类风湿关节炎合并活动性肺结核病的临床特征及相关因素分析  

Clinical features and risk factors of active tuberculosis in patients with rheumatoid arthritis

作　　者：王雯 徐婷[1] 孙甜甜 吴敏[1] WANG Wen;XU Ting;SUN Tiantian;WU Min(Department of Rheumatology and Immunology,The Third Affiliated Hospital of Suzhou University,Changzhou Jiangsu 213003,China)

机构地区：[1]苏州大学附属第三医院风湿免疫科,江苏常州213003

出　　处：《中国感染与化疗杂志》2021年第2期158-164,共7页Chinese Journal of Infection and Chemotherapy

基　　金：江苏省妇幼健康科研项目(F201837);江苏现代医院管理研究(JSY-3-2019-107);江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2019023);江苏省博士后科研资助计划(2019K260);常州市卫计委重大科技项目(ZD201609)。

摘　　要：目的分析类风湿关节炎(RA)合并活动性肺结核病的临床特征以及相关危险因素。方法回顾分析41例RA合并活动性肺结核住院患者临床资料,按照年龄、性别1∶1匹配选择同期无RA及其他风湿疾病的活动性肺结核住院患者进行临床特征分析,随机选取101例无活动性肺结核及其他病原体感染的RA同期住院患者进行相关因素分析,所有患者均有完整的病史、体格检查、实验室及辅助检查资料。结果41例RA合并活动性肺结核患者中,男18例,女23例,平均年龄(67.7±12.0)岁。与无RA的活动性肺结核患者进行对比分析发现,RA合并活动性肺结核患者的肺下叶、肺外累及和合并其他病原菌感染者较多,但两组差异无统计学意义;而抗酸杆菌培养、结核抗体及结核菌素纯蛋白衍生物(PPD)试验阳性、有咳嗽症状者比例较少,差异有统计学意义(P<0.05)。与无活动性肺结核及其他病原体感染的RA同期住院患者进行单因素分析,RA合并活动性肺结核组男性多、年龄大,有吸烟史、关节畸形、合并冠心病、应用激素治疗、淋巴细胞比例降低、血红蛋白降低、白蛋白降低患者比例高,C反应蛋白、红细胞沉降率、白细胞计数高,关节肿胀压痛和应用疾病缓解抗风湿药物(DMARD)治疗少,两组间差异有统计学意义(P<0.05)。多因素logistic回归分析发现RA合并活动性结核感染患者年龄大、有吸烟史,淋巴细胞比例降低、应用激素比例高而关节压痛和应用DMARD治疗者少(P<0.05)。结论RA合并活动性肺结核患者与年龄大、吸烟史相关,多存在激素应用及淋巴细胞比例下降。RA合并活动性肺结核患者多叶肺受累、合并其他病原体混合感染并不罕见。Objective To analyze the clinical characteristics and relevant risk factors of active tuberculosis in patients with rheumatoid arthritis(RA).Methods The clinical data of 41 RA patients complicated with active tuberculosis were retrospectively analyzed.The contemporary inpatients(1:1 matching in terms of age and sex)with active tuberculosis who did not suffer from RA or other rheumatic diseases were selected as the control group for clinical characteristics analysis.Additional 101 randomly selected RA patients without active tuberculosis or other infection during the same period were used as the control group for analysis of relevant risk factors.All patients had complete medical history,physical examination,laboratory,and auxiliary examination data.Results The 41 RA patients complicated with active tuberculosis included 18 males and 23 females,with an average age of(67.7±12.0)years.Compared with the patients with active pulmonary tuberculosis but without RA,the patients with both RA and active pulmonary tuberculosis had numerically more inferior lobe lung involvement,extrapulmonary involvement,and other bacterial infection(P>0.05),while the positive rate of acid-fast bacillus culture,tuberculosis antibody,PPD test,and the prevalence of cough symptoms were significantly lower(P<0.05).Univariate analysis showed that the patients with both active pulmonary tuberculosis and RA were older associated with more males,a history of smoking,joint deformity,coronary heart disease,glucocorticoid use,lower lymphocyte percentage,lower hemoglobin,lower albumin,higher C-reactive protein,higher erythrocyte sedimentation rate,higher white blood cell count,less joint swelling and tenderness,and lower prevalence of disease-modifying anti-rheumatic drugs treatment(P<0.05)compared with the RA patients without active tuberculosis or other infection.Multivariate logistic regression analysis found that RA and active tuberculosis comorbidity is significantly associated with older age,history of smoking,lower lymphocyte percentage,higher

关 键 词：类风湿关节炎 感染 活动性肺结核 相关因素 

分 类 号：R521[医药卫生—内科学] R593.22[医药卫生—临床医学]