Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
PLoS One. 2018 Jul 5;13(7):e0198756. doi: 10.1371/journal.pone.0198756. eCollection 2018.
This study aims to compare the latent tuberculosis infection (LTBI) screening strategy of interferon-gamma release assay (IGRA)-alone and in combination with tuberculin skin tests (TSTs) before the initiation of tumor necrosis factor (TNF) inhibitor treatment in patients with inflammatory arthritis. Between January 2011 and June 2017, we enrolled 476 patients who were followed up for ≥1 year after the TNF inhibitor initiation in a tertiary referral center in South Korea. Inflammatory arthritis comprised rheumatoid arthritis in 266 (55.9%) and ankylosing spondylitis in 210 (44.1%) patients. The following strategies were used for LTBI screening during the study period: (i) from January 2011 to October 2014, the combination of TST and QuantiFERON-TB Gold In-Tube (QFT-GIT); (ii) between November 2014 and February 2015, QFT-GIT-alone and (iii) since March 2015, either the combination of TST and QFT-GIT or QFT-GIT-alone depending on the attending physician's choice. We compared the screening strategies of QFT-GIT alone and in combination with TST. Overall, 338 (71.0%) patients received LTBI screening tests using the combination of TST and QFT-GIT, and 138 (29.0%) received QFT-GIT-alone. In addition, the LTBI tests were positive in 159 (47.0%) of 338 patients using the combination tests, and 43.8% (148/338) required LTBI treatment. Meanwhile, the LTBI tests were positive in 32.6% (45/138) of QFT-GIT-alone patients, and 30.4% (42/138) required LTBI treatment. Among 338 patients who received combination tests, 2 patients developed active tuberculosis within 1 year after the TNF inhibitor initiation. Of patients who received QFT-GIT-alone, no patient developed tuberculosis. In conclusion, among patients who received QFT-GIT-alone, the number of patients who required LTBI treatment declined compared to the TST and QFT-GIT combination, and none developed active tuberculosis within 1 year, suggesting that QFT-GIT-alone could be a potential screening strategy for diagnosing LTBI in patients with inflammatory arthritis in South Korea.
本研究旨在比较在开始使用肿瘤坏死因子（TNF）抑制剂治疗前，采用干扰素-γ释放试验（IGRA）单独或联合结核菌素皮肤试验（TST）对炎症性关节炎患者进行潜伏性结核感染（LTBI）筛查的策略。2011 年 1 月至 2017 年 6 月，我们在韩国的一家三级转诊中心招募了 476 名患者，这些患者在开始使用 TNF 抑制剂后至少随访了 1 年。炎症性关节炎包括类风湿关节炎 266 例（55.9%）和强直性脊柱炎 210 例（44.1%）。在研究期间，采用以下策略进行 LTBI 筛查：（i）2011 年 1 月至 2014 年 10 月，TST 和 QuantiFERON-TB Gold In-Tube（QFT-GIT）联合；（ii）2014 年 11 月至 2015 年 2 月，QFT-GIT 单独；（iii）自 2015 年 3 月起，根据主治医生的选择，TST 和 QFT-GIT 联合或 QFT-GIT 单独。我们比较了 QFT-GIT 单独和联合 TST 的筛查策略。总体而言，338 例（71.0%）患者接受了 TST 和 QFT-GIT 联合检测，138 例（29.0%）患者接受了 QFT-GIT 单独检测。此外，联合检测组中 159 例（47.0%）患者 LTBI 检测呈阳性，需要 LTBI 治疗的比例为 43.8%（148/338）。而 QFT-GIT 单独检测组中，45 例（32.6%）患者 LTBI 检测呈阳性，需要 LTBI 治疗的比例为 30.4%（42/138）。在接受联合检测的 338 例患者中，有 2 例患者在开始使用 TNF 抑制剂后 1 年内发生活动性肺结核。在接受 QFT-GIT 单独检测的患者中，无患者发生结核病。总之，与 TST 和 QFT-GIT 联合检测相比，接受 QFT-GIT 单独检测的患者需要进行 LTBI 治疗的比例下降，且在 1 年内无患者发生活动性肺结核，提示 QFT-GIT 单独检测可能是韩国炎症性关节炎患者 LTBI 诊断的一种潜在筛查策略。
