中国防痨杂志2024，Vol.46Issue(1)：29-39,11.DOI:10.19982/j.issn.1000-6621.20230207
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
摘要
Abstract
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(x2=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,x2=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(x2=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=3.88,95％CI:2.71-5.57),and Behcet's syndrome(aOR=3.00,95％CI:1.70-5.28)were independent related factors of T-SPOT.TB positive results;using high-dose hormones(aOR=0.67,95％CI:0.47-0.96)or biological agents(aOR=0.55,95％CI:0.36-0.84),low lymphocyte count(aOR=0.39,95％CI:0.25-0.62),hypoalbuminemia(aOR=0.72,95％CI:0.52-0.99),and multiple myositis/dermatomyositis(aOR=0.54,95％CI:0.29-0.99),systemic lupus erythematosus(aOR=0.75,95％CI:0.57-0.99)were independent correlation factors for negative T-SPOT.TB test results.Conclusion:Among patients with rheumatic diseases,the overall prevalence of LTBI is 18.1％.There is a significant difference in the positive rate of T-SPOT.TB test among different diseases.When patients are treated with high-dose glucocorticoids or biologics,have low lymphocyte counts,hypoalbuminemia,or suffer from systemic lupus erythematosus,more attention should be paid to potential false-negative results.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Key words
Rheumatic diseases/Mycobacterium tuberculosis/Infection/Immunologic techniques/Cross-sectional studies分类
医药卫生引用本文复制引用
张丽帆,吴华香,武丽君,李鸿斌,张志毅,陈盛,朱平,张缪佳,齐文成,刘毅,刘花香,马亚楠,侍效春,刘晓清,邹小青,张月秋,张奉春,曾小峰,赵岩,刘升云,左晓霞..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[J].中国防痨杂志,2024,46(1):29-39,11.基金项目
Central High Level Hospital Clinical Research Project(2022-PUMCH-C-013) （2022-PUMCH-C-013）
National Major Science and Technology Special Project for the 13th Five Year Plan(2017ZX10201302) （2017ZX10201302）
National Science and Technology Major Special Project for the 12th Five Year Plan(2014ZX10003003)中央高水平医院临床科研专项(2022-PUMCH-C-013) （2014ZX10003003）
"十三五"国家科技重大专项(2017ZX10201302) （2017ZX10201302）
"十二五"国家科技重大专项(2014ZX10003003) （2014ZX10003003）
