Interferon-γ release assays (IGRAs) on the diagnosis of Mycobacterium tuberculosis infection in immunocompromised population

doi:10.3877/cma.j.issn.1674-1358.2017.02.003

Abstract

Abstract:

Tuberculosis (TB) is a major global health problem and remains one of the world’s deadliest communicable diseases. In recent years, patients with immunocompromised conditions such as human immunodeficiency virus (HIV) infection, tumors and rheumatic diseases have increased, and these patients have a higher risk of latent tuberculosis infection (LTBI) reactivation, so Mycobacterium tuberculosis (MTB) infection in this group of patients should be paid more attention to. Early diagnosis and treatment of LTBI could decrease the risk of LTBI developing to active TB. However, traditional tuberculin skin test (TST) has some limitations in these patients, therefore studies about the interferon-γ release assays (IGRAs) for the diagnosis of TB infection in immunocompromised patients were reviewed to summarize the instructions for its clinical application.

Key words: Interferon-γ, release assays (IGRAs), Immunocompromised, Mycobacterium tuberculosis

Sainan Bian, Xiaoqing Liu. Interferon-γ release assays (IGRAs) on the diagnosis of Mycobacterium tuberculosis infection in immunocompromised population[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(02): 117-120.

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References 32

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患者人群	CDC指南^a	评论	建议方法
HIV感染者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	CD4⁺细胞计数<200个/μl，TST受限IGRAs和LTBI临床危险因素间的关系：强证据两种不确定结果的IGRAs增加可能性T-SPOT.TB更少受低CD4⁺淋巴细胞计数影响	CD4⁺细胞计数> 200个/μl的患者考虑TST；低CD4⁺淋巴细胞计数患者考虑T-SPOT.TB；不应用QFT-GIT作为常规筛查
接受TNF-α抑制剂治疗的患者和免疫介导的炎症性疾病（RA、SLE和其他自身免疫病）	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	TST在免疫介导的炎症性疾病患者中受限IGRAs和LTBI临床危险因素间的关系：强证据T-SPOT.TB较少受使用免疫抑制药物如糖皮质激素影响TST受限	拟接受TNF-α抑制剂治疗的患者在治疗前检查LTBI；高危患者考虑同时或连续检测TST和IGRAs（拟接受TNF-α抑制剂患者）；接受糖皮质激素患者考虑T-SPOT.TB
透析患者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	QFT-GIT和LTBI临床危险因素之间的关系：强证据T-SPOT.TB不具特征性TST受限	考虑QFT-GIT作为检测的选择；不推荐使用TST
血液系统恶性肿瘤患者，包括HSCT者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	IGRAs和LTBI临床危险因素间的关系：弱证据T-SPOT.TB较少受中性粒细胞减少和（或）淋巴细胞减少影响，优先选择若移植前获得，TST有价值	考虑TST作为检测的选择不推荐IGRAs作为常规检查
实体器官移植者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	IGRAs和LTBI临床危险因素间的关系：弱证据肝脏移植患者潜在的肝脏疾病可能增加IGRAs不确定结果的可能性	实体器官移植前检测LTBI；考虑TST作为检测的选择不推荐使用IGRAs作为常规筛查

患者人群	CDC指南^a	评论	建议方法
HIV感染者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	CD4⁺细胞计数<200个/μl，TST受限IGRAs和LTBI临床危险因素间的关系：强证据两种不确定结果的IGRAs增加可能性T-SPOT.TB更少受低CD4⁺淋巴细胞计数影响	CD4⁺细胞计数> 200个/μl的患者考虑TST；低CD4⁺淋巴细胞计数患者考虑T-SPOT.TB；不应用QFT-GIT作为常规筛查
接受TNF-α抑制剂治疗的患者和免疫介导的炎症性疾病（RA、SLE和其他自身免疫病）	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	TST在免疫介导的炎症性疾病患者中受限IGRAs和LTBI临床危险因素间的关系：强证据T-SPOT.TB较少受使用免疫抑制药物如糖皮质激素影响TST受限	拟接受TNF-α抑制剂治疗的患者在治疗前检查LTBI；高危患者考虑同时或连续检测TST和IGRAs（拟接受TNF-α抑制剂患者）；接受糖皮质激素患者考虑T-SPOT.TB
透析患者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	QFT-GIT和LTBI临床危险因素之间的关系：强证据T-SPOT.TB不具特征性TST受限	考虑QFT-GIT作为检测的选择；不推荐使用TST
血液系统恶性肿瘤患者，包括HSCT者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	IGRAs和LTBI临床危险因素间的关系：弱证据T-SPOT.TB较少受中性粒细胞减少和（或）淋巴细胞减少影响，优先选择若移植前获得，TST有价值	考虑TST作为检测的选择不推荐IGRAs作为常规检查
实体器官移植者	高危患者考虑TST和IGRAs连续检测^b任何阳性结果应该被认为LTBI的证据	IGRAs和LTBI临床危险因素间的关系：弱证据肝脏移植患者潜在的肝脏疾病可能增加IGRAs不确定结果的可能性	实体器官移植前检测LTBI；考虑TST作为检测的选择不推荐使用IGRAs作为常规筛查

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