摘要
目的了解中国部分地区应用肿瘤坏死因子(tumor necrosis factor,TNF)拮抗剂治疗的患者结核病预防性治疗情况。方法搜集2014年3月至2016年2月中国东、中、西部13家三级甲等综合医院接诊的应用依那西普或英夫利西单抗治疗的类风湿关节炎(rheumatoid arthritis,RA)或强直性脊柱炎(ankylosing spondylitis,AS)患者作为研究对象,共981例。收集研究对象的性别、年龄、激素和免疫抑制剂使用情况、并发基础疾病情况、结核病既往史、结核分枝杆菌潜伏感染(LTBI)筛查情况、胸部X线摄片(简称"胸片")或胸部CT扫描结果、结核病预防性治疗情况。分析应用TNF拮抗剂的RA或AS患者筛查LTBI和非活动性肺结核的比例,进行结核病预防性治疗的比例以及采用的治疗方案。结果981例研究对象中应用依那西普者779例(79.4%),应用英夫利西单抗者202例(20.6%)。仅有25.7%(252/981)的研究对象进行LTBI筛查,阳性率为18.3%(46/252)。2.8%(27/981)的研究对象诊断为非活动性肺结核,其中,有结核病既往史者19例。712例(72.6%)研究对象进行了胸片检查和(或)胸部CT扫描,报告非活动性肺结核者13例(1.8%)。共15例研究对象进行了结核病预防性治疗;并发LTBI者中有6例(13.0%,6/46)进行结核病预防性治疗;诊断为非活动性肺结核者均未进行结核病预防性治疗。进行结核病预防性治疗者中,应用异烟肼单药预防方案者9例(60.0%,9/15),疗程1~18个月不等。结论中国部分地区目前应用TNF拮抗剂治疗的RA或AS患者的LTBI筛查比例低,进行结核病预防性治疗比例低,预防对象选择标准不一且预防方案不规范。
Objective To investigate the prevention treatment for tuberculosis in patients treated with tumor necrosis factor(TNF)antagonists in some areas of China.Methods A total of 981 rheumatoid arthritis(RA)or ankylosing spondylitis(AS)patients treated with etanercept or infliximab from 13 large general hospitals in eastern,central and western China from March 2014 to February 2016 were selected.The clinical data of gender,age,hormone and immunosuppressant use,underlying disease,tuberculosis history,latent tuberculosis infection(LTBI)screening,chest X-ray or CT scan results,prevention treatment of tuberculosis were collected,.The proportion of LTBI and inactive tuberculosis screening,the proportion of prevention treatment for tuberculosis and the treatment regimens in RA or AS patients with TNF antagonist were analyzed.Results Of the 981 subjects,779(79.4%)were treated with etanercept and 202(20.6%)with infliximab.Only 25.7%(252/981)subjects were screened for LTBI,and the positive rate was 18.3%(46/252).And 2.8%(27/981)of the subjects were diagnosed as inactive tuberculosis,of which 19 cases had a history of tuberculosis.Of the 712 patients(72.6%)who underwent chest X-ray and/or CT scan,13(1.8%)were reported inactive pulmonary tuberculosis.A total of 15 subjects received TB prevention treatment;6(13.0%,6/46)of the patients complicated with LTBI received tuberculosis preventive treatment;none of the patients diagnosed as inactive tuberculosis received tuberculosis prevention treatment.Among the patients who received tuberculosis prevention treatment,9 cases(60.0%,9/15)were treated with isoniazid monotherapy for 1-18 months.Conclusion In some areas of China,the proportion of LTBI screening in RA or AS patients treated with TNF antagonists was low,the proportion of tuberculosis prevention treatment was low,the selection criteria of prevention objects were different,and the prevention scheme was not standardized.
作者
张丽帆
马慧敏
郑文洁
张奉春
刘晓清
ZHANG Li-fan;MA Hui-min;ZHENG Wen-jie;ZHANG Feng-chun;LIU Xiao-qing(Division of Infectious Diseases,State Key Labratory of Complex Severe and Rare Disease,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;不详)
出处
《中国防痨杂志》
CAS
CSCD
2021年第3期222-227,共6页
Chinese Journal of Antituberculosis
基金
“十二五”国家科技重大专项(2014ZX10003003)
“十三五”国家科技重大专项(2017ZX10201302-003)
中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-013、2019-I2M-2-005)。
关键词
肿瘤坏死因子类
拮抗剂
关节炎
类风湿
脊柱炎
强直性
结核
预防和防护用药
Tumor necrosis factors
Antistatic agents
Arthritis
rheumatoid
Spondylitis
ankylosing
Tuberculosis
Protective agents
