类风湿关节炎合并结核感染的临床特点及相关因素

Clinical characteristics and related factors of rheumatoid arthritis complicated with tuberculosis infection

目的:探讨类风湿关节炎合并结核感染的临床特点及高危因素。方法:回顾性收集2007年1月至2017年1月在四川省人民医院住院确诊的类风湿关节炎(rheumatoid arthritis,RA)合并结核感染的患者作为感染组,以1∶2比例从同期住院的RA患者未合并感染的患者中随机抽取对照组,详细收集其一般资料、临床数据、实验室检查数据、治疗方案等进行单因素分析,并对差异有统计学意义的因素进行多因素Logistic回归分析。结果:感染组临床表现以发热(83.3%)最为常见,其次为咳嗽(69%)及体质量下降(45.2%)。感染部位以肺结核居多,占73.3%,肺结核患者胸部CT表现二种及以上占59%,发生在典型结核发生部位的仅有9例(33.3%)。单因素分析中,感染组与对照组相比,红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reaction protein,CRP)水平、1年内激素使用日均剂量均高于对照组,差异有统计学意义(P<0.05),而性别、年龄、病程、疾病活动度评分、白细胞计数(white blood cell,WBC)、血小板计数(platelet,PLT)、血红蛋白(hemoglobin,HGB)、免疫球蛋白G(immunoglobulin G,IgG)、补体(complement,C)、抗环瓜氨酸肽抗体(anti cyclic citrullinated peptide antibody,anti-CCP)、CD4+T细胞计数、免疫抑制剂使用等方面差异无统计学意义(P>0.05)。多因素Logistics回归分析提示CRP(OR=1.016,95%CI:1.002~1.031)、1年内激素使用日均剂量(OR=1.229,95%CI:1.066~1.418)水平为RA合并结核感染的独立危险因素。结论:RA合并结核感染患者以肺结核为主;RA合并结核感染临床表现缺乏特异性,且肺结核胸部影像学表现呈多样性,容易误诊;CRP及1年内激素使用日均剂量是RA合并结核感染的独立危险因素。

Objective:To investigate the clinical characteristics and high risk factors of Rheumatoid arthritis(RA)complicated with tuberculosis infection.Methods:Patients with rheumatoid arthritis diagnosed in the hospital of Sichuan Provincial People’s Hospital from January 2007 to January 2017 was retrospectively collected,who were enrolled in the study group.A control group was randomly selected from the RA patients hospitalized in the same period without co-infection at a ratio of 1∶2.The general data,clinical data,laboratory test data,treatment plan,etc.of the two groups were collected in detail for single factor statistical analysis.Then multivariate Logistic regression was used to analyze the independent risk factors of RA complicated with tuberculosis infection with statistical significance in univariate analysis.Results:The clinical manifestations of fever(83.3%)were most common,followed by cough(69%)and body mass loss(45.2%).In the infected group,pulmonary tuberculosis accounted for 73.3%.In the infected group the chest CT showed two or more cases,accounting for 59%.There were 9 cases(33.3%)occurring in the typical tuberculosis occurrence site.Compared with the control group,the erythrocyte sedimentation rate(ESR),C-reaction protein(CRP)levels,and the daily average dose of glucocorticoid in 1 year in the infected group were higher than those in the control group.And those differences were statistically significant(P<0.05).There were no significant differences in gender,age,disease duration,disease activity score,white blood cell(WBC),platelet(PLT),hemoglobin(Hb),immunoglobulin G(IgG),complement(C),Anti cyclic citrullinated peptide antibody(anti-CCP),CD4+T cell count,and immunosuppressant use(P>0.05).Multivariate Logistic regression analysis showed that CRP levels(OR=1.016,95%CI:1.002-1.031)and the daily average dose of glucocorticoid in 1 year(OR=1.229,95%CI:1.066-1.418)were the independent risk factors of RA complica-ted with tuberculosis infection.Conclusion:RA patients with tuberculosis infection are mainly phthisis.The clinical manifestations of RA combined with tuberculosis infection are lack of specificity,and the chest imaging features of pulmonary tuberculosis are diverse,which are easy to be misdiagnosed.CRP levels and the daily average dose level of glucocorticoid in 1 year were risk factors for RA and tuberculosis infection.