系统性红斑狼疮并结核病临床观察

Chinic observation on systemic lupus erythematosus associated tuberculosis

目的分析总结系统性红斑狼疮(SLE)患者中结核病的发生率、临床特征以及其发病的危险因素和预后.方法研究分析了1995至2004年期间在我院随诊的915例SLE者中的42例并发结核病的患者,结核病的诊断包括临床表现、影像学检查、生化检查、微生物学及组织学检查,并记录其受累器官、治疗药物以及疗效.结果42例患者中33例女性,9例男性,年龄16～52岁(平均28岁),病程2月至6年(平均26月),临床表现主要为发热(42例)、咳嗽(25例)、骨关节痛(15例)、淋巴结肿大(8例)和头痛(4例).受累器官包括肺32例(76.2%),肺外结核者18例(42.9%),其中结核性脑膜炎6例、骨关节结核4例、结核性腹膜炎2例和淋巴结结核6例.单器官受累者34例,其中一例经经验性治疗后好转,多器官受累者8例.仅4例患者结核菌素试验阳性,其阳性率9.5%.全部患者在诊断结核病前均经过大剂量糖皮质激素的治疗.41例患者经联合抗痨治疗(INH+Rif+Eth或+Pyra),仅1例经INH+Rif+Eth治疗1月后改左氧氟沙星治疗2年,39例抗痨治疗后痊愈.结论SLE患者结核病以及肺外结核的发生率均明显增高.强的松使用可能与结核病的发生相关.早期诊断较困难,抗痨治疗有效.

Objective The aim of this retrospective study was to evaluate the incidence of tuberculosis （TB） in patients with systemic lupus erythematosus （SLE） and to determine its clinical features, prognosis and risk factors of its morbidity.Methods The study included 42 TB patients among 915 SLE patients who were followed up between 1995 and 2004 in our hospital. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological and histological examinations. Organ system involvement, treatment with anti-TB drugs and the results of therapy were noted. Restilts There were 33 females and 9 males with age ranges of 16-52 years（mean 28 years） .Their duration in SLE ranged from 2 months to 6 years （mean 26 months）. The presenting clinical features were fever（42）, cough （25）, bone ache （15）, lymph node enlargement （8） and headache（4）. The organ systems involved were pulmonary（32）, meninges（6）, bone and joints（4）, peritoneal（2） and lymphadenopathy（6） .The proportion of extrapulmonary TB in these patients was 42.9%. Single organ system involvement was noted in 34 patients and multi-systems in 8 patients. One patient were treated empirically with good response. A positive tuberculin test was observed in only 9.5 % patients. All patients were treated with high dose glucocorticoid before the diagnosis of TB. 41 patients received 3 or 4 anti-TB drugs： isoniazid （INH）, rifampicin （Rif）, ethambutol （Eth） and/or pyrazinamide （Pyra）,only 1 patient were treated with levofloxacin after treatment with （INH ＋ Eth ＋ Rif） for one month, and 39 patients were cured. Conclusions The incidences of TB infection and extrapulmonary TB in SLE patients are increased. Early diagnosis is difficulty and chemotherapy is effective. The usage of predinisone may be an important determinants for the increased risk of TB in these patients with SLE.