Pérez Catalán I, Roig Martí C, Gil Fortuño M, Torrent Ramos P, Albiol Viñals P, Carballido Fernández M, Larrea R M, Ortín Martín C, Usó Blasco J, Ramos Rincón J M
Ignacio Pérez Catalán, Medicina Interna, Hospital General Universitario de Castellón. Avda. Benicassim s/n, Castellón, Spain.
Rev Esp Quimioter. 2019 Oct;32(5):445-450. Epub 2019 Sep 16.
The immunosuppressive therapies in the treatment of the immune-mediated inflammatory diseases (EIMI) predispose individuals to the tuberculosis, so the screening of latent tuberculosis infection (ITL) and the treatment reduces the likelihood of a progression to an active tuberculosis. The aim of the study was to analyze the concordance between the test of the tuberculin (PT) and "Interferon Gamma Release Assay-IGRA" in relation to the type of EIMI and the immunosuppressive treatment (IS).
Transversal study of patients with EIMI candidates or in treatment IS forwarded to the ITL screening, from April 2017 until May 2018. The outcome variables were PT and IGRA. The explicative variables were: EIMI, IS, age, gender, prior BCG vaccination and tuberculosis risk factors.
A total of 146 patients were analyzed (33[22.6%] vaccinated with BCG, 1 [0.7%] with a pre-diagnosis of tuberculosis, and 22 [15.1%] from an endemic country). Kappa index (k) was 0,338 between PT and IGRA for the whole sample. A lower concordance was found in patients with the Crohn's disease (k=0.125), in the ones treated with corticosteroids (k=0.222), vaccinated with BCG (k=0.122) and in patients from tuberculosis endemic countries (k=0.128).
The concordance between PT and IGRA is affected in patients with EIMI, and to a greater extent to patients with the inflammatory bowel disease, with the corticotherapy, with the BCG vaccination, or in the ones from endemic countries.
免疫介导性炎症疾病（EIMI）治疗中的免疫抑制疗法使个体易患结核病，因此对潜伏性结核感染（ITL）进行筛查和治疗可降低进展为活动性结核病的可能性。本研究的目的是分析结核菌素试验（PT）和“干扰素γ释放试验 - IGRA”之间的一致性，涉及EIMI的类型和免疫抑制治疗（IS）。
对2017年4月至2018年5月转诊至ITL筛查的EIMI候选患者或接受IS治疗的患者进行横断面研究。结果变量为PT和IGRA。解释变量为：EIMI、IS、年龄、性别、既往卡介苗接种情况和结核病危险因素。
共分析了146例患者（33例[22.6%]接种了卡介苗，1例[0.7%]有结核病预诊断，22例[15.1%]来自结核病流行国家）。整个样本中PT和IGRA之间的kappa指数（k）为0.338。在克罗恩病患者（k = 0.125）、接受皮质类固醇治疗的患者（k = 0.222）、接种卡介苗的患者（k = 0.122）以及来自结核病流行国家的患者（k = 0.128）中发现一致性较低。
EIMI患者中PT和IGRA之间的一致性受到影响，在炎症性肠病患者、接受皮质激素治疗的患者、接种卡介苗的患者或来自流行国家的患者中影响更大。
