocompromised patients before introducing tumor necrosis factor (TNF-α) antagonists. The study included 300 subjects of similar age. The study group comprised of 150 QuantiFERON (QFT) positive subjects with rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis and psoriatic arthritis, while control group comprised of 150 QFT negative respondents with the same diseases. Exhaustive medical history was documented for all patients. Screening tests were performed including QFT-GIT, tuberculin skin test (TST), chest radiography and detection of Mycobacterium tuberculosisin sputum culture 2 times. A positive QFT-GIT test result, regardless of TST result, was considered as an indication for latent tuberculosis infection (LTBI) treatment. Results of this study showed good correlation between the conclusive results of QFT-GIT and TST. All study group patients had normal clinical findings, normal radiologic findings and negative results of sputum microbiological analysis during the course of prophylaxis and after its completion and during the course of biological therapy. Conversion of positive QFT-GIT test to negative was observed in 4% of study group patients, while QFT negative respondents remained negative. There was a statistically significant positive correlation between QFTGIT, TST results and patient age, smoking habit and contact with tuberculosis. Study results showed that along with good clinical evaluation and detailed medical history, it is important to conduct testing in order to avoid disease progression or unnecessary isoniazid prophylaxis.
本研究的目的是调查在引入肿瘤坏死因子(TNF-α)拮抗剂之前,QuantiFERON-TB Gold In-Tube检测(QFT-GIT)在检测免疫功能低下患者潜伏性结核中的作用。该研究纳入了300名年龄相仿的受试者。研究组由150名类风湿关节炎、克罗恩病、溃疡性结肠炎、强直性脊柱炎和银屑病关节炎的QuantiFERON(QFT)阳性受试者组成,而对照组由150名患有相同疾病的QFT阴性受试者组成。记录了所有患者详尽的病史。进行了多项筛查试验,包括QFT-GIT、结核菌素皮肤试验(TST)、胸部X线摄影以及痰培养2次以检测结核分枝杆菌。无论TST结果如何,QFT-GIT检测结果呈阳性均被视为潜伏性结核感染(LTBI)治疗的指征。本研究结果显示QFT-GIT和TST的最终结果之间具有良好的相关性。所有研究组患者在预防期间、预防完成后以及生物治疗期间,临床检查结果均正常,影像学检查结果正常,痰微生物分析结果为阴性。研究组4%的患者QFT-GIT检测结果由阳性转为阴性,而QFT阴性的受试者仍为阴性。QFT-GIT、TST结果与患者年龄、吸烟习惯以及与结核病接触情况之间存在统计学上显著的正相关。研究结果表明,除了进行良好的临床评估和详细的病史记录外,进行检测对于避免疾病进展或不必要的异烟肼预防也很重要。