我国部分地区风湿免疫病患者预防性抗结核治疗情况分析  

Analysis of preventive anti-tuberculosis treatment for patients with rheumatic immune diseases in some areas of China

作　　者：马亚楠 张丽帆 刘晓清[1] 王迁 赵岩[2] 侍效春 Ma Ya'nan;Zhang Lifan;Liu Xiaoqing;Wang Qian;Zhao Yan;Shi Xiaochun(Division of Infectious Diseases,Department of Internal Medicine,State Key Laboratory of Complex Severe and Rare Disease,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院、疑难重症及罕见病国家重点实验室感染内科,100730 [2]中国医学科学院、北京协和医学院、北京协和医院风湿免疫科、国家皮肤与免疫疾病临床医学研究中心、疑难重症及罕见病国家重点实验室、风湿免疫病学教育部重点实验室,100730

出　　处：《北京医学》2023年第1期1-6,共6页Beijing Medical Journal

基　　金：“十二五”国家科技重大专项(2014ZX10003003);“十三五”国家科技重大专项(2017ZX10201302-003);中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-013、2019-I2M-2-005)。

摘　　要：目的探讨我国部分地区风湿免疫病患者预防性抗结核治疗的现状,为进一步规范结核感染高风险患者的预防与管理提供依据。方法选取2014年3月至2016年2月我国东、中、西部13家三级甲等综合医院就诊的接受预防性抗结核治疗的风湿免疫病患者,分析患者风湿免疫病的类型及系统受累情况、结核活动危险因素、预防性抗结核治疗方案及活动性结核病的发生情况。结果共纳入109例进行预防性抗结核治疗的患者,其中男42例(38.5%),女67例(61.5%);平均年龄(46.5±14.0)岁;患者有13种风湿免疫病类型,以类风湿关节炎(27.5%)、系统性红斑狼疮(22.0%)及强直性脊柱炎(22.0%)为主,以皮肤、关节、肾脏和血液系统受累多见。71.6%的患者合并至少1项结核活动的危险因素,其中14例患者接受了TNF-α拮抗剂治疗,将应用TNF-α拮抗剂且存在潜伏结核感染风险的患者作为预防性抗结核治疗的目标人群,仅有5例(5/14,35.7%)。101例患者预防性抗结核治疗方案包括1~4种抗结核药物,以应用单药(37/101,36.6%)和二联(38/101,37.6%)方案为主。单药方案中以异烟肼(32/37,86.5%)为主,疗程1~18个月,中位疗程2个月;二联方案中以异烟肼联合利福霉素(30/38,78.9%)为主,疗程1~24个月,中位疗程2个月。2例(1.8%)发生活动性结核病。结论我国风湿免疫病患者预防性抗结核治疗尚不规范,建议进一步规范预防性干预的目标人群和干预方案,提升风湿免疫病患者预防性抗结核治疗的诊疗水平。Objective To explore the current situation of preventive anti-tuberculosis treatment for patients with rheumatic immune diseases in some areas of China,and to provide basis for further standardizing the prevention and management of patients with high risks of tuberculosis infection.Methods Patients with rheumatic immune diseases who received preventive anti-tuberculosis treatment in 13 tertiary first-class general hospitals in eastern,central and western China from March 2014 to February 2016 were selected.The types of rheumatic immune diseases,systemic involvement,risk factors of tuberculosis activity,preventive anti-tuberculosis treatment scheme and the occurrence of active tuberculosis of the patients were analyzed.Results A total of 109 patients were enrolled,including 42 males(38.5%),and 67 females(61.5%),with an average age of(46.5±14.0)years old.There were 13 different types of rheumatic immune diseases,mainly rheumatoid arthritis(27.5%),systemic lupus erythematosus(22.0%),and ankylosing spondylitis(22.0%).The involvement of skin,joint,kidney and blood system were more common.71.6%of the patients had at least one risk factor for tuberculosis,of which 14 patients had received TNF-αantagonist treatment,only five patients(5/14,35.7%)who used TNF-αantagonist and had latent tuberculosis infection risk were targeted for preventive anti-tuberculosis treatment.The preventive anti-tuberculosis treatment scheme for 101 patients included 1~4 anti-tuberculosis drugs,mainly single drug(37/101,36.6%)and double drug(38/101,37.6%).Isoniazid(32/37,86.5%)was the main drug in the single-drug regimen,with a course of 1~18 months and a median course of two months.Isoniazid combined with rifamycin(30/38,78.9%)was the main drug in the doubledrug regimen,with a course of treatment of 1~24 months and a median course of treatment of two months.Two cases(1.8%)developed active tuberculosis.Conclusions Preventive anti-tuberculosis treatment for patients with rheumatic immune diseases in China is still not standardized.It is suggest

关 键 词：风湿免疫病 预防性抗结核 活动性结核病 早期干预 

分 类 号：R593.2[医药卫生—内科学]