中国风湿免疫病患者活动性结核病患病情况多中心横断面研究:亚组分析

Prevalence of active tuberculosis in Chinese patients with rheumatic diseases:A multicenter cross-sectional subgroup analysis

目的:了解中国风湿免疫病(rheumatic diseases,RD)患者活动性结核病(active tuberculosis,ATB)的患病情况。方法:采用分层多阶段整群抽样方法,纳入2014年9月至2016年3月期间,来自全国东、中、西部13家三级甲等综合医院的进行ATB筛查的RD患者作为调查对象,共计13550例。估算RD患者的ATB患病率,并按照RD病种、患者年龄和性别进行亚组分析。结果:13550例调查对象中,105例合并ATB,其中,48例(45.7%)无咳嗽、咳痰、发热、盗汗、体质量减轻表现;在病原学和(或)组织病理学确诊的ATB患者中,无症状者占35.3%(12/34);在菌阳肺结核患者中,无症状者占30.8%(8/26)。累及肺外部位的结核病有41例(39.0%),其中单纯肺外结核28例(68.3%),肺结核合并肺外结核13例(31.7%)。亚组分析结果显示,系统性血管炎综合征患者ATB患病率最高,为1915/10万(13/679,95%CI:881/10万~2948/10万),其次为弥漫性结缔组织病患者(1002/10万,58/5789,95%CI:745/10万~1259/10万)。RD患者中16~34岁组ATB患病率最高,为1162/10万(43/3700,95%CI:817/10万~1508/10万),男性ATB患病率为919/10万(30/3264,95%CI:592/10万~1247/10万),明显高于女性(729/10万,75/10286,95%CI:565/10万~894/10万)。结论:中国RD患者中亚临床结核病、肺外结核及结核病播散负担较高,ATB患病率在不同RD患者病种、年龄、性别间存在明显差异。

Objective:This study aimed to investigate the prevalence of active tuberculosis(ATB)among patients with rheumatic diseases(RD)in China.Methods:Using a stratified multi-stage cluster sampling method,a total of 13550 RD patients who underwent ATB screening from 13 tertiary hospitals in the eastern,central,and western regions of China between September 2014 and March 2016 were included in the survey.Participants underwent screening for ATB,and the prevalence of ATB was calculated.Subgroup analyses were performed based on RD subtype,age,and sex.Results:Among the 13550 surveyed subjects,105 case diagnosed with ATB,48(45.7%)exhibited no classical symptoms such as cough,sputum production,fever,night sweats,or weight loss.Of those with microbiological and/or pathological confirmation of ATB,35.3%(12/34)were asymptomatic,while the asymptomatic rate was 30.8%(8/26)among patients with bacteriologically confirmed pulmonary tuberculosis(PTB).Extrapulmonary tuberculosis(EPTB)was identified in 41 cases(39.0%),with 28 cases(68.3%)being exclusively EPTB and 13 cases(31.7%)involving combined pulmonary and extrapulmonary disease.The highest prevalence of ATB was observed in patients with systemic vasculitis syndrome,reaching 1915/100000(13/679;95%CI:881/100000-2948/100000),followed by patients with diffuse connective tissue diseases,at 1002/100000(58/5789;95%CI:745/100000-1259/100000).Among RD patients,the 16-34 age group exhibited the highest ATB prevalence,recorded at 1162/100000(43/3700;95%CI:817/100000-1508/100000).Males demonstrated a higher prevalence(919/100000,30/3264;95%CI:592/100000-1247/100000)compared to females(729/100000,75/10286;95%CI:565/100000-894/100000).Conclusion:Patients with RD in China carry a substantial burden of subclinical TB,EPTB,and disseminated TB.The prevalence of ATB shows marked differences across RD subtypes,age groups,and genders.