Department of Gastroenterology, The State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Department of Internal Medicine, Division of Gastroenterology, The Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
Dig Dis Sci. 2019 Jul;64(7):1916-1922. doi: 10.1007/s10620-019-5475-3. Epub 2019 Jan 23.
To compare tuberculin skin test (TST) and interferon gamma release assay (IGRA) in the screening of LTBI among patients with inflammatory bowel disease (IBD) in an endemic area for tuberculosis, to evaluate the need for repeating tests during anti-TNFα, therapy, and to check whether the results may be affected by immunosuppression.
A cross-sectional study of 110 IBD patients and 64 controls was conducted in Rio de Janeiro, Brazil. The TST was administered after the Quantiferon()-TB Gold In-tube test was performed.
TST and IGRA agreement was poor regarding diagnosis (kappa: control = 0.318; UC = 0.202; and CD = - 0.093), anti-TNFα therapy (kappa: with anti-TNFα = 0.150; w/o anti-TNFα = - 0.123), and immunosuppressive therapy (IST) (kappa: with IS = - 0.088; w/o IS = 0.146). Indeterminate IGRA was reported in four CD patients on IST. Follow-up tests after anti-TNFα identified conversion in 8.62% using TST and 20.0% using IGRA. Considering IGRA as a criterion standard, TST showed low sensitivity (19.05%) and positive predictive value (PPV) (21.05%). LTBI detection remarkably improved when IGRA was added to TST (sensitivity of 80.95% and PPV of 53.13%). Results were particularly relevant among CD patients where rates started from zero to reach sensitivity and PPV of more than 60%.
IGRA alone was more effective to detect LTBI than TST alone and had an overall remarkable added value as an add-on sequential test, particularly in CD patients. While cost-effectiveness of these strategies remains to be evaluated, IGRA appears to be justified in CD prior to and during anti-TNFα therapy, where tuberculosis is endemic.
在结核病流行地区，比较结核菌素皮肤试验（TST）和干扰素释放分析（IGRA）在炎症性肠病（IBD）患者中筛查潜伏性结核感染（LTBI）的效果，评估在使用抗 TNF-α 治疗期间重复检测的必要性，并检查结果是否受免疫抑制的影响。
在巴西里约热内卢进行了一项横断面研究，共纳入 110 例 IBD 患者和 64 名对照者。在进行 QuantiFeron-TB Gold In-tube 检测后进行 TST。
TST 和 IGRA 在诊断方面的一致性较差（kappa：对照者=0.318；UC=0.202；CD=−0.093），在抗 TNF-α 治疗（kappa：使用抗 TNF-α=0.150；未使用抗 TNF-α=−0.123）和免疫抑制治疗（IST）（kappa：使用 IST=−0.088；未使用 IST=0.146）方面也较差。4 例正在接受 IST 的 CD 患者的 IGRA 结果为不确定。在使用 TST 和 IGRA 进行抗 TNF-α 治疗后随访检测中，分别有 8.62%和 20.0%的患者发生了转换。以 IGRA 为标准，TST 的敏感性（19.05%）和阳性预测值（PPV）（21.05%）较低。当将 IGRA 添加到 TST 中时，LTBI 的检出率显著提高（敏感性为 80.95%，PPV 为 53.13%）。在 CD 患者中，结果尤其相关，其敏感性和 PPV 从 0 开始增加，达到 60%以上。
与 TST 相比，单独使用 IGRA 更能有效地检测 LTBI，并且作为一种附加的序贯检测方法，总体上具有显著的附加价值，尤其是在 CD 患者中。虽然这些策略的成本效益仍有待评估，但在结核病流行地区，IGRA 似乎在 CD 患者开始使用和正在使用抗 TNF-α 治疗之前和期间都是合理的。
