比较干扰素-伽玛释放试验与TST在抗TNF治疗前筛查结核感染

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Diagn Microbiol Infect Dis. 2011 Sep;71(1):57-65.   Diagnosis of tuberculosis infection by tuberculin skin test and a whole-blood interferon-γ release assay in patients considered for anti-tumor necrosis factor-α therapy.   Casas S, Andreu A, Juanola X, Bordas X, Alcaide F, Moure R, Anibarro L, Cuchí E, Esteve M, Ortiz V, Guerra MR, Rodríguez J, Reina D, Salvador G, Guardiola J, Surís X, Pascual MA, Martí C, Martínez-Lacasa X, Cuquet J, Gonzalez L, Santin M.   Source Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain.   Abstract To assess the performance of QuantiFERON®-TB Gold in-Tube (QFT-GIT; Cellestis, Carnegie, Australia) and tuberculin skin test (TST) in patients with immune-mediated inflammatory diseases (IMID), before anti-tumor necrosis factor-α (TNF-α) therapy, and to compare the results with those from the healthy population. Three hundred fourteen subjects (214 with IMID and 100 controls) underwent simultaneous QFT-GIT and TST. QFT-GIT was positive in 21% of IMID patients and in 16% of controls (P = 0.29). Among IMID patients, 21% tested positive by QFT-GIT and 24%, by TST (P = 0.30). Positive QFT-GIT results were not affected by immunosuppressive therapy (odds ratio, 0.78; 95% confidence interval [CI], 0.36-1.68; P = 0.52). Agreement between both tests in those patients who tested positive by one of the tests was 50% (95% CI, 37.2-62.8). QFT-GIT is useful for identifying IMID patients requiring treatment of latent tuberculosis before anti-TNF therapy. However, given the poor agreement between TST and QFT-GIT, we advocate a strategy of simultaneous testing to optimize diagnostic sensitivity.   Copyright © 2011 Elsevier Inc. All rights reserved.   PMID: 21851871

比较干扰素-伽玛释放试验与TST在抗TNF治疗前筛查结核感染   Casas S, et al. Diagn Microbiol Infect Dis. 2011;71: 57-65.     评估QuantiFERON®TB Gold in-Tube检测法(QFT-GIT; Cellestis，卡内基，澳大利亚)和结核菌素皮肤试验(TST)在免疫介导的炎症疾病患者(IMID)接受抗肿瘤坏死因子-α(TNF-α)治疗之前排除结核感染的性能，并将相关结果与健康人群相比较。 共有314例受试者(其中有214例IMID病人和100例对照)，同时进行QFT-GIT和TST试验。21%的IMID患者呈QFT-GIT阳性，对照组的阳性率为16% (P = 0.29)。在IMID患者中, QFT-GIT和TST的阳性率分别为21%和24% (P = 0.30)。QFT-GIT阳性结果不受免疫抑制治疗的影响(优势比:0.78; 95%可信区间[CI为0.36 - 1.68; P = 0.52)。这两种试验的阳性一致率为50%(95%CI: 37.2 - 62.8)。 对于将要接受抗TNF治疗的IMID病人，QFT-GIT有助于发现需要抗结核治疗的结核潜伏感染者。然而, 考虑到TST与QFT-GIT之间的一致性较差，我们推荐同时进行这两种试验以便提高诊断的敏感性。