风湿免疫病患者结核分枝杆菌潜伏感染率及相关影响因素的多中心横断面研究  

Latent tuberculosis infection rate and risk factors in patients with rheumatic diseases:a multi-center,cross-sectional study

作　　者：张丽帆[1,2,3] 马亚楠 邹小青 张月秋[1] 张奉春 曾小峰 赵岩 刘升云[6] 左晓霞[7] 吴华香[8] 武丽君[9] 李鸿斌[10] 张志毅[11] 陈盛[12] 朱平[13] 张缪佳[14] 齐文成[15] 刘毅[16] 刘花香[17] 侍效春[1,3] 刘晓清[1,2,3] 中国风湿免疫病人群活动性结核病的流行病学调查和治疗效果及预后研究课题组 Zhang Lifan;Ma Yanan;Zou Xiaoqing;Zhang Yueqiu;Zhang Fengchun;Zeng Xiaofeng;Zhao Yan;Liu Shengyun;Zuo Xiaoxia;Wu Huaxiang;Wu Lijun;Li Hongbin;Zhang Zhiyi;Chen Sheng;Zhu Ping;Zhang Miaojia;Qi Wencheng;Liu Yi;Liu Huaxiang;Shi Xiaochun;Liu Xiaoqing;the Epidemiological Study and Therapeutic Evaluation of Rheumatic Patients with Tuberculosis Study Team(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;Clinical Epidemiology Unit,International Epidemiology Network,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Centre for Tuberculosis Research,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;School of Population Medicine and Public Health,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Clinical Research Center for Dermatologic and Immunologic Diseases,State Key Laboratory of Complex Severe and Rare Disease,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Beijing 100730,China;Department of Rheumatology and Immunology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Rheumatology and Immunology,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Rheumatology,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Rheumatology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Department of Rheumatology and Immunology,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,China;Department of Rheumatology and Immunology,The First Affiliated Hospital of H

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,北京100730 [2]中国医学科学院北京协和医学院,国际临床流行病学网,临床流行病学教研室,北京100730 [3]中国医学科学院北京协和医学院结核病研究中心,北京100730 [4]中国医学科学院北京协和医学院群医学与公共卫生学院,北京100730 [5]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,北京100730 [6]郑州大学第一附属医院风湿免疫科,郑州450052 [7]中南大学湘雅医院风湿免疫科,长沙410008 [8]浙江大学医学院附属第二医院风湿免疫科,杭州310009 [9]新疆维吾尔自治区人民医院风湿免疫科,乌鲁木齐830001 [10]内蒙古医科大学附属医院风湿免疫科,呼和浩特010000 [11]哈尔滨医科大学附属第一医院风湿免疫科,哈尔滨150001 [12]上海交通大学医学院附属仁济医院风湿免疫科,上海200001 [13]第四军医大学西京医院临床免疫科,西安710032 [14]南京医科大学第一附属医院风湿免疫科,南京210029 [15]天津市第一中心医院风湿免疫科,天津300192 [16]四川大学华西医院风湿免疫科,成都610041 [17]山东大学齐鲁医院风湿免疫科,济南250012 [18]不详

出　　处：《中国防痨杂志》2024年第1期29-39,共11页Chinese Journal of Antituberculosis

基　　金：中央高水平医院临床科研专项(2022-PUMCH-C-013);“十三五”国家科技重大专项(2017ZX10201302);“十二五”国家科技重大专项(2014ZX10003003)。

