Mok Mo Yin, Lo Yi, Chan Tak Mao, Wong Woon Sing, Lau Chak Sing
Department of Medicine, The University of Hong Kong, Hong Kong.
J Rheumatol. 2005 Apr;32(4):609-15.
The efficacy of isoniazid (INAH) prophylaxis against tuberculosis (TB) in patients taking corticosteroid remains controversial. Hong Kong is an endemic area for TB, with an annual risk of 0.11/100 in the general population. Patients with systemic lupus erythematosus (SLE) have an increased susceptibility to TB because of their intrinsic immunocompromised state and the use of corticosteroid therapy. We examined the usefulness of INAH in the prevention of recurrences of TB in patients with SLE receiving high dose corticosteroid therapy.
Medical records of a cohort of patients with SLE were reviewed. Patients with a history of TB who had previously been adequately treated were retrospectively examined for subsequent recurrence of TB. A comparison was performed based on the use of INAH at the discretion of the attending physician in some patients (INAH group) but not others (non-INAH group) during lupus exacerbation that required the use of prednisolone >/= 15 mg/day or equivalent.
A total of 91 episodes of TB from 76 individuals in a cohort of 652 SLE patients with a duration of followup of 13.9 +/- 7.5 years were identified (prevalence of 1.06/100 patient-years). 43 episodes were given INAH while 48 were not. There were 18 recurrences of TB (recurrence rate of 1.66/100 patient-years). Recurrence rates in the INAH and non-INAH groups were 1.59 and 1.74 per 100 patient-years (p = 0.72). However, patients in the INAH group had more lupus exacerbations. Further, extrapulmonary TB was also found to have a higher recurrence rate than pulmonary TB. A case-controlled analysis was thus performed (n = 46) matching patients for the number of lupus exacerbations, cumulative doses of prednisolone, and initial site of TB. There was no difference in the recurrence rates of TB between the matched INAH (0.55/100 patient-years) and non-INAH (1.100 patient-years) groups (p = 0.66).
Patients with SLE have a higher prevalence of TB infection than the general population. They are at risk of TB recurrence when given immunosuppressive doses of corticosteroid.
异烟肼（INAH）对服用皮质类固醇激素的患者预防结核病（TB）的疗效仍存在争议。香港是结核病的流行地区，普通人群的年发病风险为0.11/100。系统性红斑狼疮（SLE）患者因其内在的免疫功能低下状态和使用皮质类固醇激素治疗，对结核病的易感性增加。我们研究了INAH在预防接受高剂量皮质类固醇激素治疗的SLE患者结核病复发中的作用。
回顾一组SLE患者的病历。对既往有结核病病史且已得到充分治疗的患者进行回顾性检查，以观察其后结核病的复发情况。根据主治医生在部分患者（INAH组）狼疮病情加重需要使用泼尼松龙≥15mg/天或等效剂量时酌情使用INAH，而在其他患者（非INAH组）未使用INAH的情况进行比较。
在652例SLE患者队列中，随访时间为13.9±7.5年，共确定了76例患者发生91次结核病发作（患病率为1.06/100患者年）。43次发作给予了INAH，48次未给予。有18次结核病复发（复发率为1.66/100患者年）。INAH组和非INAH组的复发率分别为每100患者年1.59和1.74（p = 0.72）。然而，INAH组的患者狼疮病情加重次数更多。此外，肺外结核的复发率也高于肺结核。因此进行了病例对照分析（n = 46），匹配患者的狼疮病情加重次数、泼尼松龙累积剂量和结核病初始部位。匹配的INAH组（0.55/100患者年）和非INAH组（1.1/100患者年）之间结核病的复发率没有差异（p = 0.66）。
SLE患者的结核感染患病率高于普通人群。当给予免疫抑制剂量的皮质类固醇激素时，他们有结核病复发的风险。
