风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究

doi:10.19982/j.issn.1000-6621.20230207

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (1): 29-39.doi: 10.19982/j.issn.1000-6621.20230207

风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究

张丽帆¹^,²^,³, 马亚楠¹, 邹小青¹^,⁴, 张月秋¹, 张奉春⁵, 曾小峰⁵, 赵岩⁵, 刘升云⁶, 左晓霞⁷, 吴华香⁸, 武丽君⁹, 李鸿斌¹⁰, 张志毅¹¹, 陈盛¹², 朱平¹³, 张缪佳¹⁴, 齐文成¹⁵, 刘毅¹⁶, 刘花香¹⁷, 侍效春¹^,³(), 刘晓清¹^,²^,³(), 中国风湿免疫病人群活动性结核病的流行病学调查和治疗效果及预后研究课题组

¹中国医学科学院北京协和医学院,北京协和医院,疑难重症及罕见病国家重点实验室,感染内科,北京 100730
²中国医学科学院北京协和医学院,国际临床流行病学网,临床流行病学教研室,北京 100730
³中国医学科学院北京协和医学院结核病研究中心,北京 100730
⁴中国医学科学院北京协和医学院群医学与公共卫生学院,北京 100730
⁵中国医学科学院北京协和医学院,北京协和医院,风湿免疫科,国家皮肤与免疫疾病临床医学研究中心,疑难重症及罕见病国家重点实验室,风湿免疫病学教育部重点实验室,北京 100730
⁶郑州大学第一附属医院风湿免疫科,郑州 450052
⁷中南大学湘雅医院风湿免疫科,长沙 410008
⁸浙江大学医学院附属第二医院风湿免疫科,杭州 310009
⁹新疆维吾尔自治区人民医院风湿免疫科,乌鲁木齐 830001
¹⁰ 内蒙古医科大学附属医院风湿免疫科,呼和浩特 010000
¹¹ 哈尔滨医科大学附属第一医院风湿免疫科,哈尔滨 150001
¹² 上海交通大学医学院附属仁济医院风湿免疫科,上海 200001
¹³ 第四军医大学西京医院临床免疫科,西安 710032
¹⁴ 南京医科大学第一附属医院风湿免疫科,南京 210029
¹⁵ 天津市第一中心医院风湿免疫科,天津 300192
¹⁶ 四川大学华西医院风湿免疫科,成都 610041
¹⁷ 山东大学齐鲁医院风湿免疫科,济南 250012

收稿日期:2023-06-16 出版日期:2024-01-10 发布日期:2024-01-04
通信作者: 侍效春,Email:shixch7722@163.com;刘晓清,Email:liuxq@pumch.cn
作者简介:注:马亚楠和张丽帆对本文有同等贡献,为并列第一作者
基金资助:
中央高水平医院临床科研专项(2022-PUMCH-C-013);“十三五”国家科技重大专项(2017ZX10201302);“十二五”国家科技重大专项(2014ZX10003003)

Latent tuberculosis infection rate and risk factors in patients with rheumatic diseases: a multi-center, cross-sectional study

Zhang Lifan¹^,²^,³, Ma Yanan¹, Zou Xiaoqing¹^,⁴, Zhang Yueqiu¹, Zhang Fengchun⁵, Zeng Xiaofeng⁵, Zhao Yan⁵, Liu Shengyun⁶, Zuo Xiaoxia⁷, Wu Huaxiang⁸, Wu Lijun⁹, Li Hongbin¹⁰, Zhang Zhiyi¹¹, Chen Sheng¹², Zhu Ping¹³, Zhang Miaojia¹⁴, Qi Wencheng¹⁵, Liu Yi¹⁶, Liu Huaxiang¹⁷, Shi Xiaochun¹^,³(), Liu Xiaoqing¹^,²^,³(), the Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team

¹Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
²Clinical Epidemiology Unit, International Epidemiology Network, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
³Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
⁴School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
⁵Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Severe and Rare Disease, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
⁶Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
⁷Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha 410008, China
⁸Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
⁹Department of Rheumatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
¹⁰ Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
¹¹ Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
¹² Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
¹³ Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
¹⁴ Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
¹⁵ Department of Rheumatology, Tianjin First Central Hospital, Tianjin 300192, China
¹⁶ Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
¹⁷ Department of Rheumatology, Qilu Hospital of Shandong University, Ji’nan 250012, China

