关键词: 红斑狼疮, 系统性, 分枝杆菌, 结核, 感染, 治疗结果, 回顾性研究

Abstract:

Objective: To analyze the clinical intervention and follow-up of patients with systemic lupus erythematosus (SLE) complicated with tuberculosis infection, and to provide a reference for the prevention and treatment of tuberculosis in SLE patients. Methods: A retrospective study was conducted to collect 486 SLE patients, who admitted to the Rheumatology and Immunology Department of Peking University Shenzhen Hospital from November 2014 to March 2020. All subjects underwent tuberculin skin test (TST), interferon-gamma release assays (IGRA) and imaging examination after SLE diagnosis, and were followed up for more than two years. The clinical data of the subjects were collected, including gender, age, duration of SLE, laboratory examination, imaging examination and drug treatment, etc. The tuberculosis infection status, possible influencing factors and follow-up results of SLE patients were analyzed. Results: Among these 486 SLE patients, the incidence of tuberculosis was 20.8% (101/486), including 15 (3.1%) active tuberculosis and 86 (17.7%) inactive tuberculosis patients; of the inactive tuberculosis patients, 74 (15.2%) were latent tuberculosis infection (LTBI), and 12 (2.5%) were obsolete tuberculosis infection (OTBI). Of the LTBI patients, 12.2% (9/74) received preventive anti-tuberculosis treatment, while 87.8% (65/74) didn’t. The course of SLE in SLE with active tuberculosis group (median (quartile)) was 108.0 (84.0, 180.0) months, significantly longer than that in SLE with inactive tuberculosis group (54.0 (13.5, 108.0) months, Z=-3.151, P=0.002). The proportion of use of hormone shock, leflunomide and cyclophosphamide in SLE with active tuberculosis group were significantly higher than those in SLE with inactive tuberculosis group (33.3% (5/15) vs. 7.0% (6/86), χ²=9.142, P=0.010; 20.0% (3/15) vs. 1.2% (1/86), Fisher’s exact probability method, P=0.010; 40.0% (6/15) vs.19.8% (17/86), χ²=10.815, P=0.002). In SLE patients with LTBI undergoing prophylactic antituberculosis therapy, the average daily dose of glucocorticoids (50.0 (40.0, 60.0) mg) was significantly higher than that in the untreated group (20.0 (5.0, 47.5) mg; Z=-2.951, P=0.003), the proportions of usage of cyclophosphamide (5/9) and methotrexate (6/9) were also significantly higher than those in the untreated group (18.5% (12/65) and 13.8% (9/65); Fisher’s exact probability method, P=0.026 and 0.020, respectively). After follow-up for 2 years or more, two cases (3.1%) of SLE combined with LTBI and without prophylactic anti-tuberculosis treatment developed into active tuberculosis, while no such case was found in anti-tuberculosis treatment group, and the difference was not statistically significant (Fisher’s exact probability method, P=1.000). Conclusion: Active tuberculosis is the most common disease in SLE patients with tuberculosis infection. The long course of SLE would lead to an increased probability of tuberculosis infection. The use of high-dose hormone, leflunomide and cyclophosphamide could cause the SLE patients to be susceptible to tuberculosis. Therefore, preventive anti-tuberculosis therapy should be actively carried out for SLE patients with LTBI.

Key words: Lupus erythematosus, systemic, Mycobacterium tuberculosis, Infection, Treatment outcome, Retrospective studies