用于炎症性肠病患者潜伏性结核筛查的干扰素-γ释放试验与结核菌素皮肤试验的比较：印度情况
Comparison of Interferon-Gamma Release Assay and Tuberculin Skin Test for the Screening of Latent Tuberculosis in Inflammatory Bowel Disease Patients: Indian Scenario.
作者信息
Mantri Alok Kumar, Meena Priti, Puri Amarender Singh, Kumar Ajay, Sachdeva Sanjeev, Srivastava Siddharth, Arivarasan K, Varakanahali Shivakumar
机构信息
Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India.
Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India.
出版信息
Tuberc Res Treat. 2021 Jan 26;2021:6682840. doi: 10.1155/2021/6682840. eCollection 2021.
BACKGROUND
In a country like India, where the prevalence of tuberculosis is very high, the role of screening tools for detection of latent tuberculosis infection (LTBI) like TST and IGRA is still unclear, especially in inflammatory bowel disease (IBD) patients. Our study is aimed at comparing the interferon-gamma release assay (IGRA) and tuberculin skin test (TST) to determine the prevalence of LTBI in IBD patients in the Indian subset of the population.
METHODS
It was a prospective observational analysis. A total of 257 participants were included in the study. Both TST and IGRA were performed in consecutive patients diagnosed with IBD (131 patients) and in 126 healthy individuals. Both tests were performed on the same day. LTBI diagnosis was considered if any one of TST or IGRA was found to be positive.
RESULTS
Out of 131 IBD patients, 121 patients had ulcerative colitis and 10 patients had Crohn's disease. 29% of the IBD patients and 22% of the control subjects had LTBI. The study demonstrated concordance between TST and IGRA. Agreement test kappa value for IBD patients was 0.656 (CI 0.50-0.81), with a value of <0.001, suggestive of a fair agreement. Mean IFN- release was lower in the immunosuppressed group as compared to non-immunosuppressed individuals (0.26 ± 0.17 vs. 0.45 ± 0.07, = 0.02). Cohen's kappa coefficient values in IBD cases and control subjects were 0.66 and 0.79, respectively. TST was found to be negatively correlated to BMI.
CONCLUSION
Agreement between TST and IGRA was fair in IBD patients. For LTBI screening in IBD patients, TST and IGRA are complementary methods.
背景
在像印度这样结核病患病率很高的国家，结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）等用于检测潜伏性结核感染（LTBI）的筛查工具的作用仍不明确，尤其是在炎症性肠病（IBD）患者中。我们的研究旨在比较干扰素-γ释放试验（IGRA）和结核菌素皮肤试验（TST），以确定印度人群中IBD患者LTBI的患病率。
方法
这是一项前瞻性观察分析。共有257名参与者纳入研究。TST和IGRA均在连续诊断为IBD的患者（131例）和126名健康个体中进行。两项检测均在同一天进行。如果TST或IGRA中任何一项呈阳性，则考虑LTBI诊断。
结果
131例IBD患者中，121例患有溃疡性结肠炎，10例患有克罗恩病。29%的IBD患者和22%的对照受试者患有LTBI。研究显示TST和IGRA之间具有一致性。IBD患者的一致性检验kappa值为0.656（95%置信区间0.50 - 0.81），P值<0.001，提示一致性尚可。免疫抑制组的平均干扰素-γ释放量低于非免疫抑制个体（0.26±0.17对0.45±0.07，P = 0.02）。IBD病例组和对照组科恩kappa系数值分别为0.66和0.79。发现TST与体重指数呈负相关。
结论
IBD患者中TST和IGRA之间的一致性尚可。对于IBD患者的LTBI筛查，TST和IGRA是互补的方法。
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