Cabriada José Luis, Ruiz-Zorrilla Rafael, Barrio Jesús, Atienza Ramón, Huerta Alain, Rodríguez-Lago Iago, Bernal Antonio, Herrero César
Department of Gastroenterology Hospital de Galdakao-Usansolo, Vizcaya, Spain.
Department of Gastroenterology Hospital Río Hortega, Valladolid, Spain.
Turk J Gastroenterol. 2018 May;29(3):292-298. doi: 10.5152/tjg.2018.17162.
BACKGROUND/AIMS: Screening for latent tuberculosis infection is mandatory before starting anti-tumor necrosis factor therapy. New assays based on interferon-γ (IFN-γ) release have recently become available and may be more accurate. The aim of this study was to compare QuantiFERON-TB and tuberculin skin test in screening for latent infection in patients with inflammatory bowel disease.
We prospectively screened 138 patients with inflammatory bowel disease for latent tuberculosis infection with chest X-ray, tuberculin skin test, and a third-generation QuantiFERON-TB test. The association of the results in both tests with immunosuppression or inflammatory activity was determined by logistic regression.
The tuberculin skin test and QuantiFERON-TB were positive in 21.7% and 24.6% of the patients, respectively. Overall, 71% patients were receiving immunosuppressants. Concordance between the two tests was moderate (κ=0.59; 95% confidence interval (CI), 0.43-0.75) and was higher in immunosuppressant-naïve patients (κ=0.75; 95% CI, 0.52-0.97) than in immunosuppressed patients (κ=0.51; 95% CI, 0.30-0.72). In both the tests, disease activity and receiving immunosuppression were not associated with the test results. Nevertheless, QuantiFERON-TB was negatively influenced with two or more immunosuppressive drugs.
Concordance between the two tests was moderate, and it appears lower with immunosuppression. QuantiFERON-TB alone may be appropriate in immunosuppressant-naïve patients. Both tests should be considered in immunosuppressed patients.
背景/目的：在开始抗肿瘤坏死因子治疗之前，必须进行潜伏性结核感染筛查。基于干扰素-γ（IFN-γ）释放的新检测方法最近已可用，且可能更准确。本研究的目的是比较QuantiFERON-TB检测和结核菌素皮肤试验在筛查炎症性肠病患者潜伏感染中的效果。
我们前瞻性地对138例炎症性肠病患者进行潜伏性结核感染筛查，采用胸部X线、结核菌素皮肤试验和第三代QuantiFERON-TB检测。通过逻辑回归确定两种检测结果与免疫抑制或炎症活动之间的关联。
结核菌素皮肤试验和QuantiFERON-TB检测的阳性率分别为21.7%和24.6%。总体而言，71%的患者正在接受免疫抑制剂治疗。两种检测之间的一致性为中等（κ=0.59；95%置信区间（CI），0.43 - 0.75），在未使用免疫抑制剂的患者中更高（κ=0.75；95%CI，0.52 - 0.97），高于使用免疫抑制剂的患者（κ=0.51；95%CI，0.30 - 0.72）。在两种检测中，疾病活动度和接受免疫抑制治疗均与检测结果无关。然而，使用两种或更多种免疫抑制药物会对QuantiFERON-TB检测产生负面影响。
两种检测之间的一致性为中等，在免疫抑制情况下似乎更低。单独使用QuantiFERON-TB检测可能适用于未使用免疫抑制剂的患者。对于使用免疫抑制剂的患者，应同时考虑两种检测。
