Zhang Lu, Wang Dong-Xue, Ma Li
Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Nei Ke Za Zhi. 2008 Oct;47(10):808-10.
To investigate the characteristics and related risk factors associated with Tuberculosis(TB) in patients with systemic lupus erythematosus (SLE) who received glucocorticoid and immunosuppressive therapy.
Among the 452 SLE patients underwent the treatment of glucocorticoid and immunosuppressive agent, the clinical data was reviewed and summarized retrospectively.
42 of 452 (9.29%) patients were diagnosed as TB infection.11 patients (23.81%) had exudative pulmonary tuberculosis and 31 patients (73.81%) had extra-pulmonary TB. Statistics of the 31 patients showed that 8 patients (19.05%) had hematogenous disseminated pulmonary tuberculosis; 6 (14.29%) had tuberculo-meningitis; 2 (4.76%) had thoracic cavity TB; 2 (4.76%) had abdominal cavity TB; 1 (2.38%) had crewels; 1 (2.38%) had bone tuberculosis and 1 (2.38%) had nephronophthisis. The focus of infection was not found in 10 patients. Of all 42 patients with TB infection, 38 cases suffered form lupus nephritis, 40 with hypoalbuminosis, 10 with TB history, 14 had leucocytopenia or hyperglycaemia, respectively. The effect of antiTB therapy started up at least 7 days, or in 4 weeks as longest. 2 patients died of hematogenous disseminated pulmonary tuberculosis.
Under the treatment of glucocorticoid and immunosuppressive agent, TB incidence in patients with SLE is obviously higher than that of common people. Extra-pulmonary TB and serious infection are more frequently. It is shown that those who had lupus nephritis or TB history are more susceptible to TB.
探讨接受糖皮质激素和免疫抑制治疗的系统性红斑狼疮(SLE)患者结核病(TB)的特征及相关危险因素。
回顾性分析452例接受糖皮质激素和免疫抑制剂治疗的SLE患者的临床资料。
452例患者中42例(9.29%)诊断为结核感染。11例(23.81%)为渗出性肺结核,31例(73.81%)为肺外结核。对31例肺外结核患者统计显示,8例(19.05%)为血行播散型肺结核;6例(14.29%)为结核性脑膜炎;2例(4.76%)为胸腔结核;2例(4.76%)为腹腔结核;1例(2.38%)为骨髓炎;1例(2.38%)为骨结核;1例(2.38%)为肾结核。10例未发现感染病灶。42例结核感染患者中,38例患有狼疮性肾炎,40例有低蛋白血症,10例有结核病史,14例分别有白细胞减少或血糖升高。抗结核治疗开始起效至少7天,最长4周。2例死于血行播散型肺结核。
在糖皮质激素和免疫抑制剂治疗下,SLE患者的结核病发病率明显高于普通人群。肺外结核和严重感染更为常见。表明患有狼疮性肾炎或有结核病史的患者更易患结核病。