结核病流行地区肝移植受者发生活动性结核病的风险群体：基于胸部影像和干扰素γ释放试验的风险分层。

Risk Groups of Developing Active Tuberculosis in Liver Transplant Recipients in a Tuberculosis Endemic Area: Risk Stratification by Chest Image and Interferon Gamma Release Assay.

机构信息

Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea.

Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea.

出版信息

Int J Infect Dis. 2021 Dec;113:359-366. doi: 10.1016/j.ijid.2021.10.043. Epub 2021 Oct 28.

DOI:10.1016/j.ijid.2021.10.043

PMID:34718154

Abstract

OBJECTIVES

We implemented a stratified risk analysis to predict the development of active tuberculosis (TB) in liver transplantation (LT) recipients based on IGRA and chest images in a TB-endemic area.

METHODS

In this retrospective cohort study, LT recipients who tested for IGRA between May 2008 and December 2017 were included. Chest images compatible with old TB lesions were considered as positive images. LT recipients were divided into six groups: LT recipients with history of treated TB, image (+)/IGRA (+), image (+)/IGRA (-), image (-)/IGRA (+), image (-)/IGRA (-) and LTBI treated. The Cox regression model was used to analyze risk groups.

RESULTS

Among the 717 eligible LT recipients included in this study, 21 patients developed active TB. Incidence rates of TB were 2,261, 724, and 119 cases/100,000 person-years in the 1st, 2nd, and ≥ 3rd year after transplantation, respectively. History of treated TB (HR 18.92; 95% CI 4.10-87.25) and image (+)/IGRA (+) (HR 10.86; 95% CI 2.75-42.89) were independent risk factors for developing active TB. IGRA (+) with a negative image was not a risk factor.

CONCLUSIONS

Our findings suggested that both IGRA and chest images should be considered to identify risk groups for LTBI treatment.

摘要

目的

我们在结核病高发地区，通过对 IGRA 和胸部影像进行分层风险分析，预测肝移植（LT）受者发生活动性结核病（TB）的风险。

方法

本回顾性队列研究纳入了 2008 年 5 月至 2017 年 12 月期间进行 IGRA 检测的 LT 受者。与陈旧性 TB 病变一致的胸部影像被认为是阳性影像。将 LT 受者分为以下六组：有 TB 治疗史、影像（+）/IGRA（+）、影像（+）/IGRA（-）、影像（-）/IGRA（+）、影像（-）/IGRA（-）和 LTBI 治疗。采用 Cox 回归模型分析风险组。

结果

本研究共纳入 717 例符合条件的 LT 受者，其中 21 例发生活动性 TB。移植后第 1、2 和≥3 年的 TB 发生率分别为 2,261、724 和 119 例/10 万人年。有 TB 治疗史（HR 18.92；95%CI 4.10-87.25）和影像（+）/IGRA（+）（HR 10.86；95%CI 2.75-42.89）是发生活动性 TB 的独立危险因素。IGRA（+）但影像阴性不是危险因素。