Division of Thoracic Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Oriental Institute of Technology, New Taipei City, Taiwan.
BMC Pulm Med. 2020 Aug 31;20(1):232. doi: 10.1186/s12890-020-01274-9.
A study of latent tuberculosis infection (LTBI) burden by chest roentgenography (CXR) with reference to interferon-gamma release assay (IGRA) is still lacking in rheumatic patients of an intermediate tuberculosis burden area.
We retrospectively reviewed clinical data of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) receiving LTBI screening for biologics from Jan 2013 to April 2014.
A total of 238 rheumatic patients who underwent LTBI screening were included in this study, of whom 46 (19.3%) had positive IGRA tests, 178 (74.8%) had negative results, and 14 (5.9%) had indeterminate results. Radiological findings suggesting healed tuberculosis (CXR-old-TB) were found in 18.1% of all patients, 23.9% in the IGRA -positive patients vs 16.9% in the IGRA-negative patients (OR 1.55 95% CI: 0.71-3.39, p = 0.27). Forty (40/46, 87.0%) IGRA-positive patients received isoniazid prophylaxis and 77.5% of them finished treatment. Six patients developed adverse effects of isoniazid treatment, resulting in an overall number needed to harm (NNH) of 6.7 (40/6). IGRA-non-positive patients with old TB-suggestive CXR comprised 13.4% (32/238) of all our rheumatic patients, and one of them developed pulmonary tuberculosis within one year after screening.
LTBI disease burden in rheumatic patients is substantial according to the estimation of CXR and IGRA screening. Correlation between CXR and IGRA is not significant in rheumatic patients, which implies their complementary roles. IGRA-non-positive patients with old TB-suggestive CXR comprise a significant portion in rheumatic patients and merit cautious follow-up by rheumatologists, tuberculosis specialists, and pulmonologists.
在结核病负担处于中等水平的地区，利用胸部 X 线（CXR）检查结合干扰素 -γ 释放试验（IGRA）来研究潜伏性结核感染（LTBI）负担的研究仍然较少。
我们回顾性分析了 2013 年 1 月至 2014 年 4 月间因接受生物制剂治疗而接受 LTBI 筛查的类风湿关节炎（RA）、强直性脊柱炎（AS）或银屑病关节炎（PsA）患者的临床资料。
共有 238 例接受 LTBI 筛查的风湿患者纳入本研究，其中 46 例（19.3%）IGRA 检测阳性，178 例（74.8%）IGRA 检测阴性，14 例（5.9%）IGRA 检测结果不确定。所有患者中，影像学检查提示陈旧性肺结核（CXR-陈旧性-TB）的比例为 18.1%，IGRA 阳性患者中为 23.9%，IGRA 阴性患者中为 16.9%（比值比 1.55，95%可信区间：0.71-3.39，p=0.27）。40 例（40/46，87.0%）IGRA 阳性患者接受了异烟肼预防治疗，其中 77.5%完成了治疗。6 例患者出现异烟肼治疗不良反应，导致危害人数需要（NNH）为 6.7（40/6）。CXR 提示陈旧性-TB 的 IGRA 阴性患者占所有风湿患者的 13.4%（32/238），其中 1 例患者在筛查后 1 年内发生肺结核。
根据 CXR 和 IGRA 筛查结果，风湿患者的 LTBI 疾病负担较大。在风湿患者中，CXR 与 IGRA 之间的相关性不显著，这表明它们具有互补作用。CXR 提示陈旧性-TB 的 IGRA 阴性患者在风湿患者中占很大比例，需要风湿科医生、结核病专家和肺病专家进行谨慎随访。
