类风湿关节炎患者发生潜伏性结核感染的多因素分析

Multivariate analysis of latent tuberculosis infection in patients with rheumatoid arthritis

目的类风湿关节炎患者免疫功能低下,易发生潜伏性结核感染(LTBI),诊断和治疗结核潜伏感染是消除结核病的关键。本研究探讨类风湿关节炎(RA)患者发生LTBI的危险因素,为临床抗结核防治措施提供依据。方法回顾性调查本院经行结核γ-干扰素释放实验,且经其他检查排除活动性结核病的RA患者165例,其中LTBI组59例,对照组106例。收集患者临床资料,包括年龄、性别、病程、免疫抑制剂治疗情况、吸烟史和实验室常规指标,采用单因素和二元logistic回归分析影响RA患者发生LTBI的因素。结果165例RA患者中,年龄>40岁发生LTBI高于年龄≤40岁的患者(41.9%vs.25.0%),差异有统计学意义(P<0.05);LTBI组补体C3、C4水平、单核细胞计数均高于对照组,差异有统计学意义(P<0.05);165例RA患者中,仅有80例进行了淋巴细胞免疫功能的检测,其中LTBI组CD4+/CD8+、NK细胞计数均显著高于对照组,差异有统计学意义(P<0.05)。二元logistic回归分析显示补体C4、年龄(>40岁)和单核细胞计数对RA患者发生LTBI的影响差异有统计学意义(P<0.05)。结论补体C4水平、单核细胞计数和年龄(>40岁)是影响RA患者发生LTBI的独立危险因素,患者年龄(>40岁)越大、补体C4和单核细胞计数越高,发生LTBI的风险越大。

Objective Patients with rheumatoid arthritis(RA)are immunocompromised and prone to latent tuberculosis infection(LTBI).The diagnosis and treatment of LTBI are the key to eliminate TB.This study aims to investigate the risk factors of LTBI in patients with RA and provide the basis for clinical anti-tuberculosis prevention and treatment.Methods A total of 165 cases of RA with active tuberculosis were investigated retrospectively,including 59 cases in LTBI group and 106 cases in control group.Clinical data were collected,including age,sex,disease duration,immunosuppressive therapy,smoking history,and laboratory routine parameters,and univariate and binary logistic regression were used to analyze the factors affecting LTBI in RA patients.Results Among 165 RA patients,the incidence of LTBI was higher in patients aged>40 years(41.9%)than in patients aged≤40 years(25.0%).Complement C3,C4 levels,and monocyte count in the LTBI group were higher than those in the control group,and the differences were statistically significant(P<0.05);Among 165 RA patients,only 80 patients were tested for lymphocyte immune function,and CD4+/CD8+and NK cell counts in the LTBI group were significantly higher than those in the control group(P<0.05).Binary logistic regression analysis showed that complement C4,age(>40 years),and monocyte count had a statistically significant effect on the probability of LTBI in patients with RA(P<0.05).Conclusion Complement C4 level,monocyte count and age(>40 years)are independent risk factors of LTBI in RA patients.The older the age(>40 years),the higher the complement C4 and monocyte count,the greater the risk of lLTBI.