Osorio-Chávez Joy Selene, Martínez-López David, Álvarez-Reguera Carmen, Portilla Virginia, Cifrián José Manuel, Castañeda Santos, Ferraz-Amaro Iván, Blanco Ricardo
Department of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Avda. Valdecilla s/n., 39008 Santander, Spain.
Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Immunopathology Group, Avda. Valdecilla s/n., 39008 Santander, Spain.
J Clin Med. 2024 Dec 11;13(24):7546. doi: 10.3390/jcm13247546.
Patients with rheumatic immune-mediated diseases (rheumatic-IMID) and latent tuberculosis (LTBI) are at an increased risk of developing active tuberculosis (TB); therefore, screening is recommended before starting biological treatment. The aims of this study were as follows: (i) to assess the prevalence of LTBI, (ii) to determine the importance of using a booster test in TST-negative patients, (iii) to compare the tuberculin skin test (TST) with the interferon-gamma release assay (IGRA), (iv) to perform a review of the prevalence of LTBI. A cross-sectional hospital study was performed, including patients diagnosed with rheumatic-IMID who underwent a TST and/or IGRA during the period 2016-2020. If the first TST was negative, a new TST (booster) was performed. A total of 1117 patients were included. The overall prevalence of LTBI was estimated to be 31.7% (95% confidence interval, 29.74-33.66). The LTBI prevalence ranged from 38.5% for vasculitis to 14% for sarcoidosis. The booster test was positive in 22.9% of 817 patients with a negative or indeterminate IGRA. The IGRA was positive in 3.8% of 793 patients with a negative booster.The adjusted Cohen's kappa coefficient between TST (+booster) and IGRA was 0.62. LTBI is frequent in patients with rheumatic-IMID. IGRA and TST (+booster) show a moderate, fair grade of agreement. Therefore, performing both tests before biological therapy should be highly recommended.
患有风湿免疫介导疾病（rheumatic - IMID）和潜伏性结核（LTBI）的患者发生活动性结核（TB）的风险增加；因此，建议在开始生物治疗前进行筛查。本研究的目的如下：（i）评估LTBI的患病率，（ii）确定在结核菌素皮肤试验（TST）阴性患者中进行增强试验的重要性，（iii）比较结核菌素皮肤试验（TST）与干扰素-γ释放试验（IGRA），（iv）对LTBI的患病率进行综述。进行了一项横断面医院研究，纳入了2016 - 2020年期间被诊断为rheumatic - IMID并接受TST和/或IGRA检测的患者。如果首次TST为阴性，则进行新的TST（增强试验）。共纳入1117例患者。LTBI的总体患病率估计为31.7%（95%置信区间，29.74 - 33.66）。LTBI患病率从血管炎的38.5%到结节病的14%不等。在817例IGRA阴性或结果不确定的患者中，增强试验阳性率为22.9%。在793例增强试验阴性的患者中，IGRA阳性率为3.8%。TST（+增强试验）与IGRA之间的校正科恩kappa系数为0.62。LTBI在rheumatic - IMID患者中很常见。IGRA和TST（+增强试验）显示出中等程度、尚可的一致性。因此，强烈建议在生物治疗前同时进行这两种检测。
