系统性红斑狼疮伴结核菌感染临床特点分析

The tuberculosis infection in patients with systemic lupus erythematosus

目的分析系统性红斑狼疮(SLE)并发结核菌感染的临床特点。方法分析我院自1991年1月至2004年1月共收治的426例SLE住院患者。结果426例SLE患者中18例伴有结核,患病率为4.2%,死亡7,例病死率为39%。明显高于普通人群。其中肺结核12,例结核性脑膜炎例淋3,巴结核3例。18例做结核菌素试验纯蛋白衍生物(PPD)强阳性2例(12.5%),阴性16例(87.5%),结核菌素试验PPD阴性率明显高于正常人群。15/18(83%)患者在应用免疫抑制剂6个月～3年内患结核。结论SLE患者由于长期服用免疫抑制剂,易发生结核菌感染且临床表现不典型。其患病率及病死率均明显高于普通人群,因此对结核菌感染的早期诊治对降低病死率十分重要。

Objective To investigate the prevalence and clinical features of tuberculosis (TB) infection in patients with systemic lupus erythematosus (SLE). Methods Four hundred and twenty-six patients with SLE in our hospital from 1991 to 2004 were analyzed. Results TB was found in 18/426 (4.2%) patients and 7 (39%) of them died. The morbidity and mortality was obviously higher than in normal peoples. Of all 18 patients, 12, 3, 3 cases suffered pulmonary tuberculosis, tuberculo-meningitis and lymphy node tuberculosis respectively. Tuberculin test was strong positive in 2/18 (12.5%) patients and negative in 16/18 (87.5%) patients. The negative rate was significantly higher compared with normal peoples. Fifteen (83%) cases were diagnosed TB infection after taken immunosuppressive agents for 6～36 months. Conclusion Because of long-term immunosuppressive agents therapy, patients with SLE are prone to tuberculosis infection. The clinical manifestation is not always typical and the morbidity and mortality is high. Early detection of TB infection is important.