Received:2023-06-16 Online:2024-01-10 Published:2024-01-04
Contact: Shi Xiaochun, Email: shixch7722@163.com;Liu Xiaoqing, Email: liuxq@pumch.cn
Supported by:
Central High Level Hospital Clinical Research Project(2022-PUMCH-C-013);National Major Science and Technology Special Project for the 13th Five Year Plan(2017ZX10201302);National Science and Technology Major Special Project for the 12th Five Year Plan(2014ZX10003003)

摘要/Abstract

摘要：

目的：以结核感染T细胞斑点试验(T-SPOT.TB)检测作为筛查结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)的工具,调查我国风湿免疫病患者结核分枝杆菌潜伏感染率,并分析影响T-SPOT.TB检测结果的相关因素。方法：纳入自2014年9月至2016年3月我国东、中、西部13家三级甲等综合医院接诊的风湿免疫病患者作为研究对象,共计3715例。应用T-SPOT.TB对研究对象进行LTBI筛查。收集研究对象的基本信息,包括性别、年龄、地区、体质量指数、病程、吸烟史、基础疾病、结核病患者密切接触史、结核病既往史,以及糖皮质激素、免疫抑制剂及生物制剂的使用情况,实验室化验结果,风湿免疫病诊断结果等。采用单因素及多因素logistic回归模型分析影响T-SPOT.TB检测结果的因素。结果：3715例研究对象T-SPOT.TB检测阳性者有672例(18.1%,95%CI:16.9%~19.3%)。不同风湿免疫病病种患者T-SPOT.TB检测阳性率差异有统计学意义(χ²=79.003,P<0.001),白塞综合征患者检测阳性率最高(44.4%,32/72),混合性结缔组织病患者检测阳性率最低(8.9%,4/45)。男性风湿免疫病患者T-SPOT.TB检测阳性率为23.6%(168/711),明显高于女性(16.8%,504/3004),差异有统计学意义(χ²=18.213,P<0.001)。不同年龄组风湿免疫病患者T-SPOT.TB检测阳性率差异有统计学意义 (χ²=67.189,P<0.001),51~60岁组检测阳性率最高(24.8%,143/577),16~20岁组检测阳性率最低(8.1%,13/160)。多因素logistic回归分析显示:年龄≥41岁(aOR=1.81,95%CI:1.48~2.23),吸烟≥21支/d(aOR=1.66,95%CI:1.15~2.40),有结核病既往史(aOR=3.88,95%CI:2.71~5.57),患白塞综合征(aOR=3.00,95%CI:1.70~5.28)是T-SPOT.TB检测阳性结果的独立相关因素;使用大剂量激素(aOR=0.67,95%CI:0.47~0.96)或生物制剂(aOR=0.55,95%CI:0.36~0.84),淋巴细胞计数偏低(aOR=0.39,95%CI:0.25~0.62),低蛋白血症(aOR=0.72,95%CI:0.52~0.99),以及患多发性肌炎/皮肌炎(aOR=0.54,95%CI:0.29~0.99)、系统性红斑狼疮(aOR=0.75,95%CI:0.57~0.99)是T-SPOT.TB检测阴性结果的独立相关因素。结论：风湿免疫病患者总体结核分枝杆菌潜伏感染率为18.1%,各病种T-SPOT.TB检测阳性率差异明显。当患者有大剂量糖皮质激素、生物制剂的使用,淋巴细胞计数偏低,低蛋白血症,以及罹患系统性红斑狼疮时警惕假阴性结果。

关键词: 风湿性疾病, 分枝杆菌, 结核, 感染, 免疫学技术, 横断面研究

Abstract:

