肿瘤坏死因子抑制剂致风湿免疫性疾病患者结核病风险增加的研究进展

Recent advances in the use of tumor necrosis factor inhibitors to increase the risk of tuberculosis among patients with rheumatic immune diseases

肿瘤坏死因子(TNF-α)抑制剂是治疗风湿免疫性疾病的常用药物,其使用与结核病风险增加有关。结核高风险患者考虑接受TNF-α抑制剂治疗时,推荐使用如依那西普等融合蛋白类TNF-α抑制剂,其次考虑单克隆抗体类TNF-α抑制剂,如英夫利西单克隆抗体和阿达木单克隆抗体等。在开始TNF-α抑制剂治疗前,应对患者进行潜伏性结核感染筛查,在治疗过程中应监测结核病的症状和体征。本文对抗TNF-α治疗致风湿免疫疾病患者结核病风险增加的流行病学、致病机制、筛查及治疗策略等进行综述。

Tumor necrosis factor(TNF-α)inhibitors are common agents to treat rheumatic immune diseases,and their application is associated with an increased risk of tuberculosis.Therefore,when patients at high risk of tuberculosis are considered for the treatment with TNF-αinhibitors,fusion protein-based TNF-αinhibitors such as etanercept are recommended,followed by monoclonal antibody-based TNF-αinhibitors such as infliximab and adalimumab.Before starting TNF-αinhibitor therapy,patients should be screened for latent tuberculosis infection and be monitored for signs and symptoms of tuberculosis.In this article,the epidemiology,pathogenesis,screening and treatment strategies of the increased risk of tuberculosis caused by TNF-αinhibitors in patients with rheumatic immune diseases are reviewed.