常见风湿病合并结核病的临床特点及相关影响因素。
Clinical characteristics and related influencing factors of common rheumatic diseases concomitant with tuberculosis.
机构信息
Department of Nephrology, Bishan Hospital of Chongqing Medical University, Chongqing, China.
Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Front Public Health. 2023 Jan 16;10:948652. doi: 10.3389/fpubh.2022.948652. eCollection 2022.
OBJECTIVE
To explore the clinical characteristics and risk factors of common systemic rheumatism concomitant with tuberculosis (TB).
METHODS
A total of 3,906 patients of RA, SLE, and SS diagnosed in the People's Hospital of Sichuan Province from January 2007 to January 2017 were collected. One hundred and five patients with TB were included as TB group, including 42 RA, 41 SLE, and 22 SS patients. In the non-TB group, 84 RA, 82 SLE, and 44 SS patients were randomly selected during the same period.
RESULTS
Fever was the most common symptom among RA, SLE, and SS patients with TB, accounting for 83.3%, 92.7%, and 68.2%, respectively. Cough, weight loss or fatigue were the next common. RA patients with TB were mostly pulmonary TB (PTB), accounting for 64.3%. The proportion of PTB for SLE and SS were 46.3%, 59.01%, respectively. In TB group, 59% RA, 57% SLE, and 62% SS with PTB had two or more chest CT findings. There were 48 TB cases received both Interferon Gamma Release Assay (IGRA) and Tuberculin skin test (TST) with positive rates of 91.8%, 45.8%, respectively. The daily average dose of glucocorticoids within 1 year in TB group was higher than that in non-TB group of SLE patients, lower counts of CD4+ T cell count were found in TB group ( < 0.05), while no such differences were found in RA and SS patients.
CONCLUSION
RA patients with TB are mainly pulmonary TB. For SLE and SS patients, the chance of PTB and extrapulmonary tuberculosis is similar. Daily average dose of glucocorticoids within 1 year may be a common risk factor for RA, SLE and SS patients developing TB. Decreased CD4+ T cell count may also be a risk factor for SLE patients with TB. Symptoms of RA, SLE, SS with TB, are similar with the primary disease or other infection. It is recommended to conduct both TST and IGRA to help diagnose TB.
目的
探讨常见系统性风湿病合并结核（TB）的临床特征和危险因素。
方法
收集 2007 年 1 月至 2017 年 1 月在四川省人民医院诊断的 RA、SLE 和 SS 患者共 3906 例。其中 105 例 TB 患者纳入 TB 组，包括 42 例 RA、41 例 SLE 和 22 例 SS 患者。同期随机选择 84 例 RA、82 例 SLE 和 44 例 SS 患者纳入非 TB 组。
结果
RA、SLE 和 SS 合并 TB 患者中，发热最常见，占 83.3%、92.7%和 68.2%，其次为咳嗽、体重减轻或乏力。RA 合并 TB 患者多为肺结核（PTB），占 64.3%，SLE 和 SS 分别为 46.3%和 59.01%。TB 组中，59%的 RA、57%的 SLE 和 62%的 SS 合并 PTB 的患者有两种或两种以上的胸部 CT 表现。48 例 TB 患者同时接受了干扰素γ释放试验（IGRA）和结核菌素皮肤试验（TST），阳性率分别为 91.8%和 45.8%。TB 组患者 SLE 患者 1 年内糖皮质激素日平均剂量高于非 TB 组，TB 组 CD4+T 细胞计数较低（<0.05），而 RA 和 SS 患者则无差异。
结论
RA 合并 TB 患者主要为肺结核。对于 SLE 和 SS 患者，PTB 和肺外结核的机会相似。1 年内糖皮质激素日平均剂量可能是 RA、SLE 和 SS 患者发生 TB 的共同危险因素。CD4+T 细胞计数降低也可能是 SLE 合并 TB 患者的危险因素。TB 合并 RA、SLE、SS 患者的症状与原发病或其他感染相似。建议同时进行 TST 和 IGRA 以帮助诊断 TB。
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