Damara Ivan, Ariane Anna, Winston Kevin
Internal Medicine, Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, IDN.
Rheumatology, Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, IDN.
Cureus. 2022 Jun 28;14(6):e26410. doi: 10.7759/cureus.26410. eCollection 2022 Jun.
Indonesia has the second-highest tuberculosis cases in the world, according to the global WHO tuberculosis report, amounting to approximately 10% of the world's tuberculosis cases. Systemic lupus erythematosus (SLE) patients are at an increased risk for tuberculosis infection. This research aims to analyze the association between corticosteroid pulse dose, corticosteroid cumulative dose, SLE disease duration, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and lupus nephritis status with the development of tuberculosis in SLE patients.
This research was a matched case-control study to identify risk factors of tuberculosis infection in SLE patients. Data were taken from medical records of Cipto Mangunkusumo National General Hospital, a national tertiary hospital. Inclusion criteria were patients who meet the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria of SLE in the period of 2012-2016 or patients who meet the SLICC 2012 SLE criteria and developed tuberculosis between 2012 and 2016. Statistical analyses used were bivariate analysis and correlation analysis. All statistical analyses were conducted using SPSS software (IBM Corp., Armonk, NY). All statistical analyses were defined as statistically significant when the p-value was less than 0.05.
A total of 48 SLE patients were included from medical records consisting of 24 SLE patients with tuberculosis infection and controls of 24 SLE patients without tuberculosis infection. In this study, it was observed that the presence of lupus nephritis (p = 0.001), administration of pulse corticosteroids (p = 0.048), high corticosteroid cumulative dose (p = 0.001), and high SLEDAI score (p = 0.003) were associated with tuberculosis infection. Correlation analysis showed that all of these variables had a weak positive correlation with tuberculosis infection in SLE patients.
SLE patients with lupus nephritis, administration of pulse corticosteroids, high cumulative corticosteroid dose, and high SLEDAI score have a higher risk of tuberculosis infection. Clinicians and patients should be aware of these risk factors in SLE patients to prevent tuberculosis infection. Corticosteroid pulse dose should be avoided in SLE patients and if it is needed, tuberculosis prophylaxis may be considered.
根据世界卫生组织全球结核病报告，印度尼西亚是全球结核病病例数第二多的国家，约占全球结核病病例的10%。系统性红斑狼疮（SLE）患者感染结核病的风险增加。本研究旨在分析皮质类固醇脉冲剂量、皮质类固醇累积剂量、SLE病程、系统性红斑狼疮疾病活动指数（SLEDAI）评分以及狼疮肾炎状态与SLE患者结核病发生之间的关联。
本研究为配对病例对照研究，以确定SLE患者结核病感染的危险因素。数据取自国家三级医院西托·曼古库苏莫国立综合医院的病历。纳入标准为在2012 - 2016年期间符合系统性红斑狼疮国际协作临床中心（SLICC）2012年SLE标准的患者，或在2012年至2016年期间符合SLICC 2012年SLE标准且发生结核病的患者。所采用的统计分析为双变量分析和相关性分析。所有统计分析均使用SPSS软件（IBM公司，纽约州阿蒙克）进行。当p值小于0.05时，所有统计分析均被定义为具有统计学意义。
从病历中纳入了48例SLE患者，其中24例为感染结核病的SLE患者，24例为未感染结核病的SLE患者作为对照。在本研究中，观察到狼疮肾炎的存在（p = 0.001）、脉冲皮质类固醇的使用（p = 0.048）、高皮质类固醇累积剂量（p = 0.001）和高SLEDAI评分（p = 0.003）与结核病感染相关。相关性分析表明，所有这些变量与SLE患者的结核病感染呈弱正相关。
患有狼疮肾炎、使用脉冲皮质类固醇、皮质类固醇累积剂量高以及SLEDAI评分高的SLE患者感染结核病的风险更高。临床医生和患者应了解SLE患者中的这些危险因素以预防结核病感染。SLE患者应避免使用皮质类固醇脉冲剂量，如需使用，可考虑预防性抗结核治疗。
