TNF-α拮抗剂影响IMID患者结核感染风险的追踪研究  

A Follow-up Investigation of the Effect of TNF-α Antagonists on the Risk of Tuberculosis Infection in IMID Patients

作　　者：赵志鹏[1] 唐婧 颜妍 赵秀英[1] ZHAO Zhipeng;TANG Jing;YAN Yan;ZHAO Xiuying(Laboratory Medicine Department,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghu University,Beijing 100044,China;Pharmaceutical Department,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghu University,Beijing 100044,China)

机构地区：[1]清华大学附属北京清华长庚医院,清华大学临床医学院检验医学科,北京102218 [2]清华大学附属北京清华长庚医院,清华大学临床医学院药学部,北京102218

出　　处：《标记免疫分析与临床》2023年第7期1106-1109,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的基于γ干扰素释放试验(IGRAs)结果,探讨免疫介导的炎症性疾病患者(immune-mediated inflammatory diseases,IMID)应用TNF-α拮抗剂后发生结核感染的风险,以期为临床预防性治疗提供参考和借鉴。方法对比分析健康对照组(a组)、IMID患者用药前组(b组)、用药后组(c组)以及阳转病例观察组(d组)的IGRAs结果,评估TNF-α拮抗剂的应用对患有IMID患者感染结核风险的影响。结果健康对照组和用药前组IGRAs阳性率之间差异无统计学意义(P ab=0.521);用药后组IGRAs阳性率显著高于健康对照组和用药前组(P ac=0.002,P bc=0.003);用药后发生IGRAs由阴性转为阳性的阳转率为30.56%,显著高于健康对照组的阳性率(P ad=0.042)。平均阳转时间为17个月,但发生阳转的11例病例均无结核相关症状,且均未获得能够确诊的病原学证据或影像学证据。结论患有IMID不是结核感染的高风险因素;应用TNF-α拮抗剂会增加感染结核的风险,但以潜伏性结核感染为主要形式;预防性抗结核治疗的价值有待进一步评估。Objective Based on the results of gamma-interferon release assay(IGRAs),we studied the risk of tuberculosis infection in patients with immune-mediated inflammatory diseases(IMID)after TNF-αantagonist intervention,in order to provide knowledge reference for clinical preventive therapy.Methods IGRAs results of the healthy control group,untreated IMID patients group,treated IMID patients group,and observation group of negative to positive cases,were compared and analyzed to evaluate the effect of TNF-αantagonist intervention on the risk of tuberculosis infection in patients with IMID.Results The positive rates of IGRAs between the healthy control group and untreated IMID patients group showed no significant differencere(P ab=0.521);The positive rate of IGRAs in the treated IMID patients group c was significantly higher than that in the healthy control group and untreated IMID patients group(P ac=0.002;P bc=0.003);The rate of IGRAs from negative to positive was 30.56%in the observation group d,which was significantly higher than that of the healthy control group(P ad=0.042);The average duration from negative to positive was 16 months,while none of the 11 cases with positive rotation had symptoms related to tuberculosis,and no etiological evidence or imaging evidence was obtained.Conclusion IMID is not a high risk factor for TB infection;The use of TNF-αantagonists increases the risk of TB infection;Latent tuberculosis infection is the main form.The value of prophylactic antituberculosis therapy needs to be further evaluated.

关 键 词：TNF-α拮抗剂 免疫介导的炎症性疾病 干扰素-Γ 结核潜伏感染 IGRAs 

分 类 号：R52[医药卫生—内科学]