摘　　要：目的:以结核感染T细胞斑点试验(T-SPOT.TB)检测作为筛查结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)的工具,调查我国风湿免疫病患者结核分枝杆菌潜伏感染率,并分析影响T-SPOT.TB检测结果的相关因素。方法:纳入自2014年9月至2016年3月我国东、中、西部13家三级甲等综合医院接诊的风湿免疫病患者作为研究对象,共计3715例。应用T-SPOT.TB对研究对象进行LTBI筛查。收集研究对象的基本信息,包括性别、年龄、地区、体质量指数、病程、吸烟史、基础疾病、结核病患者密切接触史、结核病既往史,以及糖皮质激素、免疫抑制剂及生物制剂的使用情况,实验室化验结果,风湿免疫病诊断结果等。采用单因素及多因素logistic回归模型分析影响T-SPOT.TB检测结果的因素。结果:3715例研究对象T-SPOT.TB检测阳性者有672例(18.1%,95%CI:16.9%~19.3%)。不同风湿免疫病病种患者T-SPOT.TB检测阳性率差异有统计学意义(χ^(2)=79.003,P<0.001),白塞综合征患者检测阳性率最高(44.4%,32/72),混合性结缔组织病患者检测阳性率最低(8.9%,4/45)。男性风湿免疫病患者T-SPOT.TB检测阳性率为23.6%(168/711),明显高于女性(16.8%,504/3004),差异有统计学意义(χ^(2)=18.213,P<0.001)。不同年龄组风湿免疫病患者T-SPOT.TB检测阳性率差异有统计学意义(χ^(2)=67.189,P<0.001),51~60岁组检测阳性率最高(24.8%,143/577),16~20岁组检测阳性率最低(8.1%,13/160)。多因素logistic回归分析显示:年龄≥41岁(aOR=1.81,95%CI:1.48~2.23),吸烟≥21支/d(aOR=1.66,95%CI:1.15~2.40),有结核病既往史(aOR=3.88,95%CI:2.71~5.57),患白塞综合征(aOR=3.00,95%CI:1.70~5.28)是T-SPOT.TB检测阳性结果的独立相关因素;使用大剂量激素(aOR=0.67,95%CI:0.47~0.96)或生物制剂(aOR=0.55,95%CI:0.36~0.84),淋巴细胞计数偏低(aOR=0.39,95%CI:0.25~0.62),低蛋白血症(aOR=0.72,95%CI:0.52~0.99),以及患多发性肌炎/皮肌炎(aOR=0.54,95%CI:0.29~0.99)、系Objective:This study aimed to screen latent tuberculosis infection(LTBI)among patients with rheumatic diseases in China using the T-SPOT.TB assay and investigate factors affecting the results of T-SPOT.TB.Methods:Rheumatic diseases patients(n=3715)were enrolled from 13 tertiary hospitals in Eastern,Middle,and Western China from September 2014 to March 2016 and were screened by the T-SPOT.TB assay to detect LTBI.Basic information about the subjects were collected,including gender,age,region,body mass index,course of disease,smoking history,underlying disease,close contact history of tuberculosis patients,evidence of previous tuberculosis,the use of glucocorticoids,immunosuppressants and biologics,laboratory tests,and diagnosis of rheumatic disease,etc.Univariate analysis and multivariable logistic regression were performed to identify factors affecting the results of T-SPOT.TB.Results:out Of the 3715 patients,672 were positive in T-SPOT.TB,the positive rate was 18.1%(95%CI:16.9%-19.3%).There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with different types of rheumatic immune diseases(χ^(2)=79.003,P<0.001),patients with Behcet’s syndrome had the highest positive rate(44.4%,32/72),while patients with mixed connective tissue disease had the lowest positive rate(8.9%,4/45).The positive rate of T-SPOT.TB test in male patients with rheumatic immune disease was 23.6%(168/711),which was significantly higher than that in females(16.8%,504/3004,χ^(2)=18.213,P<0.001).There was a statistically significant difference in the positive rate of T-SPOT.TB test among patients with rheumatic immune disease in different age groups(χ^(2)=67.189,P<0.001),the 51-60 years old group had the highest positive rate(24.8%,143/577),while the 16-20 years old group had the lowest positive rate(8.1%,13/160).Multivariate logistic regression analysis showed that age≥41 years(aOR=1.81,95%CI:1.48-2.23),smoking≥21 cigarettes/d(aOR=1.66,95%CI:1.15-2.40),previous history of tuberculosis(aOR=3.

关 键 词：风湿性疾病 分枝杆菌 结核 感染 免疫学技术 横断面研究 

分 类 号：R593[医药卫生—内科学] R52[医药卫生—临床医学]