风湿性疾病的T细胞γ干扰素释放分析诊断潜伏性结核分枝杆菌感染

T-cell Interferon-gamma Release Assays to Detect Latent Tuberculosis Infection in Rheumatic Diseases

风湿性疾病患者的机体处于免疫抑制状态,而其中接受肿瘤坏死因子α(tumor necrosis factorα,TNF-α)拮抗剂治疗的患者更可能存在结核(tuberculosis,TB)复燃的风险。T细胞γ干扰素释放试验(interferon-γrelease assays,IGRA)对于潜伏性结核感染(latent tuberculosis infection,LTBI)诊断的敏感性和特异性均高于结核菌素试验(tuberculin skin test,TST),尤其是在免疫抑制人群。目前有限的研究数据表明,在风湿性疾病患者中,用于LTBI诊断的IGRA与TST所得的结果不一致。IGRA的阳性与LTBI的临床危险因素相关。IGRA的阳性结果,结合LTBI相关临床危险因素的共同判读,将有助于在风湿性疾病人群中诊断LTBI。对这部分患者应考虑预防性的抗结核治疗。

Patients with rheumatic diseases are in the immunosuppresive status and anti-TNF therapy may increase the risk of tuberculosis （TB） reactivation.T cell Interferon-γ release assays （IGRA） are more sensitive and specific than tuberculin skin test （TST） to detect latent TB infection （LTBI）,especially in the immunosuppresive patients.The limited research data showed the discordance of IGRA and TST in diganosing LTBI.IGRA positive results were more significantly related with clinical risk factors for LTBI.A positive result of IGRA in addition to clinical screening of risk factors for LTBI,will contribute to the detection of LTBI in rheumatic diseases.Preventive treatment of TB should be considered in this high risk population.