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

doi:10.19982/j.issn.1000-6621.20240283

Chinese Journal of Antituberculosis ›› 2025, Vol. 47 ›› Issue (1): 22-28.doi: 10.19982/j.issn.1000-6621.20240283

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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

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)

Abstract

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

CLC Number:

R52
R593

Zhang Lifan, Chen Yan, Zhang Yueqiu, Zhang Fengchun, Zeng Xiaofeng, Zhao Yan, Liu Shengyun, Zuo Xiaoxia, Zhang Zhiyi, Wu Huaxiang, Chen Sheng, Li Hongbin, Zhu Ping, Wu Lijun, Qi Wencheng, Liu Yi, Zhang Miaojia, Liu Huaxiang, Zhou Baotong, Shi Xiaochun, Ruan Guiren, Liu Xiaoqing, The Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team. Prevalence of active tuberculosis in Chinese patients with rheumatic diseases: A multicenter cross-sectional subgroup analysis[J]. Chinese Journal of Antituberculosis, 2025, 47(1): 22-28. doi: 10.19982/j.issn.1000-6621.20240283

Figures/Tables 5

特征	风湿免疫病患者	合并活动性结核病	未合并活动性结核病
年龄(岁, $x ˉ$ ±s)	45±14	41±14	45±14
年龄组[例(构成比,%)]
16~34岁	3700(27.3)	43(41.0)	3657(27.2)
35~44岁	2782(20.5)	18(17.1)	2764(20.6)
45~54岁	3402(25.1)	21(20.0)	3381(25.1)
≥55岁	3666(27.1)	23(21.9)	3643(27.1)
性别[例(构成比,%)]
男性	3264(24.1)	30(28.6)	3234(24.1)
女性	10286(75.9)	75(71.4)	10211(75.9)
风湿免疫病类型[例(构成比,%)]
弥漫性结缔组织病	5789(42.7)	58(55.2)	5731(42.6)
系统性血管炎综合征	679(5.0)	13(12.4)	666(5.0)
脊柱关节病	7082(52.3)	34(32.4)	7048(52.4)
应用肿瘤坏死因子抑制剂[例(构成比,%)]
否	12784(94.3)	99(94.3)	12685(94.3)
是	766(5.7)	6(5.7)	760(5.7)
合计[例(构成比,%)]	13550(100.0)	105(0.8)	13445(99.2)

特征	病原学和(或)组织病理学确诊(34例)	临床诊断 (71例)	统计检验值	P值
年龄(岁, $x ˉ$ ±s)	40±14	42±15	t=-0.564	0.574
年龄组[例(构成比,%)]			χ²=7.168	0.067
16~34岁	15(34.9)	28(65.1)
35~44岁	4(22.2)	14(77.8)
45~54岁	11(52.4)	10(47.6)
≥55岁	4(17.4)	19(82.6)
性别[例(构成比,%)]			χ²=2.940	0.086
男性	6(20.0)	24(80.0)
女性	28(37.3)	47(62.7)
风湿免疫病类型[例(构成比,%)]			χ²=15.824	<0.001
弥漫性结缔组织病	28(48.3)	30(51.7)
系统性血管炎综合征	3(23.1)	10(76.9)
脊柱关节病	3(8.8)	31(91.2)

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年龄组 (岁)	弥漫性结缔组织病	系统性血管炎综合征	脊柱关节病	合计
年龄组 (岁)	弥漫性结缔组织病	系统性血管炎综合征	脊柱关节病	患病率	调整患病率
16~34	1160(666~1654)	3502(1239~5765)	796(365~1228)	1162(817~1508)	1163
35~44	967(443~1491)	1449(0~3468)	231(0~492)	647(349~945)	677
45~54	1042(517~1567)	1550(0~3711)	218(4~432)	617(354~881)	641
≥55	753(262~1244)	0	604(289~920)	627(372~883)	641

年龄组 (岁)	脊柱关节病		弥漫性结缔组织病		系统性血管炎综合征		合计
年龄组 (岁)	应用TNFi者	全部患者	应用TNFi者	全部患者	应用TNFi者	全部患者	应用TNFi者	全部患者
16~34	337(44.9)	1633(23.1)	1(1/2)	1810(31.3)	6(46.2)	257(37.8)	344(44.9)	3700(27.3)
35~44	138(18.4)	1300(18.4)	0(0/2)	1344(23.2)	4(30.8)	138(20.3)	142(18.5)	2782(20.5)
45~54	130(17.3)	1833(25.9)	0(0/2)	1440(24.9)	3(23.1)	129(19.0)	133(17.4)	3402(25.1)
≥55	146(19.4)	2316(32.7)	1(1/2)	1195(20.6)	0(0.0)	155(22.8)	147(19.2)	3666(27.1)
合计	751(100.0)	7082(100.0)	2(2/2)	5789(100.0)	13(100.0)	679(100.0)	766(100.0)	13550(100.0)

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

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性别	弥漫性结缔组织病	系统性血管炎综合征	脊柱关节病	合计
性别	弥漫性结缔组织病	系统性血管炎综合征	脊柱关节病	患病率	调整患病率
男性	1165(304~2025)	1767(223~3311)	756(408~1105)	919(592~1247)	925
女性	983(714~1252)	2020(628~3412)	340(174~507)	729(565~894)	760

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