Objective: This study aimed to screen latent tuberculosis infection (LTBI) among patients with rheumatic diseases in China using the T-SPOT.TB assay and investigate factors affecting the results of T-SPOT.TB. Methods: Rheumatic diseases patients (n=3715) were enrolled from 13 tertiary hospitals in Eastern, Middle, and Western China from September 2014 to March 2016 and were screened by the T-SPOT.TB assay to detect LTBI. Basic information about the subjects were collected, including gender, age, region, body mass index, course of disease, smoking history, underlying disease, close contact history of tuberculosis patients, evidence of previous tuberculosis, the use of glucocorticoids, immunosuppressants and biologics, laboratory tests, and diagnosis of rheumatic disease, etc. Univariate analysis and multivariable logistic regression were performed to identify factors affecting the results of T-SPOT.TB. Results: out Of the 3715 patients, 672 were positive in T-SPOT.TB, the positive rate was 18.1% (95%CI: 16.9%-19.3%). There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with different types of rheumatic immune diseases (χ²=79.003, P<0.001), patients with Behcet’s syndrome had the highest positive rate (44.4%, 32/72), while patients with mixed connective tissue disease had the lowest positive rate (8.9%, 4/45). The positive rate of T-SPOT.TB test in male patients with rheumatic immune disease was 23.6% (168/711), which was significantly higher than that in females (16.8%, 504/3004, χ²=18.213, P<0.001). There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with rheumatic immune disease in different age groups (χ²=67.189, P<0.001), the 51-60 years old group had the highest positive rate (24.8%, 143/577), while the 16-20 years old group had the lowest positive rate (8.1%, 13/160). Multivariate logistic regression analysis showed that age≥41 years (aOR=1.81, 95%CI: 1.48-2.23), smoking ≥21 cigarettes/d (aOR=1.66, 95%CI: 1.15-2.40), previous history of tuberculosis (aOR=3.88, 95%CI: 2.71-5.57), and Behcet’s syndrome (aOR=3.00, 95%CI: 1.70-5.28) were independent related factors of T-SPOT.TB positive results; using high-dose hormones (aOR=0.67, 95%CI: 0.47-0.96) or biological agents (aOR=0.55, 95%CI: 0.36-0.84), low lymphocyte count (aOR=0.39, 95%CI: 0.25-0.62), hypoalbuminemia (aOR=0.72, 95%CI: 0.52-0.99), and multiple myositis/dermatomyositis (aOR=0.54, 95%CI: 0.29-0.99), systemic lupus erythematosus (aOR=0.75, 95%CI: 0.57-0.99) were independent correlation factors for negative T-SPOT.TB test results. Conclusion: Among patients with rheumatic diseases, the overall prevalence of LTBI is 18.1%. There is a significant difference in the positive rate of T-SPOT.TB test among different diseases. When patients are treated with high-dose glucocorticoids or biologics, have low lymphocyte counts, hypoalbuminemia, or suffer from systemic lupus erythematosus, more attention should be paid to potential false-negative results.

Key words: Rheumatic diseases, Mycobacterium tuberculosis, Infection, Immunologic techniques, Cross-sectional studies

中图分类号:

R593
R52

张丽帆, 马亚楠, 邹小青, 张月秋, 张奉春, 曾小峰, 赵岩, 刘升云, 左晓霞, 吴华香, 武丽君, 李鸿斌, 张志毅, 陈盛, 朱平, 张缪佳, 齐文成, 刘毅, 刘花香, 侍效春, 刘晓清, 中国风湿免疫病人群活动性结核病的流行病学调查和治疗效果及预后研究课题组. 风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究[J]. 中国防痨杂志, 2024, 46(1): 29-39. doi: 10.19982/j.issn.1000-6621.20230207

Zhang Lifan, Ma Yanan, Zou Xiaoqing, Zhang Yueqiu, Zhang Fengchun, Zeng Xiaofeng, Zhao Yan, Liu Shengyun, Zuo Xiaoxia, Wu Huaxiang, Wu Lijun, Li Hongbin, Zhang Zhiyi, Chen Sheng, Zhu Ping, Zhang Miaojia, Qi Wencheng, Liu Yi, Liu Huaxiang, Shi Xiaochun, Liu Xiaoqing, the Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team. Latent tuberculosis infection rate and risk factors in patients with rheumatic diseases: a multi-center, cross-sectional study[J]. Chinese Journal of Antituberculosis, 2024, 46(1): 29-39. doi: 10.19982/j.issn.1000-6621.20230207

