白塞综合征与结核感染的关联  

Behçet’s syndrome and its association with tuberculosis infection

作　　者：王洁 敖懿源[1] 赵丽丹 刘晓清 郑文洁[1] WANG Jie;AO Yi-yuan;ZHAO Li-dan;LIU Xiao-qing;ZHNEG Wen-jie(Department of Rheumatology and Clinical Immunology,Key Laboratory of Rheumatology and Immunology,Ministry of Education,State Key Laboratory of Complex Severe and Rare Diseases,Ministry of Science&Technology,National Clinical Research Center for Dermatology and Immunology Diseases(NCRC-DID);Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Rheumatology,Shanxi Provincial People’s Hospital)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院风湿免疫科,风湿免疫病学教育部重点实验室,疑难重症及罕见病国家重点实验室,国家皮肤与免疫疾病临床医学研究中心,北京100730 [2]北京协和医院感染科 [3]山西省人民医院风湿免疫科

出　　处：《中华临床免疫和变态反应杂志》2024年第1期51-56,共6页Chinese Journal of Allergy & Clinical Immunology

基　　金：中央高水平医院临床科研业务费资助项目(2022-PUMCH-C-013);国家自然科学基金资助项目(82171800,82371822)。

摘　　要：白塞综合征(Behçet’s syndrome,BS)是一种病因未明的慢性、复发性、系统性血管炎。结核菌(mycobacterium tuberculosis,Mtb)感染同时触发和放大炎症反应和免疫反应,促进BS的发生发展。结核病(tuberculosis,TB)和BS多种相似的临床表现易造成临床诊断和鉴别的困难。同时,在治疗BS的过程中,使用糖皮质激素、免疫抑制剂和生物制剂造成固有免疫和适应免疫缺陷,增加TB机会感染或再激活风险,对BS合并TB感染的诊疗提出了挑战。本文围绕BS和TB的发病机制及潜在相关性、临床表现要点、结核感染T细胞斑点试验(T-SPOT.TB)检验价值及治疗药物对TB感染再发风险进行讨论,重视BS在发生、发展中TB感染的问题,早期识别。Behçet’s syndrome(BS)is a chronic,recurrent,systemic vasculitis of unknown etiology.Mycobacterium tuberculosis(Mtb)infection triggers and amplifies both inflammatory and immune responses,promoting the development of BS.The similar clinical manifestations of tuberculosis(TB)and BS make clinical diagnosis and differentiation difficult.At the same time,the use of glucocorticoids,immunosuppressants and biologic agents in the treatment of BS can cause defects in innate and adaptive immunity,increasing the risk of opportunistic TB infection or reactivation,which poses a challenge to the diagnosis and treatment of BS combined with TB infection.We mainly discuss the pathogenetic and underlying relevance between TB and BS,the clinical manifestations of BS and TB infection,the value of the T-SPOT.TB assays,and the risk of recurrent TB infection with therapeutic drugs.This review focuses on TB infection during the development of BS and aims to improve the early identification of TB infection in the BS patients.

关 键 词：白塞综合征 结核菌感染 临床表现 鉴别诊断 

分 类 号：R597[医药卫生—内科学] R52[医药卫生—临床医学]