长期生物治疗下风湿病患者及基线筛查阴性患者的结核病筛查检测的转化率和逆转率
Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment.
作者信息
Thomas Konstantinos, Hadziyannis Emilia, Hatzara Chrisoula, Makris Anastasia, Tsalapaki Christina, Lazarini Argyro, Klavdianou Kalliopi, Antonatou Katerina, Koutsianas Christos, Vassilopoulos Dimitrios
机构信息
Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.
出版信息
Pathog Immun. 2020 Feb 26;5(1):34-51. doi: 10.20411/pai.v5i1.349. eCollection 2020.
BACKGROUND
To determine the conversion and reversion rates of tuberculosis (TB) screening tests (Tuberculin Skin Test-TST, Interferon Gamma Release Assay-IGRA: T-SPOT.TB) during biologic treatment in patients with rheumatic diseases and negative baseline screening.
METHODS
This was a long-term, longitudinal cohort study of 50 patients with rheumatic diseases and negative baseline TB screening (TST: < 5 mm, negative T-SPOT.TB) treated with tumor necrosis factor inhibitors (TNFi) or other non-TNFi biologics. Patients were rescreened at a mean time of 1.4 (first rescreening) and 6.9 (second rescreening) years from baseline, with both assays. The conversion (negative to positive) and reversion (positive to negative) rate was calculated for each TB screening test.
RESULTS
Fifty patients (mean age = 60 years) with various rheumatic diseases (rheumatoid arthritis: n = 24, spondyloarthropathies: n = 23, other: n = 3) were enrolled. During the first phase (baseline to first rescreening), all patients were treated with TNFi while during the second phase (first to second rescreening), TNFi (54%) and non-TNFi (46%) were used. Fifteen patients (30%) displayed conversion of at least 1 screening assay during follow-up (10 at the first and 5 at the second rescreening). This conversion rate was higher with TST (n = 11, 22% or 3.47/100 patient-years) compared to T-SPOT.TB (n = 4, 8% or 1.74/100 patient-years). Among the 10 converters at the first rescreening, 5 received isoniazid (INH) preventive therapy and 5 did not; an equal number of patients (3/5, 60%) reverted to negative with or without INH therapy. None of the patients developed active TB during follow-up (6.9 ± 1.0 years).
CONCLUSIONS
Approximately one-third of patients with rheumatic diseases and negative baseline TB screening developed conversion of at least 1 screening test during long-term biologic treatment. This occurred most often with TST and was usually a transient event. These findings do not support routine serial TB retesting in biologic-treated patients with rheumatic diseases in the absence of TB risk factors.
背景
确定风湿性疾病患者在生物治疗期间且基线筛查为阴性时，结核病（TB）筛查试验（结核菌素皮肤试验-TST、干扰素γ释放试验-IGRA：T-SPOT.TB）的转换率和逆转率。
方法
这是一项针对50例风湿性疾病患者的长期纵向队列研究，这些患者基线TB筛查为阴性（TST：<5mm，T-SPOT.TB阴性），接受肿瘤坏死因子抑制剂（TNFi）或其他非TNFi生物制剂治疗。患者在距基线平均1.4年（首次复查）和6.9年（第二次复查）时用两种检测方法进行重新筛查。计算每次TB筛查试验的转换率（阴性转为阳性）和逆转率（阳性转为阴性）。
结果
纳入了50例（平均年龄=60岁）患有各种风湿性疾病的患者（类风湿关节炎：n=24，脊柱关节病：n=23，其他：n=3）。在第一阶段（基线至首次复查），所有患者接受TNFi治疗，而在第二阶段（首次至第二次复查），使用TNFi的患者占54%，使用非TNFi的患者占46%。15例患者（30%）在随访期间至少有1项筛查试验结果发生转换（首次复查时有10例，第二次复查时有5例）。与T-SPOT.TB（n=4，8%或1.74/100患者年）相比，TST的转换率更高（n=11，22%或3.47/100患者年）。在首次复查时转换的10例患者中，5例接受了异烟肼（INH）预防性治疗，5例未接受；接受或未接受INH治疗的患者中，转为阴性的患者数量相同（3/5，60%）。随访期间（6.9±1.0年）无患者发生活动性TB。
结论
在长期生物治疗期间，约三分之一基线TB筛查为阴性的风湿性疾病患者至少有1项筛查试验结果发生转换。这种情况最常发生在TST，且通常是短暂事件。这些发现不支持在无TB危险因素的接受生物制剂治疗的风湿性疾病患者中进行常规系列TB复查。
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