图/表 4

表1

表2

风湿免疫病患者结核感染T细胞斑点试验影响因素的单因素分析

因素	阴性	阳性	单因素分析
因素	阴性	阳性	OR(95%CI)值	P值
性别[例(构成比,%)]
女性	2500(83.2)	504(16.8)	1.00
男性	543(76.4)	168(23.6)	1.53(1.26~1.87)	<0.001
年龄组[例(构成比,%)]
16~40岁	1601(86.6)	248(13.4)	1.00
≥41岁	1442(77.3)	424(22.7)	1.90(1.60~2.26)	<0.001
体质量指数[M(Q₁,Q₃)]	22.04(20.0,24.5)	22.3(20.0,25.0)	1.00(0.99~1.01)	0.770
病程[月,M(Q₁,Q₃)]	16.00(1.0,57.0)	16.0(2.0,62.0)	1.00(1.00~1.00)	0.249
吸烟≥21支/d [例(构成比,%)]
否	2901(82.6)	612(17.4)	1.00
是	124(69.7)	54(30.3)	2.06(1.48~2.88)	<0.001
糖尿病史[例(构成比,%)]
无	2872(82.1)	627(17.9)	1.00
有	143(78.6)	39(21.4)	1.25(0.87~1.80)	0.231
肝硬化[例(构成比,%)]
无	3027(81.9)	669(18.1)	1.00
有	12(92.3)	1(7.7)	0.38(0.05~2.91)	0.349
肿瘤史[例(构成比,%)]
无	3025(82.0)	663(18.0)	1.00
有	15(71.4)	6(28.6)	1.83(0.71~4.72)	0.215
结核病患者密切接触史[例(构成比,%)]
无	2989(82.2)	646(17.8)	1.00
有	36(73.5)	13(26.5)	1.67(0.88~3.17)	0.116
结核病既往史[例(构成比,%)]
无	2951(83.3)	592(16.7)	1.00
有	84(51.5)	79(48.5)	4.69(3.41~6.45)	<0.001
现用激素[例(构成比,%)]
无	539(75.6)	174(24.4)	1.00
有	2499(83.4)	498(16.6)	0.62(0.51~0.75)	<0.001
现用激素剂量[例(构成比,%)]^a
0~29mg/d	1960(79.8)	496(20.2)	1.00
30~59mg/d	650(84.4)	120(15.6)	0.73(0.59~0.91)	0.005
≥60mg/d	395(88.6)	51(11.4)	0.51(0.38~0.69)	<0.001
使用免疫抑制剂[例(构成比,%)]
否	1248(82.3)	268(17.7)	1.00
是	1795(81.6)	404(18.4)	1.05(0.88~1.24)	0.589
使用环磷酰胺[例(构成比,%)]
否	2616(81.6)	590(18.4)	1.00
是	427(83.9)	82(16.1)	0.85(0.66~1.10)	0.212
使用吗替麦考酚酯[例(构成比,%)]
否	2646(81.6)	595(18.4)	1.00
是	397(83.8)	77(16.2)	0.86(0.67~1.12)	0.264
使用甲氨蝶呤[例(构成比,%)]
否	2622(82.4)	559(17.6)	1.00
是	421(78.8)	113(21.2)	1.26(1.00~1.58)	0.047
使用硫唑嘌呤[例(构成比,%)]
否	2964(81.9)	656(18.1)	1.00
是	79(83.2)	16(16.8)	0.92(0.53~1.58)	0.749
使用来氟米特[例(构成比,%)]
否	2747(82.1)	599(17.9)	1.00
是	296(80.2)	73(19.8)	1.13(0.86~1.48)	0.373
使用环孢素A [例(构成比,%)]
否	2973(81.9)	656(18.1)	1.00
是	70(81.4)	16(18.6)	1.04(0.60~1.80)	0.900
使用他克莫司[例(构成比,%)]
否	2945(81.6)	664(18.4)	1.00
是	98(92.5)	8(7.5)	0.36(0.18~0.75)	0.006
使用生物制剂[例(构成比,%)]
否	2791(81.5)	634(18.5)	1.00
是	252(86.9)	38(13.1)	0.66(0.47~0.94)	0.022
使用肿瘤坏死因子α拮抗剂[例(构成比,%)]
否	2859(94.0)	640(95.2)	1.00
是	184(6.0)	32(4.8)	0.78(0.53~1.14)	0.199
