系统性红斑狼疮伴结核分枝杆菌感染42例临床分析

目的 探讨系统性红斑狼疮(SEE)患者伴结核分枝杆菌感染的临床特点.方法 回顾性分析452例SLE患者在应用糖皮质激素和免疫抑制剂治疗过程中出现结核分枝杆菌感染的临床资料.结果 452例SLE患者中42例(9.29%)在住院期间被确诊为活动性结核,单纯浸润犁肺结核11例(26.19%);肺外结核31例(73.81%),其中有10例(23.81%)未找到结核感染病灶,8例(19.05%)血行播散型肺结核,6例(14.29%)结核性脑膜炎,2例(4.76%)胸腔结核,2例(4.76%)腹腔结核,1例(2.38%)淋巴结核,1例(2.38%)骨结核,1例(2.38%)肾结核.42例结核感染患者有狼疮肾炎38例,血清白蛋白低40例,有结核病史10例,白细胞低14例,血糖升高14例.抗结核治疗起效时间一般在1周以上,最长可达4周.死亡2例,均为血行播散型结核.结论 应用糖皮质激素及免疫抑制剂治疗SLE的过程中,结核分枝杆菌感染的发病率明显升高,以重症结核和肺外结核为多.既往有结核病史、狼疮肾炎等SLE患者,町能易感染结核分枝杆菌.

A clinical study of tuberculosis infection in systemic lupus erythematosus

Objective To investigate the characteristics and related risk factors associated with tuberculosis(TB) in patients with systemic lupus erythematosus (SLE) who received glucocorticoid and immunosuppressive therapy. Methods Among the 452 SLE patients underwent the treatment of glucocorticoid and immunosuppressive agent, the clinical data was reviewed and summarized retrospectively.Results 42 of 452(9.29% ) patients were diagnosed as TB infection. 11 patients (23.81% )had exudative pulmonary tuberculosis and 31 patients(73.81% ) had extra-plumonary TB. Statistics of the 31 patientsshowed that 8 patients( 19.05% ) had hematogenous disseminated pulmonary tuberculosis;6 (14.29%) had tuberculo-meningitis ;2 (4.76%) had thoracic cavity TB; 2 ( 4.76% ) had abdominal cavity TB; 1 ( 2.38% )had crewels ; 1 ( 2.38% ) had bone tuberculosis and 1 (2.38%) had nephronophthisis. The focus of infection was not found in 10 patients. Of all 42 patients with TB infection, 38 cases suffered form lupus nephritis, 40 with hypoalbuminosis, 10 with TB history, 14 had leucocytopenia or hyperglycaemia, respectively. The effect of antiTB therapy started up at least 7 days, or in 4 weeks as longest. 2 patients died of hematogenous disseminated pulmonary tuberculosis. Conclusion Under the treatment of glucocorticoid and immunosuppressive agent ,TB incidence in patients with SLE is obviously higher than that of common people.Extra-pulmonary rib and serious infection are more frequently. It is shown that those who had lupus nephritis or TB history are more susceptible to TB.