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中国防痨杂志 ›› 2025, Vol. 47 ›› Issue (1): 22-28.doi: 10.19982/j.issn.1000-6621.20240283

• 论著 • 上一篇    下一篇

中国风湿免疫病患者活动性结核病患病情况多中心横断面研究:亚组分析

张丽帆1,2,3, 陈艳1, 张月秋1, 张奉春4, 曾小峰4, 赵岩4, 刘升云5, 左晓霞6, 张志毅7, 吴华香8, 陈盛9, 李鸿斌10, 朱平11, 武丽君12, 齐文成13, 刘毅14, 张缪佳15, 刘花香16, 周宝桐1,3, 侍效春1,3, 阮桂仁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. 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,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
    5郑州大学第一附属医院风湿免疫科,郑州 450052
    6中南大学湘雅医院风湿免疫科,长沙 410008
    7哈尔滨医科大学附属第一医院风湿免疫科,哈尔滨 150001
    8浙江大学医学院附属第二医院风湿免疫科,杭州 310009
    9上海交通大学医学院附属仁济医院风湿免疫科,上海 200001
    10内蒙古医科大学附属医院风湿免疫科,呼和浩特 010000
    11第四军医大学西京医院临床免疫科,西安 710032
    12新疆维吾尔自治区人民医院风湿免疫科,乌鲁木齐 830001
    13天津市第一中心医院风湿免疫科,天津 300192
    14四川大学华西医院风湿免疫科,成都 610041
    15南京医科大学第一附属医院风湿免疫科,南京 210029
    16山东大学齐鲁医院风湿免疫科,济南 250012
  • 收稿日期:2024-07-09 出版日期:2025-01-10 发布日期:2025-01-02
  • 通信作者: 刘晓清 E-mail:liuxq@pumch.cn
  • 基金资助:
    国家科技重大专项(2014ZX10003003);中央高水平医院临床科研专项(2022-PUMCH-A-119);中央高水平医院临床科研专项(2022-PUMCH-C-013);国家自然科学基金面上项目(82373648)

Prevalence of active tuberculosis in Chinese patients with rheumatic diseases: A multicenter cross-sectional subgroup analysis

Zhang Lifan1,2,3, Chen Yan1, Zhang Yueqiu1, Zhang Fengchun4, Zeng Xiaofeng4, Zhao Yan4, Liu Shengyun5, Zuo Xiaoxia6, Zhang Zhiyi7, Wu Huaxiang8, Chen Sheng9, Li Hongbin10, Zhu Ping11, Wu Lijun12, Qi Wencheng13, Liu Yi14, Zhang Miaojia15, Liu Huaxiang16, Zhou Baotong1,3, Shi Xiaochun1,3, Ruan Guiren1,3, Liu Xiaoqing1,2,3(), The Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team   

  1. 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
    4Department 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
    5Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    6Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha 410008, China
    7Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
    8Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
    9Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
    10Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
    11Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
    12Department of Rheumatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    13Department of Rheumatology, Tianjin First Central Hospital, Tianjin 300192, China
    14Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
    15Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    16Department of Rheumatology, Qilu Hospital of Shandong University, Ji’nan 250012, China
  • Received:2024-07-09 Online:2025-01-10 Published:2025-01-02
  • Contact: Liu Xiaoqing E-mail:liuxq@pumch.cn
  • Supported by:
    National Science and Technology Major Project of the People’s Republic of China(2014ZX10003003);National High Level Hospital Clinical Research Funding(2022-PUMCH-A-119);National High Level Hospital Clinical Research Funding(2022-PUMCH-C-013);National Natural Science Foundation of China(82373648)

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摘要：

目的：了解中国风湿免疫病(rheumatic diseases,RD)患者活动性结核病(active tuberculosis,ATB)的患病情况。方法：采用分层多阶段整群抽样方法,纳入2014年9月至2016年3月期间,来自全国东、中、西部13家三级甲等综合医院的进行ATB筛查的RD患者作为调查对象,共计13550例。估算RD患者的ATB患病率,并按照RD病种、患者年龄和性别进行亚组分析。结果：13550例调查对象中,105例合并ATB,其中,48例(45.7%)无咳嗽、咳痰、发热、盗汗、体质量减轻表现;在病原学和(或)组织病理学确诊的ATB患者中,无症状者占35.3%(12/34);在菌阳肺结核患者中,无症状者占30.8%(8/26)。累及肺外部位的结核病有41例(39.0%),其中单纯肺外结核28例(68.3%),肺结核合并肺外结核13例(31.7%)。亚组分析结果显示,系统性血管炎综合征患者ATB患病率最高,为1915/10万(13/679,95%CI:881/10万~2948/10万),其次为弥漫性结缔组织病患者(1002/10万,58/5789,95%CI:745/10万~1259/10万)。RD患者中16~34岁组ATB患病率最高,为1162/10万(43/3700,95%CI:817/10万~1508/10万),男性ATB患病率为919/10万(30/3264,95%CI:592/10万~1247/10万),明显高于女性(729/10万,75/10286,95%CI:565/10万~894/10万)。结论：中国RD患者中亚临床结核病、肺外结核及结核病播散负担较高,ATB患病率在不同RD患者病种、年龄、性别间存在明显差异。

关键词: 结核, 风湿性疾病, 共病现象, 患病率, 横断面研究

Abstract:

Objective: This study aimed to investigate the prevalence of active tuberculosis (ATB) among patients with rheumatic diseases (RD) in China. Methods: Using a stratified multi-stage cluster sampling method, a total of 13550 RD patients who underwent ATB screening from 13 tertiary hospitals in the eastern, central, and western regions of China between September 2014 and March 2016 were included in the survey. Participants underwent screening for ATB, and the prevalence of ATB was calculated. Subgroup analyses were performed based on RD subtype, age, and sex. Results: Among the 13550 surveyed subjects, 105 case diagnosed with ATB, 48 (45.7%) exhibited no classical symptoms such as cough, sputum production, fever, night sweats, or weight loss. Of those with microbiological and/or pathological confirmation of ATB, 35.3% (12/34) were asymptomatic, while the asymptomatic rate was 30.8% (8/26) among patients with bacteriologically confirmed pulmonary tuberculosis (PTB). Extrapulmonary tuberculosis (EPTB) was identified in 41 cases (39.0%), with 28 cases (68.3%) being exclusively EPTB and 13 cases (31.7%) involving combined pulmonary and extrapulmonary disease. The highest prevalence of ATB was observed in patients with systemic vasculitis syndrome, reaching 1915/100000 (13/679; 95%CI: 881/100000-2948/100000), followed by patients with diffuse connective tissue diseases, at 1002/100000 (58/5789; 95%CI: 745/100000-1259/100000). Among RD patients, the 16-34 age group exhibited the highest ATB prevalence, recorded at 1162/100000 (43/3700; 95%CI: 817/100000-1508/100000). Males demonstrated a higher prevalence (919/100000, 30/3264; 95%CI: 592/100000-1247/100000) compared to females (729/100000, 75/10286; 95%CI: 565/100000-894/100000). Conclusion: Patients with RD in China carry a substantial burden of subclinical TB, EPTB, and disseminated TB. The prevalence of ATB shows marked differences across RD subtypes, age groups, and genders.

Key words: Tuberculosis, Rheumatic diseases, Comorbidities, Prevalence, Cross-sectional studies

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