Riestra Sabino, Taxonera Carlos, Zabana Yamile, Carpio Daniel, Chaparro María, Barrio Jesús, Rivero Montserrat, López-Sanroman Antonio, Esteve María, de Francisco Ruth, Bastida Guillermo, García-López Santiago, Mañosa Miriam, Martin-Arranz María Dolores, Pérez-Calle José Lázaro, Guardiola Jordi, Muñoz Fernando, Arranz Laura, Cabriada José Luis, García-Sepulcre Mariana Fe, Navarro Mercè, Montoro-Huguet Miguel Ángel, Ricart Elena, Bermejo Fernando, Calvet Xavier, Piqueras Marta, Garcia-Planella Esther, Márquez Lucía, Mínguez Miguel, Van Domselar Manuel, Bujanda Luis, Aldeguer Xavier, Sicilia Beatriz, Iglesias Eva, Alcaín Guillermo, Pérez-Martínez Isabel, Rolle Valeria, Castaño-García Andrés, P Gisbert Javier, Domènech Eugeni
Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain.
Gastroenterology Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
J Clin Med. 2022 Jul 5;11(13):3915. doi: 10.3390/jcm11133915.
(1) Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). (2) Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-ץ-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. (3) Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18−20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50−0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66−0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20−22%] vs. 14% [95% CI 13−16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. (4): Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM.
（1）目的：接受抗肿瘤坏死因子（抗TNF）治疗的患者有发生结核病（TB）的风险，通常是由于潜伏性结核感染（LTBI）的重新激活。LTBI筛查和治疗可降低患TB的风险。本研究评估了不同LTBI筛查策略对炎症性肠病（IBD）患者的诊断效能。（2）方法：纳入西班牙ENEIDA登记处2003年1月至2018年1月期间接受LTBI筛查的IBD患者。分析了不同策略（结核菌素皮肤试验[TST]和干扰素-γ释放试验[IGRA]双重筛查、两步TST以及在开始生物治疗前至少12个月进行的早期筛查）的诊断率。（3）结果：在7594例接受筛查的患者中，1445例（19%；95%CI 18 - 20%）患有LTBI。筛查时使用免疫调节剂（IMM）治疗降低了检测到LTBI的概率（20%对17%，p = 0.001）。关于筛查策略，双重筛查比单一筛查策略更频繁地诊断出LTBI（IGRA，OR 0.60；95%CI 0.50 - 0.73，p < 0.001；TST，OR 0.76；95%CI 0.66 - 0.88，p < 0.001）。两步TST使单次TST的诊断率提高了24%。早期筛查比在开始抗TNF药物前进行的常规筛查诊断出更多的LTBI病例（21%[95%CI 20 - 22%]对14%[95%CI 13 - 16%]，p < 0.001）。在未使用IMM的患者中，通过结合早期筛查和TST/IGRA双重筛查策略获得了最高的LTBI诊断效能（29%）。（4）结论：早期筛查和TST/IGRA双重筛查策略均显著提高了IBD患者LTBI的诊断效能，在未使用IMM的情况下联合使用时可实现最佳效能。
