预防治疗系统性红斑狼疮患者医源性活动性结核病的临床观察  

Preventive therapy for iatrogenic active tuberculosis in systemic lupus erythematosus patients

作　　者：马丽[1] 林冰[1] 王丽英[1] 王冬雪[1] 李桂叶[1] 王国春[1] 

机构地区：[1]中日友好医院风湿免疫科,北京100029

出　　处：《中华医学杂志》2014年第45期3579-3582,共4页National Medical Journal of China

基　　金：首都医学发展基金（2005-3120）

摘　　要：目的观察预防性抗结核治疗糖皮质激素所致的医源性活动性结核病的疗效及其安全性。方法203例系统性红斑狼疮（SLE）均来自2007至2011年中日友好医院风湿免疫科住院患者，在开始使用糖皮质激素治疗时，对有活动性结核易感因素（有结核病史、PPD皮试强阳性、结核病家族史、血清白蛋白低、血糖升高）者进行随机、对照预防性抗结核治疗。203例患者被随机分成3组：单纯激素治疗组（70例）；激素＋异烟肼治疗组（67例）；激素＋异烟肼＋乙胺丁醇治疗组（66例），抗结核治疗组患者行12个月预防性抗结核治疗。定期随诊情况：入组患者如出现发热，咳嗽等症状随时就诊；无特殊情况2个月随诊1次，观察有无活动性结核病发生、抗结核药物疗效和不良反应；停预防性抗结核药后每3个月随诊1次，共随诊2年。如出现发热等症状，并证实有活动性结核病者，行3～4联抗结核治疗。结果（1）激素＋抗结核药组无活动性结核病病例发生；（2）单纯激素组发生活动性结核病8例（11．43％），包括1例血行播散型结核，3例肺结核，1例骨结核，1例结核性脑膜炎，2例病灶不明的活动性结核病；（3）出现活动性结核病症状的时间：6／8例患者在用激素后半年内出现活动性结核病症状；（4）7／8例患者在随访中确诊活动I生结核病后按研究计划（3～4联）抗结核治疗1年，其中骨结核患者行病灶清除后继续抗结核治疗，7／8例活动性结核病患者得到较好控制，1例失访后死于结核性脑膜炎；（5）抗结核治疗未发生明显不良反应：2例患者出现轻度一过性双手指尖感觉异常；3例激素＋异烟肼＋乙胺丁醇组患者出现肝酶轻度升高，停抗结核治疗，口服保肝药，肝功恢复正常。结论在活动性结核病高危人群中，应用糖皮质激素治疗的同时加用1联或2联抗结核治�Objective To explore the efficacy and safety of preventive therapy for iatrogenic active tuberculosis （TB） induced by glucocorticoid. Methods During 2007 -2011, a total of 203 systemic lupus erythematosus （SLE） patients with high-risk active TB, such as a history of TB infection, TB family member and strong positive purified protein derivative （PPD） skin test or hypoalbuminemia and hyperglycemia were enrolled. They were randomly divided into three groups based on whether or not anti-TB treatment was offered at the beginning of glucocorticoid treatment for SLE ： simple glucocorticoid group （ n = 70） ; glucocorticoid plus rimifon group （n = 67） ; glucocorticoid plus rimifou plus ethambutol group （n = 66）. Anti-TB treatment was offered at least 12 months for the preventive anti-TB group. And follow-ups were conducted every 2 - 3 months for 2 year to observe the efficacy and side effects of anti-TB drugs. During this period, anyone with fever and/or cough consulted a physician immediately. Results No active TB occurred in anti-TB treatment group. And 8 patients （11.43%） had active TB in simple glucocorticoid group, including hematogenous disseminated TB （ n = 1 ）, pulmonary TB （ n = 3 ）, bone TB （ n = 1 ）, tuberculous meningitis （ n = 1 ） and undefined focus TB infection （n = 2 ） . And 6/8 cases had active TB within 6 months after using glucocorticoids. According to the study protocol, any case of active TB shall receive 3 -4 combined anti-TB drugs for 1 year. The TB conditions of 7/8 patients were better controlled by anti-TB treatment. One patient died of tuberculous meningitis after lost follow-up. Two patients had mild temporary numbness in finger tap of both hands. And 3 patients on double anti-TB drugs showed a mild elevation of liver enzymes. Conclusion For high-risk population of active TB, glucocorticoid therapy plus 1 or 2 preventive anti-TB treatment drugs may prevent its occurrence. And there is no serious adverse reaction during preventive anti-TB treatme

关 键 词：红斑狼疮 系统性 糖皮质激素 结核病 医源性 

分 类 号：R593.241[医药卫生—内科学]