我国部分地区肿瘤坏死因子拮抗剂使用人群的结核病预防性治疗情况分析

doi:10.3969/j.issn.1000-6621.2021.03.006

摘要/Abstract

摘要：

目的了解中国部分地区应用肿瘤坏死因子(tumor necrosis factor,TNF)拮抗剂治疗的患者结核病预防性治疗情况。方法搜集2014年3月至2016年2月中国东、中、西部13家三级甲等综合医院接诊的应用依那西普或英夫利西单抗治疗的类风湿关节炎(rheumatoid arthritis,RA)或强直性脊柱炎(ankylosing spondylitis,AS)患者作为研究对象,共981例。收集研究对象的性别、年龄、激素和免疫抑制剂使用情况、并发基础疾病情况、结核病既往史、结核分枝杆菌潜伏感染(LTBI)筛查情况、胸部X线摄片(简称“胸片”)或胸部CT扫描结果、结核病预防性治疗情况。分析应用TNF拮抗剂的RA或AS患者筛查LTBI和非活动性肺结核的比例,进行结核病预防性治疗的比例以及采用的治疗方案。结果 981例研究对象中应用依那西普者779例(79.4%),应用英夫利西单抗者202例(20.6%)。仅有25.7%(252/981)的研究对象进行LTBI筛查,阳性率为18.3%(46/252)。2.8%(27/981)的研究对象诊断为非活动性肺结核,其中,有结核病既往史者19例。712例(72.6%)研究对象进行了胸片检查和(或)胸部CT扫描,报告非活动性肺结核者13例(1.8%)。共15例研究对象进行了结核病预防性治疗;并发LTBI者中有6例(13.0%,6/46)进行结核病预防性治疗;诊断为非活动性肺结核者均未进行结核病预防性治疗。进行结核病预防性治疗者中,应用异烟肼单药预防方案者9例(60.0%,9/15),疗程1~18个月不等。结论中国部分地区目前应用TNF拮抗剂治疗的RA或AS患者的LTBI筛查比例低,进行结核病预防性治疗比例低,预防对象选择标准不一且预防方案不规范。

关键词: 肿瘤坏死因子类, 拮抗剂, 关节炎,类风湿, 脊柱炎,强直性, 结核, 预防和防护用药

Abstract:

Objective To investigate the prevention treatment for tuberculosis in patients treated with tumor necrosis factor (TNF) antagonists in some areas of China. Methods A total of 981 rheumatoid arthritis (RA) or ankylosing spondylitis (AS) patients treated with etanercept or infliximab from 13 large general hospitals in eastern, central and western China from March 2014 to February 2016 were selected. The clinical data of gender, age, hormone and immunosuppressant use, underlying disease, tuberculosis history, latent tuberculosis infection (LTBI) screening, chest X-ray or CT scan results, prevention treatment of tuberculosis were collected,. The proportion of LTBI and inactive tuberculosis screening, the proportion of prevention treatment for tuberculosis and the treatment regimens in RA or AS patients with TNF antagonist were analyzed. Results Of the 981 subjects, 779 (79.4%) were treated with etanercept and 202 (20.6%) with infliximab. Only 25.7% (252/981) subjects were screened for LTBI, and the positive rate was 18.3% (46/252). And 2.8% (27/981) of the subjects were diagnosed as inactive tuberculosis, of which 19 cases had a history of tuberculosis. Of the 712 patients (72.6%) who underwent chest X-ray and/or CT scan, 13 (1.8%) were reported inactive pulmonary tuberculosis. A total of 15 subjects received TB prevention treatment; 6 (13.0%, 6/46) of the patients complicated with LTBI received tuberculosis preventive treatment; none of the patients diagnosed as inactive tuberculosis received tuberculosis prevention treatment. Among the patients who received tuberculosis prevention treatment, 9 cases (60.0%, 9/15) were treated with isoniazid monotherapy for 1-18 months. Conclusion In some areas of China, the proportion of LTBI screening in RA or AS patients treated with TNF antagonists was low, the proportion of tuberculosis prevention treatment was low, the selection criteria of prevention objects were different, and the prevention scheme was not standardized.

Key words: Tumor necrosis factors, Antistatic agents, Arthritis,rheumatoid, Spondylitis,ankylosing, Tuberculosis, Protective agents

张丽帆, 马慧敏, 郑文洁, 张奉春, 刘晓清. 我国部分地区肿瘤坏死因子拮抗剂使用人群的结核病预防性治疗情况分析[J]. 中国防痨杂志, 2021, 43(3): 222-227. doi: 10.3969/j.issn.1000-6621.2021.03.006

ZHANG Li-fan, MA Hui-min, ZHENG Wen-jie, ZHANG Feng-chun, LIU Xiao-qing. Analysis of prevention treatment for tuberculosis in tumor necrosis factor antagonist users in some regions of China[J]. Chinese Journal of Antituberculosis, 2021, 43(3): 222-227. doi: 10.3969/j.issn.1000-6621.2021.03.006

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参考文献 35

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患者序号	性别	年龄 (岁)	诊断	TNF 拮抗剂	应用激素	应用免疫抑制剂	基础病	T-SPOT. TB检测	TST 检测	结核病既往史	非活动性肺结核	预防性治疗方案	总疗程
1	男	50	RA	英夫利西单抗	是	甲氨蝶呤	无	-	-	无	无	异烟肼+ 利福喷丁	2个月
2	女	46	RA	依那西普	是	来氟米特	无	-	-	无	无	异烟肼+ 利福平	8个月
3	女	46	RA	依那西普	是	甲氨蝶呤	无	-	-	无	无	异烟肼	4个月
4	女	61	RA	依那西普	是	甲氨蝶呤; 来氟米特	无	阳性	-	无	无	异烟肼	不详
5	男	53	RA	依那西普	是	甲氨蝶呤; 来氟米特	无	-	-	无	-	异烟肼+ 利福平+ 乙胺丁醇+ 吡嗪酰胺	1个月
6	女	61	RA	依那西普	否	无	糖尿病	-	-	无	无	异烟肼	18个月
7	男	31	AS	依那西普	否	无	无	阳性	-	无	无	异烟肼	1个月
8	男	55	AS	依那西普	否	柳氮磺胺吡啶	无	-	阳性	无	无	异烟肼	不详
9	女	24	AS	依那西普	否	无	无	-	-	无	无	异烟肼	1个月
10	男	53	AS	依那西普	否	无	无	阴性	-	无	无	异烟肼	1个月
11	男	20	AS	依那西普	是	柳氮磺胺吡啶	无	阴性	阳性	无	无	异烟肼	不详
12	女	19	AS	依那西普	是	甲氨蝶呤;柳氮磺胺吡啶	无	-	-	无	无	异烟肼+ 利福平+ 乙胺丁醇+ 吡嗪酰胺	6个月
13	男	45	AS	依那西普	是	柳氮磺胺吡啶	无	-	-	无	-	不详	不详
14	男	33	AS	依那西普	否	甲氨蝶呤;柳氮磺胺吡啶	无	阳性	-	无	无	异烟肼	4个月
15	男	28	AS	依那西普	否	甲氨蝶呤;柳氮磺胺吡啶	无	阳性	-	无	-	异烟肼+ 利福平	24个月