系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析

目的: 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并结核感染患者的临床特征及其外周血淋巴细胞亚群的特点。方法: 采用回顾性研究方法,搜集2015年1月至2021年12月深圳市人民医院收治并同时完成γ-干扰素释放试验及淋巴细胞亚群检测的287例SLE患者作为研究对象。其中,SLE合并活动性结核病者30例(结核病组),SLE合并结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)者16例(LTBI组)。按SLE合并活动性结核病组1∶2的比例,选取同时期性别、年龄匹配的未合并结核分枝杆菌及其他病原体感染的SLE患者60例,作为未感染组。同时,从本院体检中心纳入性别、年龄与SLE合并活动性结核病组相匹配,并完成淋巴细胞亚群检测的健康成年人40名,作为对照组。收集研究对象临床特征、实验室检测结果及临床治疗资料等进行分析。结果: 结核病组的结核病病程为4.0(1.0,8.0)周,以合并单纯肺结核为主17例(56.7%)]。结核病组的SLE病程为54.0(7.5,96.0)月,明显短于LTBI组96.0(72.0,180.0)月],而出现间质性肺炎的比例23.3%,7例]明显多于LTBI组(0.0%),差异均有统计学意义(Z=-2.832,P=0.005;χ²=4.403,P=0.036)。与未感染组相比,结核病组的CD3⁺ T细胞计数(766±480)个/μl vs. (1146±636)个/μl]、CD4⁺ T细胞计数(370±278)个/μl vs.(517±291)个/μl]和CD8⁺ T细胞计数376(244,421)个/μl vs.420(322,742)个/μl]明显降低,差异均有统计学意义(t=-2.875,P=0.005;t=-2.298,P=0.024;Z=-2.842,P=0.004)。3组SLE患者的淋巴细胞亚群比例均无明显差异。结论: SLE患者合并的结核感染多累及肺部;SLE合并活动性结核病患者发生间质性肺炎的比例较高。临床治疗中,如SLE患者出现T淋巴细胞减少,尤其CD8⁺ T细胞严重减少时,应警惕结核感染。

Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection

Objective: To investigate the clinical features and characteristics of peripheral blood lymphocyte subsets in systemic lupus erythematosus (SLE) patients complicated with tuberculosis infection. Methods: A retrospective study was conducted in 287 SLE patients who were admitted to Shenzhen People’s Hospital and completed the interferon-gamma release assays and lymphocyte subset detection from January 2015 to December 2021. Among them, 30 cases complicated with active tuberculosis, and 16 cases complicated with latent tuberculosis infection (LTBI). According to the ratio of 1∶2 in the group of SLE complicated with active tuberculosis, 60 patients with SLE not infected with Mycobacterium tuberculosis or other pathogens in the same period were selected as the uninfected group. Meanwhile, 40 healthy volunteers who matched the gender and age of the SLE patients complicated with active tuberculosis and completed the detection of lymphocyte subsets from the health screen center of our hospital were selected as the control group. The clinical features, laboratory test results and clinical treatment were collected and analyzed. Results: The duration of tuberculosis in active tuberculosis group was 4.0 (1.0, 8.0) weeks, and mainly complicated with pulmonary tuberculosis alone (17 cases, 56.7%). The duration of SLE in the active tuberculosis group was 54.0 (7.5, 96.0) months, which was significantly shorter than that of the LTBI group (96.0 (72.0, 180.0) months; Z=-2.832, P=0.005), and the proportion of interstitial pneumonia (7 cases, 23.3%) was significantly higher than that in the LTBI group (0.0%; χ²=4.403, P=0.036). Compared with the uninfected group, CD3⁺ T cell count ((766±480) cells/μl vs. (1146±636) cells/μl), CD4⁺ T cell count ((370±278) cells/μl vs. (517±291) cells/μl) and CD8⁺ T cell counts (376 (244, 421) cells/μl vs. 420 (322, 742) cells/μl) in tuberculosis group were significantly decreased, and the difference was statistically significant (t=-2.875, P=0.005; t=-2.298, P=0.024; Z=-2.842, P=0.004, respectively). There was no significant difference in the proportion of lymphocyte subsets in the three groups of SLE patients. Conclusion: Tuberculosis infection in SLE patients were mainly in the lungs. The incidence of interstitial pneumonia in SLE patients complicated with active tuberculosis was higher. In clinical treatment, if there is a decrease in T lymphocytes in SLE patients, especially when CD8⁺ T cells are significantly decreased, we should be alert whether complicated with tuberculosis infection.