在中华人民共和国接受依那西普治疗的银屑病患者中获得性潜伏结核感染
Acquired latent tuberculosis infection in psoriasis patients treated with etanercept in the People's Republic of China.
作者信息
Li Cheng-Rang, Mao Qiu-Xia, Chen Min, Jia Wei-Xue, Yao Xu, Feng Su-Ying, Jia Hong, Gong Juan-Qin, Yang Xue-Yuan
机构信息
Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, People's Republic of China.
出版信息
Drug Des Devel Ther. 2015 Oct 12;9:5591-4. doi: 10.2147/DDDT.S87260. eCollection 2015.
BACKGROUND
TNF-α plays a key role in host defense against mycobacterial infection, and patients receiving TNF-α blocker treatment have increased susceptibility to tuberculosis disease. In the People's Republic of China, an intermediate tuberculosis-burden country, the latent tuberculosis infection (LTBI) risk in patients with psoriasis who are treated with etanercept, the safest kind of TNF-α blocker, is unknown.
OBJECTIVES
This study reports the LTBI risk in patients with psoriasis after etanercept treatment and aims to answer the question of how often rescreening for LTBI should be done in order to reduce active tuberculosis infection of patients and further reduce the incidence of active tuberculosis disease.
PATIENTS AND METHODS
This retrospective review evaluated patients with moderate-to-severe chronic plaque psoriasis between 2009 and 2013. All patients were excluded tuberculosis infection and received etanercept 25 mg twice weekly, then the patients were checked for LTBI 3 months after etanercept treatment to observe the incidence of LTBI and assess the need for rescreening for LTBI every 3 months.
RESULTS
We retrospectively analyzed 192 patients with psoriasis with moderate-to-severe chronic plaque whose tuberculin skin test and chest X-rays were negative and who received etanercept 25 mg twice weekly. Eighteen of them were excluded because they received less than 3 months of etanercept therapy. After treatment with etanercept, four patients were found to have LTBI.
CONCLUSION
In this study, the incidence of LTBI after 3 months was four in 192 (2.1%), which is higher than the annual incidence of LTBI in the People's Republic of China (0.72%), so LTBI could be expected to occur within 3 months in psoriasis patients on etanercept. Periodic screening for LTBI in the therapy course, as well as before initiating treatment, is necessary in those patients who use a TNF-α blocker. We recommend rescreening for LTBI every 3 months.
背景
肿瘤坏死因子-α（TNF-α）在宿主抵抗分枝杆菌感染的防御中起关键作用，接受TNF-α阻滞剂治疗的患者患结核病的易感性增加。在结核病负担处于中等水平的中华人民共和国，使用最安全的TNF-α阻滞剂依那西普治疗的银屑病患者的潜伏结核感染（LTBI）风险尚不清楚。
目的
本研究报告依那西普治疗后银屑病患者的LTBI风险，并旨在回答应多久重新筛查一次LTBI以减少患者活动性结核感染并进一步降低活动性结核病发病率的问题。
患者和方法
这项回顾性研究评估了2009年至2013年间患有中度至重度慢性斑块状银屑病的患者。所有患者均排除结核感染，接受每周两次25mg依那西普治疗，然后在依那西普治疗3个月后检查患者的LTBI情况，以观察LTBI的发生率并评估每3个月重新筛查LTBI的必要性。
结果
我们回顾性分析了192例中度至重度慢性斑块状银屑病患者，他们的结核菌素皮肤试验和胸部X光检查均为阴性，且每周接受两次25mg依那西普治疗。其中18例因接受依那西普治疗少于3个月而被排除。依那西普治疗后，发现4例患者患有LTBI。
结论
在本研究中，3个月后LTBI的发生率为192例中有4例（2.1%），高于中华人民共和国LTBI的年发病率（0.72%），因此预计接受依那西普治疗的银屑病患者在3个月内可能发生LTBI。对于使用TNF-α阻滞剂的患者，在治疗过程中以及开始治疗前定期筛查LTBI是必要的。我们建议每3个月重新筛查一次LTBI。
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