使用依那西普[例(构成比,%)]
否	2931(81.8)	652(18.2)	1.00
是	112(84.8)	20(15.2)	0.80(0.50~1.30)	0.373
使用英夫利昔单抗[例(构成比,%)]
否	3005(81.9)	663(18.1)	1.00
是	38(80.9)	9(19.1)	1.07(0.52~2.23)	0.850
使用阿达木单抗[例(构成比,%)]
否	3006(81.8)	669(18.2)	1.00
是	37(92.5)	3(7.5)	0.36(0.11~1.19)	0.093
使用托珠单抗[例(构成比,%)]
否	3012(81.8)	668(18.2)	1.00
是	31(88.6)	4(11.4)	0.58(0.21~1.65)	0.310
使用利妥昔单抗[例(构成比,%)]
否	3013(81.8)	671(18.2)	1.00
是	30(96.8)	1(3.2)	0.15(0.02~1.10)	0.062
白细胞计数[例(构成比,%)]
≥4×10⁹/L	2567(81.3)	589(18.7)	1.00
<4×10⁹/L	461(86.3)	73(13.7)	0.69(0.53~0.90)	0.006
中性粒细胞计数[例(构成比,%)]
≥1.5×10⁹/L	2843(81.9)	629(18.1)	1.00
<1.5×10⁹/L	183(84.3)	34(15.7)	0.84(0.58~1.22)	0.363
淋巴细胞计数[例(构成比,%)]
≥0.5×10⁹/L	2761(81.3)	636(18.7)	1.00
<0.5×10⁹/L	261(90.9)	26(9.1)	0.43(0.29~0.65)	<0.001
血红蛋白[例(构成比,%)]
≥90g/L	2725(81.4)	624(18.6)	1.00
<90g/L	298(88.7)	38(11.3)	0.56(0.39~0.79)	0.001
血小板计数[例(构成比,%)]
<300×10⁹/L	2551(82.7)	534(17.3)	1.00
≥300×10⁹/L	473(78.8)	127(21.2)	1.28(1.03~1.59)	0.025
白蛋白[例(构成比,%)]
≥30g/L	2412(80.9)	569(19.1)	1.00
<30g/L	414(87.3)	60(12.7)	0.61(0.46~0.82)	0.001
谷丙转氨酶[例(构成比,%)]
正常	2579(81.5)	584(18.5)	1.00
升高	414(84.8)	74(15.2)	0.79(0.61~1.03)	0.078
尿素氮[例(构成比,%)]
≤7.1mmol/L	2290(81.7)	514(18.3)	1.00
>7.1mmol/L	442(80.8)	105(19.2)	1.06(0.84~1.34)	0.634
肌酐[例(构成比,%)]
正常	2779(81.8)	619(18.2)	1.00
升高	145(82.9)	30(17.1)	0.93(0.62~1.39)	0.719
血红细胞沉降率[例(构成比,%)]
正常	1321(82.9)	273(17.1)	1.00
升高	1602(81.3)	368(18.7)	1.11(0.94~1.32)	0.230
C-反应蛋白[例(构成比,%)]
≤8mg/L	1308(81.9)	290(18.1)	1.00
>8mg/L	616(78.9)	165(21.1)	1.21(0.98~1.50)	0.083
病种分类[例(构成比,%)]
类风湿关节炎	422(76.2)	132(23.8)	1.00
系统性红斑狼疮	1895(85.0)	334(15.0)	0.56(0.45~0.71)	<0.001
干燥综合征	116(80.0)	29(20.0)	0.80(0.51~1.26)	0.331
系统性硬化	40(71.4)	16(28.6)	1.28(0.69~2.36)	0.431
混合性结缔组织病	41(91.1)	4(8.9)	0.31(0.11~0.89)	0.029
多发性肌炎/皮肌炎	118(86.8)	18(13.2)	0.49(0.29~0.83)	0.008
大动脉炎	27(75.0)	9(25.0)	1.07(0.49~2.32)	0.873
白塞综合征	40(55.6)	32(44.4)	2.56(1.55~4.24)	<0.001
其他血管炎^a	64(77.1)	19(22.9)	0.95(0.55~1.64)	0.852
强直性脊柱炎	255(79.2)	67(20.8)	0.84(0.60~1.17)	0.304
银屑病关节炎	25(67.6)	12(32.4)	1.54(0.75~3.14)	0.241

