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Diagnostic value of neopterin for detecting tuberculosis in rheumatoid arthritis patients with QuantiFERON conversion during biologic therapy
|關鍵字:||新喋呤;結核感染;生物製劑;類風濕性關節炎;結核菌感染診斷試管組;neopterin;tuberculosis (TB);biologics;rheumatoid arthritis (RA);QuantiFERON-TB-Gold In Tube (QFT-GIT)||引用:||1. World Health Organization. Global tuberculosis report 2014. [online], http://www.who.int/tb/publications/global_report/en/ 2. Centers for Disease Control, R.O.C. (Taiwan). Taiwan Tuberculosis Control Report 2013. http://www.cdc.gov.tw/professional/index.aspx 3. Liao TL, Lin CH, Shen GH, Chang CL, Lin CF, Chen DY. Risk and Mortality of Mycobacterial Diseases in Rheumatoid Arthritis Patients, Taiwan, 2001–2011. Emerg Infect Dis 2015; 21:1387-1395. 4. Winthrop KL, Iseman M. Bedfellows: mycobacteria and rheumatoid arthritis in the era of biologic therapy. Nat Rev Rheumatol 2013; 9:524-531. 5. Kourbeti IS, Ziakas PD, Mylonakis E. Biologic therapies in rheumatoid arthritis and the risk of opportunistic infections: a meta-analysis. Clin Infect Dis 2014; 58:1649-1657. 6. Arkema EV, Jonsson J, Baecklund E, Bruchfeld J, Feltelius N, Askling J. 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Med Sci Monit 2006; 12:CR521-524.||摘要:||
Frequent QuantiFERON-TB-Gold In Tube (QFT-GIT) conversion was observed in rheumatoid arthritis (RA) patients receiving biologic therapy. We aimed to evaluate the diagnostic utility of plasma cytokines and chemokines for identifying active tuberculosis (TB) in RA patients with QFT conversion.
We prospectively evaluated 187 patients who received biologic therapy and serial QFT-GIT assays. QFT-GIT was performed by measuring IFN-γ levels in whole blood treated with TB-specific antigens. Levels of TB-related cytokines and chemokines at the time of QFT-GIT assays were determined by multiplex assay using the Milliplex MAP Human Cytokine/ Chemokine Panel and enzyme-linked immunosorbent assay.
QFT conversion was observed in 54 (28.9%) of 187 RA patients, 54 RA patients with QFT conversion at baseline, 7 patients developed active TB (RA-TB) during the period of biologic therapy. Neopterin levels assessed at the time of active TB were higher in RA-TB patients than in RA non-TB subjects. The optimal cut-off neopterin level for detecting active TB using ROC curve analysis was 5045 pg/ml.
RA patients with QFT conversion during the period of biologic therapy should be carefully evaluated and stimulated levels (TB-specific antigens) of neopterin may provide an useful information for identifying active TB.
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