风湿免疫性疾病并发结核感染的临床特征分析

doi:10.3969/j.issn.1000-6621.2018.04.009

摘要/Abstract

摘要：

目的分析风湿免疫性疾病患者并发结核感染的状况,探讨风湿免疫性疾病患者并发结核感染的特点。方法对2011年1月至2015年12月深圳市第三人民医院和北京大学深圳医院诊断为风湿免疫性疾病的1218例患者进行结核筛查,对其中并发结核感染的300例患者进行回顾性分析,其中系统性红斑狼疮(systemic lupus erythematosus, SLE)患者32例,强直性脊柱炎(ankylosing spondylitis, AS)患者174例,类风湿关节炎(rheumatoid arthritis, RA)患者73例,干燥综合征(sicca syndrome, SS)患者18例,皮肌炎(dermatomyositis, DM)患者3例。应用结核菌素皮肤试验 (tuberculin skin test, TST)、X线摄影、CT扫描和病原学检查等方法评价结核感染状况,并进行追踪随访24~36个月。结果 300例风湿免疫性疾病并发结核感染患者中,结核潜伏感染(latent tuberculosis infection,LTBI)发生率为86.33%(259/300),非活动性结核病(inactive tuberculosis,IATB)发生率为9.0%(27/300),活动性结核病(active tuberculosis,ATB)发生率为4.67%(14/300);并发结核感染患者中,男性占54.7%(164/300),女性占45.3%(136/300),差异有统计学意义(χ ²=48.368,P<0.01);在结核筛查的1218例患者中,不同风湿免疫性疾病患者并发结核感染率(包括LTBI+ATB+IATB)[SLE占9.5%(32/335),AS占37.7%(174/461),RA占22.7%(73/321),SS占26.4%(18/68),DM占9.1(3/33)]的构成不同,差异有统计学意义(χ ²=88.766, P<0.01);不同风湿免疫性疾病患者并发结核潜伏感染率(TST方法检测)[SLE占8.0%(27/335),AS占33.6%(155/461),RA占18.7%(60/321),SS占23.5%(16/68),DM占3.0(1/33))差异有统计学意义(χ ²=84.971,P<0.01)。结论风湿免疫性疾病患者并发结核感染以LTBI为主,AS患者并发结核感染的比例最高,男性多于女性,临床医生应增强认识。

关键词: 风湿性疾病, 潜伏性结核病, 共病现象, 诊断, 抗生素预防, 结果评价(卫生保健)

Abstract:

Objective This paper analyzed the status of tuberculosis infection patients with rheumatic immune diseases and discussed the characteristics of tuberculosis infection patients with rheumatic autoimmune diseases (RAD).Methods Among the 1218 patients who were screened for tuberculosis, a retrospective analysis was performed on 300 cases of tuberculosis (TB) infection in patients diagnosed as the RAD in Shenzhen Third People’s Hospital and Peking University Shenzhen Hospital between January 2011 and December 2015. Among 300 patients, 32 had systemic lupus erythematosus (SLE), 174 had ankylosing spondylitis (AS), and 73 had rheumatoid arthritis (RA). Besides, another 18 patients with sicca syndrome (SS), and 3 patients with dermatomyositis (DM). Tuberculin skin test (TST), X-ray, CT and aetiological methods were implemented to evaluate the status of tuberculosis infection and patients were followed for 24-36 months.Results Among 300 TB infection patients with rheumatic immune diseases,the incidence of latent tuberculosis infection (LTBI) was 86.33% (259/300), and that of inactive tuberculosis (IATB) was 9.0% (27/300). The incidence of active tuberculosis (ATB) was 4.67% (14/300). The incidence of TB infection in patients with RAD was 54.7% (164/300)in males and 45.3% (136/300) in females, which was statistically significant (χ ²=48.368,P<0.01). Among the 1218 patients who were screened for tuberculosis, the prevalence of TB infection (including LTBI+ATB+IATB), among different RAD patients was different which were as followed, among the patients with SLE, the patients with AS, the RA group, the SS group and the DM group was 9.5% (32/335), 37.7% (174/461), 22.7% (73/321), 26.4% (18/68), and 9.1 (3/33), respectively (χ ²=88.766, P<0.01). The prevalence of LTBI in patients with different rheumatic immune diseases was different, among the SLE group, the AS group, the RA group, the SS group and the DM group was 8.0% (27/335), 33.6% (155/461), 18.7% (60/321), 23.5% (16/68), and 3.0 (1/33) respectively (χ ²=84.971, P<0.01). Conclusion LTBI accounted for the main part of the RAD patients with tuberculosis infections,which was more frequent in males than in females. AS patients had the highest infection rate. Clinicians should enhance their understanding.

Key words: Rheumatic diseases, Latent tuberculosis, Comorbidity, Diagnosis, Antibiotic prophylaxis, Outcome assessment(health care)

邓国防,王玉香,陈涛,王庆文,郑俊峰,谭洁,张培泽. 风湿免疫性疾病并发结核感染的临床特征分析[J]. 中国防痨杂志, 2018, 40(4): 392-396. doi: 10.3969/j.issn.1000-6621.2018.04.009

Guo-fang DENG,Yu-xiang WANG,Tao CHEN,Qing-wen WANG,Jun-feng ZHENG,Jie TAN,Pei-ze ZHANG. Analysis on the clinical characteristics of tuberculosis infection in patients with rheumatic immune diseases[J]. Chinese Journal of Antituberculosis, 2018, 40(4): 392-396. doi: 10.3969/j.issn.1000-6621.2018.04.009

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参考文献 14

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因素	并发结核感染(300例)		未并发结核感染(918例)
因素	例数	构成比(%)	例数	构成比(%)
性别
男	164	54.7	296	32.2
女	136	45.3	622	67.8
年龄组(岁)
<18	6	2.0	11	1.2
18~	169	56.3	568	61.9
40~	95	31.7	254	27.6
>60	30	10.0	85	9.3

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