表2

表3

表4

风湿免疫病患者结核感染T细胞斑点试验检测阳性影响因素的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	aOR(95%CI)值
年龄
16~40岁					1.00
≥41岁	0.594	0.105	32.156	<0.001	1.81(1.48~2.23)
吸烟≥21支/d
否					1.00
是	0.505	0.189	7.164	0.007	1.66(1.15~2.40)
结核病既往史
无					1.00
有	1.356	0.184	54.207	<0.001	3.88(2.71~5.57)
现用激素剂量
0~29mg/d					1.00
30~59mg/d	-0.216	0.128	2.821	0.093	0.81(0.63~1.04)
≥60mg/d	-0.394	0.182	4.704	0.030	0.67(0.47~0.96)
使用他克莫司
否					1.00
是	-0.702	0.384	3.336	0.068	0.50(0.23~1.05)
使用生物制剂
否					1.00
是	-0.597	0.216	7.674	0.006	0.55(0.36~0.84)
淋巴细胞计数(×10⁹/L)
≥0.5					1.00
<0.5	-0.940	0.236	15.856	<0.001	0.39(0.25~0.62)
白蛋白(g/L)
≥30					1.00
<30	-0.335	0.167	4.023	0.045	0.72(0.52~0.99)
病种分类
类风湿关节炎					1.00
系统性红斑狼疮	-0.284	0.141	4.054	0.044	0.75(0.57~0.99)
干燥综合征	-0.083	0.252	0.110	0.741	0.92(0.56~1.51)
系统性硬化	0.273	0.328	0.694	0.405	1.31(0.69~2.50)
混合性结缔组织病	-0.829	0.552	2.255	0.133	0.44(0.15~1.29)
多发性肌炎/皮肌炎	-0.625	0.312	4.005	0.045	0.54(0.29~0.99)
大动脉炎	0.529	0.442	1.434	0.231	1.70(0.71~4.03)
白塞综合征	0.159	0.317	0.251	<0.001	3.00(1.70~5.28)
其他血管炎^a	1.098	0.289	14.457	0.616	1.17(0.63~2.18)
强直性脊柱炎	0.171	0.201	0.721	0.396	1.19(0.80~1.76)
银屑病关节炎	0.460	0.407	1.277	0.259	1.58(0.71~3.51)

表4

参考文献 37

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变量	赋值	变量	赋值
年龄	1=16~40岁,2=≥41岁	淋巴细胞计数	1=≥0.5×10⁹/L,2=<0.5×10⁹/L
吸烟≥21支/d	1=否,2=是	淋巴细胞计数	1=≥0.5×10⁹/L,2=<0.5×10⁹/L
吸烟≥21支/d	1=否,2=是	白蛋白	1=≥30g/L,2=<30g/L
结核病既往史	1=无,2=有	白蛋白	1=≥30g/L,2=<30g/L
结核病既往史	1=无,2=有	病种分类	1=类风湿关节炎,2=系统性红斑狼疮,3=干燥综合征,4=系统性硬化,5=混合性结缔组织病,6=多发性肌炎/皮肌炎,7=大动脉炎,8=白塞综合征,9=其他血管炎^a,10=强直性脊柱炎,11=银屑病关节炎
现用激素剂量	1=0~29mg/d,2=30~59mg/d,3=≥60mg/d
使用他克莫司	1=否,2=是
使用生物制剂	1=否,2=是

风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究

Latent tuberculosis infection rate and risk factors in patients with rheumatic diseases: a multi-center, cross-sectional study

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参考文献 37

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特征	患者数 (例)	结核感染T细胞斑点试验		χ²值	P值
特征	患者数 (例)	阳性(例)	阳性率(%,95%CI)	χ²值	P值
病种分类				79.003	<0.001
类风湿关节炎	554	132	23.8(20.3~27.4)
系统性红斑狼疮	2229	334	15.0(13.5~16.5)
干燥综合征	145	29	20.0(13.4~26.6)
系统性硬化	56	16	28.6(16.4~40.8)
混合性结缔组织病	45	4	8.9(0.2~17.5)
多发性肌炎/皮肌炎	136	18	13.2(7.5~19.0)
大动脉炎	36	9	25.0(10.1~39.9)
白塞综合征	72	32	44.4(32.7~56.2)
其他血管炎^a	83	19	22.9(13.7~32.1)
强直性脊柱炎	322	67	20.8(16.3~25.3)
银屑病关节炎	37	12	32.4(16.6~48.3)
性别				18.213	<0.001
男性	711	168	23.6(20.4~26.6)
女性	3004	504	16.8(15.5~18.1)
年龄组(岁)				67.189	<0.001
16~20	160	13	8.1(3.8~12.4)
21~30	923	109	11.8(9.6~13.8)
31~40	810	140	17.3(14.8~20.0)
41~50	820	162	19.8(17.0~22.5)
51~60	577	143	24.8(21.3~28.3)
61~83	425	105	24.7(20.6~28.8)
合计	3715	672	18.1(16.9~19.3)

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