Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Lung. 2013 Oct;191(5):565-71. doi: 10.1007/s00408-013-9481-5. Epub 2013 Jun 1.
The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics.
We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays.
Rheumatoid arthritis (43.6 %) and ankylosing spondylitis (27.9 %) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 %), infliximab (23.4 %), or adalimumab (13.2 %). The remaining patients received two or more TNF antagonists (30 %). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 % CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year.
Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.
本研究旨在确定在韩国接受肿瘤坏死因子（TNF）拮抗剂治疗的患者中结核病（TB）和非结核分枝杆菌（NTM）肺部疾病的发生率，并评估其临床特征。
我们调查了 2002 年 1 月至 2011 年 12 月期间在韩国 Severance 医院接受 TNF 拮抗剂治疗的所有患者（N=509）。我们回顾了患者的病历，并收集了微生物学、影像学和临床数据，包括使用的 TNF 阻滞剂类型、结核菌素皮肤试验和干扰素-γ释放试验结果。
类风湿关节炎（43.6%）和强直性脊柱炎（27.9%）是接受 TNF 拮抗剂治疗的患者最常见的疾病。患者接受依那西普（33.4%）、英夫利昔单抗（23.4%）或阿达木单抗（13.2%）治疗。其余患者接受两种或两种以上 TNF 拮抗剂（30%）治疗。9 例患者发生 TB，4 例患者发生 NTM 肺部疾病。在调整年龄和性别后，与普通人群相比，标准化 TB 发病率比为 6.4[95%CI 3.1-11.7]。估计 NTM 发病率为每年每 100,000 名患者 230.7 例。
我们的结果表明，接受 TNF 拮抗剂治疗的患者中分枝杆菌感染增加。需要确定治疗潜伏性结核病感染的 TB 的其他预测因子，并对接受 TNF 拮抗剂长期治疗的患者进行密切监测和及时诊断 NTM 相关肺部疾病。
