Retrospective analysis of clinical intervention and follow-up of patients with systemic lupus erythematosus complicated with tuberculosis infection

doi:10.19982/j.issn.1000-6621.20220244

Abstract

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

CLC Number:

R593
R52

Zhou Qian, Deng Guofang, Wang Qingwen. Retrospective analysis of clinical intervention and follow-up of patients with systemic lupus erythematosus complicated with tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2022, 44(12): 1294-1302. doi: 10.19982/j.issn.1000-6621.20220244

Figures/Tables 2

临床资料	非活动性结核病组(86例)	活动性结核病组(15例)	统计检验值	P值
性别[例(构成比,%)]			χ²=3.678	0.076
女性	78(90.7)	10(66.7)
男性	8(9.3)	5(33.3)
年龄(岁, $x ˉ$ ±s)	37.42±11.03	36.40±12.14	t=0.325	0.746
吸烟史[例(构成比,%)]			-	1.000
无	84(97.7)	15(100.0)
有	2(2.3)	0(0.0)
结核病接触史[例(构成比,%)]			-	1.000
无	86(100.0)	15(100.0)
有	0(0.0)	0(0.0)
合并症[例(构成比,%)]			-	1.000
无	84(97.7)	15(100.0)
有	2(2.3)	0(0.0)
SLE病程[月,M(Q₁,Q₃)]	54.0(13.5,108.0)	108.0(84.0,180.0)	Z=-3.151	0.002
SLEDAI-2000评分[分,M(Q₁,Q₃)]	3.0(0.0,8.0)	2.0(0.0,11.0)	Z=-0.097	0.922
糖皮质激素使用日均剂量[mg,M(Q₁,Q₃)]	23.3(9.4,50.0)	30.0(8.0,75.0)	Z=-0.353	0.724
使用激素冲击治疗[例(构成比,%)]			χ²=9.142	0.010
否	80(93.0)	10(66.7)
是	6(7.0)	5(33.3)
使用环磷酰胺[例(构成比,%)]			χ²=10.815	0.002
否	69(80.2)	6(40.0)
是	17(19.8)	9(60.0)
使用甲氨蝶呤[例(构成比,%)]			χ²=3.946	0.078
否	71(82.6)	9(60.0)
是	15(17.4)	6(40.0)
使用环孢素[例(构成比,%)]			χ²=1.873	0.204
否	66(76.7)	9(60.0)
是	20(23.3)	6(40.0)
使用马替麦考酚酯[例(构成比,%)]			-	1.000
否	63(73.3)	11(73.3)
是	23(26.7)	4(26.7)
使用羟氯喹[例(构成比,%)]			-	0.605
否	4(4.7)	3(20.0)
是	82(95.3)	12(80.0)
使用来氟米特[例(构成比,%)]			-	0.010
否	85(98.8)	12(80.0)
是	1(1.2)	3(20.0)
使用硫唑嘌呤[例(构成比,%)]			-	0.149
否	86(100.0)	14(93.3)
是	0(0.0)	1(6.7)
临床资料	非活动性结核病组(86例)	活动性结核病组(15例)	统计检验值	P值
使用沙利度胺[例(构成比,%)]			-	0.480
否	83(96.5)	14(93.3)
是	3(3.5)	1(6.7)
使用雷公藤[例(构成比,%)]			-	1.000
否	85(98.8)	15(100.0)
是	1(1.2)	0(0.0)
使用他克莫司[例(构成比,%)]			-	1.000
否	85(98.8)	15(100.0)
是	1(1.2)	0(0.0)
使用生物制剂[例(构成比,%)]			-	1.000
否	85(98.8)	15(100.0)
是	1(1.2)	0(0.0)
补体C3水平[例(构成比,%)]			χ²=1.186	0.276
正常	53(61.6)	11(73.3)
下降	33(38.4)	4(26.7)
补体C4水平[例(构成比,%)]			χ²=0.764	0.382
正常	56(65.1)	8(53.3)
下降	30(34.9)	7(46.7)
血红细胞沉降率水平[例(构成比,%)]			χ²=0.164	0.686
正常	41(47.7)	8(53.3)
升高	45(52.3)	7(46.7)
超敏C反应蛋白水平[例(构成比,%)]			χ²=1.109	0.380
正常	77(89.5)	12(80.0)
下降	9(10.5)	3(20.0)
白细胞计数[例(构成比,%)]			-	0.503
正常	69(80.2)	11(73.3)
下降	14(16.3)	4(26.7)
升高	3(3.5)	0(0.0)
淋巴细胞百分比[例(构成比,%)]			0.941	0.462
正常	72(86.0)	11(73.3)
下降	14(14.0)	4(26.7)

