風濕免疫病人施打生物製劑後丙型干擾素釋放試驗結果4年追蹤研究-以基隆市某區域醫院為例

Interferon Gamma Release Assays in rheumatological patients receiving biological agents therapy: a 4 year follow up study at a regional hospital in Keelung

徐荷淑(Ho-Shu Hsu)

指導教授 ： 方啟泰

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2022年)

https://doi.org/10.6342/NTU202200284

摘要

目的：使用生物製劑造成結核病(tuberculosis, TB)風險上升，是值得探討的，本研究目的為了解基隆區自體免疫疾病患者在施打生物製劑等免疫抑制劑後，interferon-γ release assays (IGRA)檢驗陽轉情況，以做為臨床治療參考。
方法：本研究設計採回溯性研究，蒐集時間從2013年1月1日至2020年12月31日，以基隆某區域醫院風濕科為研究場域，使用生物製劑的個案，每1年會追蹤一次interferon-γ release assays (IGRA)檢驗，檢驗至病患陽轉後，追蹤其後續變化。
結果：本研究納入120位使用生物製劑之個案，其中有16人陽轉，IGRA陽轉比例為13.3%，平均年齡約62.4歲，至於女性比率13人(81%)。陽轉個案中，50%(8/16)治療組病患接受isoniazid預防性治療，50%對照組拒絕服用，最終治療組與對照組患者長期追蹤後在第三年IGRA指數皆有下降趨勢。
結論：基隆區因為過去環境因素影響，結核病(tuberculosis, TB)率仍然屬於中度風險區，免疫疾病病人在使用生物製劑上造成陽轉比率仍有13.3%，雖然病患給的答覆皆為沒有任何接觸史，這也顯示我們的周遭仍然存在著未被發現的感染風險。希望此次研究能在未來對於風濕疾病接受生物製劑治療過程中 IGRA陽轉的病患 能有效降低肺結核之發生率，建議未來需進一步長期且更大規模進行研究及探討。

關鍵字

類風濕性關節炎 ； 僵直性脊椎炎 ； 乾癬性關節炎 ； 生物製劑 ； 肺結核 ； interferon-γ release assays (IGRA)

並列摘要

Purpose：The increased risk of tuberculosis (TB) caused by the use of biological agents is worth exploring. The purpose of this study was to understand the result of seroconversion of the interferon Gamma release assays (IGRA) test for patients with autoimmune diseases in Keelung District after receiving biological agents therapy.
Method：This study was designed as a retrospective study. The collection time was from January 1st, 2013 to December 31st, 2020. The rheumatology department of a regional hospital in Keelung was used as the research field. The cases of using biological agents will be tracked every year and Interferon Gamma release assays (IGRA) test will be used to track the subsequent changes of patients after seroconversion.
Results：This study included 120 patients who receiving biological agents, 16 of them had seroconversion, the IGRA conversion rate was 13.3%, the average age was about 62.4 years, and the proportion of women is 81.3% which stands for 13 people. Among the positive conversion cases, 50% (8/16) of the patients in the treatment group received isoniazid preventive therapy, and 50% of the control group refused to take it. Finally, the IGRA index of both the treatment group and the control group showed a downward trend in the third year after long-term follow-up.
Conclusions：In Keelung District, due to past environmental factors, the rate of tuberculosis (TB) is still a medium-risk area. The ratio of seroconversion for immune disease patients who receiving biological agents is still 13.3%, although the patient's response is “no contact history”, which also shows that there are still undetected risks of infection around us. It is hoped that this study can effectively reduce the incidence of tuberculosis in patients with IGRA seroconversion during the treatment of rheumatic diseases with biological agents in the future.

並列關鍵字

Rheumatoid Arthritis ； Ankylosing Spondylitis ； Psoriatic Arthritis ； biological ； Tuberculosis ； interferon-γ release assays

參考文獻

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