不同类型风湿性疾病合并结核病临床特点分析

A study of clinical characteristics of tuberculosis in patients with different types of rheumatic diseases

目的了解不同类型风湿性疾病患者合并结核病的临床特点,为临床诊治提供参考。方法收集并分析2012年1月至2018年12月深圳市第三人民医院诊断为风湿性疾病并发结核病患者220例和同期单纯结核病(无合并症)患者95例,比较不同类型风湿性疾病合并结核病患者的临床特点。结果220例风湿性疾病合并结核病患者中,系统性红斑狼疮(SLE)患者占29.10%(64/220);类风湿性关节炎(RA)患者占35.91%(79/220);强直性脊柱炎(AS)患者占15.91%(35/220);干燥综合征(SS)患者占10.00%(22/220);银屑病(PSO)患者占5.45%(12/220);皮肌炎(DM)患者3.63%(8/220)。在性别分布上,SLE、SS、DM以女性发病为主,RA、AS、PSO以男性为主(均P<0.0033);在年龄分布上,SLE以青壮年发病为主,RA、SS、PSO以中老年为主(均P<0.0033);在病原学检测上,TB-DNA阳性率仅AS和DM间差异有统计学意义(P<0.0033),抗酸杆菌涂片阳性率RA与AS间差异有统计学意义(P<0.0033)。与普通结核病患者比较,风湿性疾病合并结核病患者在性别构成、年龄构成、结核类型、初治或复治、γ-干扰素释放试验阳性率、GeneXpert、TB-DNA、分枝杆菌培养阳性等方面差异均有统计学意义(均P<0.05)。结论在不同类型风湿性疾病患者合并结核病中,SLE、SS、DM以女性发病为主,而RA、AS、银屑病以男性为主;风湿性疾病合并结核病患者γ-干扰素释放试验阳性率、病原学检出率均低于普通结核病患者。

Objective To investigate the clinical characteristics of tuberculosis in patients with different rheumatic diseases,and to provide reference for clinical diagnosis and treatment.Methods Medical records for 220 tuberculosis patients with different rheumatic diseases and 95 ordinary tuberculosis patients in the Third People’s Hospital of Shenzhen from January 2012 to December 2018 were retrieved.Clinical characteristics between patients of different rheumatic diseases and patients were described.Result Among 220 patients with rheumatic diseases and tuberculosis,there were 29.10%(64/220)tuberculosis patients with systemic lupus erythematosus(SLE);35.91%(79/220)with rheumatoid arthritis(RA);15.91%(35/220)with ankylosing spondylitis(AS);10.00%(22/220)with sicca syndrome(SS);5.45%(12/220)with of psoriasis;3.63%(8/220)with dermatomyositis(DM).In terms of gender distribution,most patients with SLE or SS or DM were female while most patients with AS and psoriasis were male.In terms of age distribution,most patients with SLE were young adults while most patients with RA,SS and PSO were middle-aged and elderly(P<0.0033).In the detection of pathogens,the positive rate of TB-DNA was only statistically different between AS and DM(P<0.0033),and there was a statistical difference of acid-fast bacilli smear positive rate between RA and AS(P<0.0033).Compared to ordinary tuberculosis patients,there were statistical differences in sex,age,tuberculosis type,initial treatment or re-treatment,the positive rate of interferon-gamma release assays,GeneXpert,TB-DNA and mycobacterium culture(P<0.05).Conclusion Tuberculosis patients with SLE,SS and DM are mainly female,while with RA,AS and psoriasis are mainly male;Comparing to ordinary tuberculosis patients,patients with rheumatic diseases have lower positive rate of interferon-gamma release test and lower positive rate of pathogen.