摘要
目的 了解慢性炎症性关节炎患者潜伏性结核感染(LTBI)情况,并对比结核菌素皮肤试验(TST)和QuantiFERON-TB Gold(QFT)在该人群中筛查LTBI的诊断价值。 方法 回顾性分析2015年12月至2017年12月北京大学国际医院风湿免疫科诊断为类风湿关节炎、强直性脊柱炎、血清阴性脊柱关节炎、银屑病关节炎或反应性关节炎的慢性炎症性关节炎患者,共149例,记录性别、年龄、既往有无结核感染史、胸部X线片或胸部CT有无陈旧钙化灶,TST结果、QFT结果、检查前用药史、后续生物制剂应用及随访情况。 结果 慢性炎症性关节炎患者中TST阳性率18.2%(14/77),QFT阳性率27.1%(26/96),两种方法一致性一般。以QFT结果诊断LTBI患病率22.9%(22/96)。TST在50岁以下人群阳性率高于50岁以上人群,但QFT阳性率在两组间差异无统计学意义。QFT中M-N值在50岁以上人群及使用免疫抑制剂者均降低。64例接受生物制剂治疗的慢性炎症性关节炎患者,TST或QFT阳性者中2例预防性抗结核后加用生物制剂,14例未抗结核治疗直接使用生物制剂。随访3~24个月,均未出现活动性结核病病例。 结论 慢性炎症性关节炎患者LTBI患病率与既往报道风湿病患者LTBI患病率一致,高于一般人群。在50岁以上慢性炎症性关节炎患者中,尤其是服用免疫抑制剂人群,QFT相较TST更适合用于潜伏性结核感染的筛查。
Objective To investigate the prevalence of latent tuberculosis infection (LTBI) in patients with inflammatory arthritis, and to compare the efficacy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) in screening for LTBI in these patients. Method Medical records of 149 patients with inflammatory arthritis admitted to inpatient of Peking University International Hospital from December 2015 to December 2017 (diagnosis with rheumatoid arthritis, ankylosing spondylitis, sero-negative spondyloarthropathy, psoriatic arthritis, or reactive arthritis) who accepted TST or QFT were collected. The information included gender, age, history of tuberculosis infection, calcifications presence in chest X-ray or chest CT, TST result, QFT result, medication history before test, and biological treatment and all the patients were made a follow-up. Results The positive rate of TST was 18.2%(14/77) and that of QFT was 27.1%(26/96), and the overall consistency between the two tests was fair. The rate of LTBI diagnosed by QFT was 22.9%(22/96). The positive rate of TST in patients older than 50 years was significantly higher than those younger than 50 years, but there was no significant difference between the two groups screened by QFT. The M-N values in QFT were decreased in both the patients above the age of 50 and in the patients using immunosuppressive agents. A total of 64 patients accepted biological agent therapy, and in those with a positive result of TST or QFT, only 2 cases received anti-LTBI treatment, but the other 14 cases without anti-LTBI treatment. None of them developed active tuberculosis in the following 3-24 months. Conclusion The prevalence of LTBI in patients with inflammatory arthritis is consistent with that reported in rheumatoid patients, which is higher than in general people. In patients with inflammatory arthritis older than 50 years, especially those accepted immunosuppressive agents therapy, the immunity may be impaired and QFT is more sensitive than TST for screening LTBI.
作者
刘羽佳
徐婧
郭倩
李记
孙宇晶
石连杰
Liu Yujia;Xu Jing;Guo Qian;Li Ji;Sun Yujing;Shi Lianjie(Department of Respiratory and Critical Care Medicine,Peking University International Hospital,Beijing 102206,China;Department of Rheumatology and Immunology,Peking University International Hospital, Beijing 102206,China;Department of Laboratory Medicine,Peking University International Hospital,Beijing 102206,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第1期20-24,共5页
National Medical Journal of China
基金
国家自然科学基金(81501396)
北京大学国际医院院内科研基金(YN2017QX1).
