Concordance between tuberculin skin test and interferon-gamma release assay for latent tuberculosis screening in inflammatory bowel disease
Concordance between tuberculin skin test and interferon-gamma release assay for latent tuberculosis screening in inflammatory bowel disease
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DOI：
10.5217/ir.2019.00116
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发表时间：
2020-07-01
影响因子：
4.9
通讯作者：
Afif, Waqqas
中科院分区：
文献类型：
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作者：
Alrajhi, Saad;Germain, Pascale;Afif, Waqqas
背景/目的：在开始抗肿瘤坏死因子（anti-TNF）药物治疗之前，潜伏性结核病筛查是强制性的。指南推荐干扰素γ释放试验（IGRA）作为一线筛查方法为一般人群。炎症性肠病（IBD）患者IGRA和结核菌素皮肤试验(1)表现的研究提供了相互矛盾的证据。我们评估了测试一致性和免疫抑制对IBD患者表现的影响。方法：检索MEDLINE、Embase和Cochrane数据库（2011-2018），检索IBD患者TST和IGRA检测的研究。主要观察指标为TST和IGRA的一致性。次要结局是免疫抑制治疗对表现的影响。免疫抑制定义为使用类固醇、硫嘌呤、甲氨蝶呤或环孢素。我们使用混合随机效应模型来调整异质性，使用（I-2-Q统计）进行分析。我们比较了固定模型，排除了较小的研究影响。结果：纳入16项研究（2488例患者）。合并TST和IGRA的一致性为85%（95%可信区间[CI]， 81%-88%； P=0.01）。8项研究（814例患者）报道了免疫抑制的效果。免疫抑制组IGRA阳性的优势比降至0.57 （95% CI, 0.31-1.03; P =0.06）。免疫抑制患者TST检测阳性的优势比为1.14 （95% CI, 0.61-2.12； P=0.69）。固定模型结果相似，但免疫抑制对IGRA的负作用有统计学意义（P =0.01）。结论：虽然TST和IGRA的一致性为85%，但IGRA的表现似乎受到免疫抑制的负面影响。鉴于在抗-1 NF启动前检测潜伏结核的重要性，需要进一步的随机对照试验来比较TST和IGRA在IBD患者中的表现。
Background/Aims: Latent tuberculosis screening is mandatory prior to initiating anti-tumor necrosis factor (anti-TNF) medications. Guidelines recommend interferon-gamma release assays (IGRA) as first line screening method for the general population. Studies provided conflicting evidence on IGRA and tuberculin skin test (1ST) performance in inflammatory bowel disease (IBD) patients. We assessed test concordance and the effects of immunosuppression on their performance in IBD patients. Methods: We searched MEDLINE, Embase and Cochrane databases (2011-2018) for studies testing TST and IGRA in IBD. Primary outcome was TST and IGRA concordance. Secondary outcomes were effects of immunosuppressive therapy on performance. Immunosuppression defined as either steroids, thiopurine, methotrexate or cyclosporine use. We used the pooled random effects model to adjust for heterogeneity analyzed using (I-2-Q statistics). We compared the fixed model to exclude smaller study effects. Results: Sixteen studies (2,488 patients) were included. Pooled TST and IGRA concordance was 85% (95% confidence interval [CI], 81%-88%; P=0.01). Effects of immunosuppression were reported in 8 studies (814 patients). The odds ratio of testing positive by IGRA decreased to 0.57 if immunosuppressed (95% CI, 0.31-1.03; P =0.06). The odds ratio of testing positive by TST if immunosuppressed was 1.14 (95% CI, 0.61-2.12; P=0.69). The fixed model yielded similar results, however the negative effect of immunosuppression on IGRA reached statistical significance (P =0.01). Conclusions: While concordance was 85% between TST and IGRA, the performance of IGRA seems to be negatively affected by immunosuppression. Given the importance of detecting latent tuberculosis prior to anti-1 NF initiation, further randomized controlled trials comparing the performance of TST and IGRA in IBD patients are needed.