Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn's disease in tuberculosis endemic areas.
Karan Sachdeva, Peeyush Kumar, Bhaskar Kante, Sudheer K Vuyyuru, Srikant Mohta, Mukesh K Ranjan, Mukesh K Singh, Mahak Verma, Govind Makharia, Saurabh Kedia, Vineet Ahuja
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引用次数: 2
Abstract
Background/aims: Intestinal tuberculosis (ITB) and Crohn's disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same.
Methods: Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL. Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy.
Results: Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55-0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17.
Conclusions: In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.
背景/目的:肠结核(ITB)和克罗恩病(CD)经常出现诊断困境，因为相似的表现。干扰素- γ释放试验(IGRA)已被用于区分ITB和CD，但其在结核病流行地区的诊断准确性报道很少，本研究对此进行了评估。方法:回顾性纳入2014年7月至2021年9月在新德里全印度医学科学研究所(All India Institute of Medical Sciences)接受IGRA检测的确诊ITB (n=59)或CD (n=49)患者(n=307)。根据标准诊断为CD或ITB。IGRA在>0.35 IU/mL时被认为是阳性。收集相关数据，比较ITB和CD的IGRA结果，确定其准确性。结果:59例ITB患者(平均年龄32.6±13.1岁;中位病程为1年;男性占59.3%)，IGRA阳性24例，阴性35例。49例CD患者(平均年龄37.8±14.0;中位病程为4年;男性占61.2%)，IGRA阳性12例，阴性37例。因此，IGRA诊断ITB的敏感性为40.68%，特异性为75.51%，阳性预测值为66.67%，阴性预测值为51.39%。IGRA诊断ITB的曲线下面积为0.66(95%可信区间为0.55 ~ 0.75)。在一个亚群(n=64)中，结核菌素皮肤试验(TST)的敏感性、特异性、阳性预测值和阴性预测值分别为64.7%、73.3%、73.3%和64.71%。38例(59.4%)患者IGRA与TST一致，κ=0.17。结论:在结核病流行地区，IGRA在区分ITB和CD方面的诊断准确性较差，表明IGRA在这种情况下的价值有限。
期刊介绍：
Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.
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