中国1711例炎症性肠病患者在英夫利西单克隆抗体治疗前行结核筛查的现况调查

Investigation on status quo of tuberculosis screening in 1711 patients with inflammatory bowel diseases before infliximab therapy in China

目的 回顾性调查在中国炎症性肠病(IBD)患者中使用肿瘤坏死因子(TNF)拮抗剂英夫利西单克隆抗体(IFX)前结核筛查的情况.方法 本研究回顾性纳入全国22所医院自2009年1月至2016年12月接受IFX治疗的IBD患者,收集并分析患者IFX治疗前结核筛查的临床资料,包括既往结核病史、结核菌素试验(TST试验)、γ-干扰素释放试验(IGRA)及胸部影像(胸部X线片和/或胸部CT扫描,即胸部CT)检查的结果,收集医生判断的结核筛查结果及是否采取预防性抗结核的措施.结果 研究共纳入1711例IBD患者,其中1606例(93.9％)的IBD患者在使用IFX前接受TST或IGRA联合胸部X线片或胸部CT的筛查,有663例(38.7％)采用IGRA联合胸部CT进行结核筛查,仅有504例(29.5％)的IBD患者同时完成TST+IGRA联合胸部CT的筛查.1711例患者中有77例(4.5％)没有行胸部影像的筛查及66例(3.9％)没有完成TST或IGRA任何一项的筛查.筛查结果显示潜伏性结核(LTBI)患者为7.1％(121/1711).22.3％(27例)合并LTBI的IBD患者仍被临床医生忽视,表现为漏判或在IFX治疗时未采取预防性抗结核.结论 中国IBD患者中使用IFX前的筛查不够充分,筛查出LTBI的患病率可能偏低而临床医生对LTBI认识相对不足,推荐中国IBD患者使用IFX前进行规范的结核筛查.

Objective To investigate the status quo of tuberculosis (TB) screening among patients with inflammatory bowel diseases (IBD) before receiving infliximab (IFX) therapy in China.Methods IBD patients receiving IFX treatment during January 2009 to December 2016 from 22 hospitals nationwide were enrolled retrospectively.Clinical data of TB screening before IFX therapy,including previous TB history,tuberculin test (TST test),interferon-γrelease assay (IGRA) and chest image results (chest X-ray and chest CT) were all recorded.TB screening result whether was latent tuberculosis infection (LTBI)judged by the doctor and clinical data related to whether receiving prophylactic treatment were collected.Results A total of 1711 IBD patients were enrolled,including 1606 (93.9％) cases receiving TB screening with TST or IGRA combining chest X-ray or CT scan before IFX treatment,663 (38.7％) cases with IGRA combining chest CT scan,and only 504 (29.5％) cases with complete TST plus IGRA combining chest CT scan,while 77(4.5％) cases had no chest imaging screening and 66(3.9％) cases did not receive any screening for TST or IGRA.TB screening results before IFX treatment showed 7.1％(121/1711) of IBD patients were LTBI,in whom 27 (27/121,22.3％) IBD patients with LTBI were neglected by clinicians,presenting as omission of judgment for LTBI or failure to take prophylactic anti-TB treatment during IFX treatment.Conclusions The TB screening before IFX treatment in China is not sufficient at present.The LTBI prevalence of IBD patients in China may be on the low side and clinicians have no enough knowledge of LTBI.It is recommended that IBD patients should undergo a standard TB screening before IFX therapy.