临床资料	未预防治疗组(65例)	预防治疗组(9例)	统计检验值	P值
性别[例(构成比,%)]			-	0.052
女性	60(92.3)	6(6/9)
男性	5(7.7)	3(3/9)
年龄(岁, $x ˉ$ ±s)	36.66±10.88	41.44±10.94	t=-1.236	0.221
SLE病程[月,M(Q₁,Q₃)]	60(14,108)	36(12,66)	Z=-0.970	0.332
吸烟史[例(构成比,%)]			-	0.109
无	62(95.4)	7(7/9)
有	3(4.6)	2(2/9)
结核病接触史[例(构成比,%)]			-	1.000
无	65(100.0)	9(9/9)
有	0(0.0)	0(0/9)
合并症[例(构成比,%)]			-	1.000
无	64(98.5)	9(9/9)
有	1(1.5)	0(0/9)
SLEDAI-2000评分[分,M(Q₁,Q₃)]	2.0(0.0,8.0)	6.0(1.0,11.0)	Z=-0.861	0.389
糖皮质激素使用日均剂量[mg,M(Q₁,Q₃)]	20.0(5.0,47.5)	50.0(40.0,60.0)	Z=-2.951	0.003
使用环磷酰胺[例(构成比,%)]			-	0.026
否	53(81.5)	4(4/9)
是	12(18.5)	5(5/9)
使用甲氨蝶呤[例(构成比,%)]			-	0.020
否	56(86.2)	3(3/9)
是	9(13.8)	6(6/9)
使用环孢素[例(构成比,%)]			-	0.439
否	48(73.8)	8(8/9)
是	17(26.2)	1(1/9)
使用马替麦考酚酯[例(构成比,%)]			-	0.711
否	44(67.7)	7(7/9)
是	21(32.3)	2(2/9)
使用来氟米特[例(构成比,%)]			-	0.230
否	64(98.5)	8(8/9)
是	1(1.5)	1(1/9)
使用沙利度胺[例(构成比,%)]			-	1.000
否	62(95.4)	9(9/9)
是	3(4.6)	0(0/9)
使用雷公藤 [例(构成比,%)]			-	0.230
否	63(96.9)	8(8/9)
是	2(3.1)	1(1/9)
使用硫唑嘌呤 [例(构成比,%)]			-	0.122
否	65(100.0)	8(8/9)
是	0(0.0)	1(1/9)
临床资料	未预防治疗组(65例)	预防治疗组(9例)	统计检验值	P值
使用他克莫司 [例(构成比,%)]			-	1.000
否	64(98.5)	9(9/9)
是	1(1.5)	0(0/9)
使用生物制剂 [例(构成比,%)]			-	0.122
否	65(100.0)	8(8/9)
是	0(0.0)	1(1/9)
补体C3水平[例(构成比,%)]			-	0.999
正常	43(66.2)	6(6/9)
下降	22(33.8)	3(3/9)
补体C4水平[例(构成比,%)]			-	0.711
正常	44(67.7)	7(7/9)
下降	21(32.3)	2(2/9)
血红细胞沉降率水平[例(构成比,%)]			-	0.152
正常	35(53.8)	2(2/9)
升高	30(46.2)	7(7/9)
白细胞计数[例(构成比,%)]			-	1.000
正常	51(78.5)	8(8/9)
下降	11(16.9)	1(1/9)
升高	3(4.6)	0(0/9)
淋巴细胞百分比[例(构成比,%)]			-	0.338
正常	54(83.1)	9(9/9)
下降	11(16.9)	0(0/9)

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