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OACSTPCD

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.