两种不同的干扰素-γ释放试验在风湿性疾病患者中用于潜伏性结核感染筛查的性能。

Performance of LTBI Screening in Patients with Rheumatic Diseases Using Two Different Interferon-Gamma Releasing Assays.

机构信息

Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 200002 Shanghai, China.

Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 200002 Shanghai, China.

出版信息

Front Biosci (Landmark Ed). 2022 Oct 8;27(10):282. doi: 10.31083/j.fbl2710282.

DOI:10.31083/j.fbl2710282

PMID:36336855

Abstract

BACKGROUND

To evaluate the concordance between QuantiFERON-TB Gold in-tube test (QFT-GIT) and T-SPOT.TB test (T-SPOT) for the screening of latent tuberculosis infection (LTBI) in patients with rheumatic diseases (RDs).

METHODS

Patients diagnosed as rheumatic diseases (RDs) with clinical indications for test of interferon gamma release test (IGRA) were prospectively recruited from 2019 to 2020. The consistency of QFT-GIT and T-SPOT was assessed by Kappa analysis and the factors associated with the indeterminate results were explored by multivariable logistic analysis.

RESULTS

A total of 108 patients with RDs were enrolled, including 64 patients with systemic lupus erythematosus (SLE) and 44 with inflammatory arthritis (26 with rheumatoid arthritis (RA) and 18 with ankylosing spondylitis (AS)). Poor concordance was confirmed between QFT-GIT and T-SPOT results in patients with SLE (K = 0.175, 95% confidence interval [95% CI] [-0.06, 0.40], < 0.001), whereas concordance was moderate in patients with inflammatory arthritis (K = 0.539, 95% CI [0.11, 0.88], < 0.001). Among SLE patients, the ratio of indeterminate results in detecting LTBI was significantly higher by QFT-GIT than by T-SPOT (18.8% vs. 4.7%, = 0.013), while the statistical difference was not achieved in patients with inflammatory arthritis. The multivariable logistic analysis identified that the presence of lower lymphocyte counts (odds ratio [OR] = 0.81, 95% CI [0.68, 0.97], = 0.020) was the independent predictor of an indeterminate result of the QFT-GIT in SLE patients.

CONCLUSIONS

In patients with RDs, the result of screening of LTBI was more definitive by T-SPOT test than QFT, and the concordance was poor especially in the setting of SLE.

摘要

背景

评估结核感染 T 细胞斑点试验（T-SPOT）与结核干扰素释放试验（QFT-GIT）在风湿性疾病（RDs）患者中筛查潜伏性结核感染（LTBI）的一致性。

方法

2019 年至 2020 年，前瞻性招募临床指征适合检测干扰素释放试验（IGRA）的确诊为风湿性疾病（RDs）的患者。采用 Kappa 分析评估 QFT-GIT 与 T-SPOT 的一致性，并采用多变量逻辑分析探讨与不确定结果相关的因素。

结果

共纳入 108 例 RDs 患者，其中系统性红斑狼疮（SLE）患者 64 例，炎性关节炎患者 44 例（类风湿关节炎 26 例，强直性脊柱炎 18 例）。SLE 患者 QFT-GIT 与 T-SPOT 结果的一致性较差（K = 0.175，95%置信区间[95%CI]为[-0.06，0.40]，<0.001），而炎性关节炎患者的一致性为中度（K = 0.539，95%CI 为[0.11，0.88]，<0.001）。在 SLE 患者中，QFT-GIT 检测 LTBI 的不确定结果比例明显高于 T-SPOT（18.8% vs. 4.7%，= 0.013），而在炎性关节炎患者中则未达到统计学差异。多变量逻辑分析发现，淋巴细胞计数较低（比值比[OR] = 0.81，95%CI [0.68，0.97]，= 0.020）是 SLE 患者 QFT-GIT 不确定结果的独立预测因素。