Latent Tuberculosis Infection and Associated Factors in Patients with Systemic Lupus Erythematosus: a Multicenter, Cross-Sectional Study

被引:5
作者
Zhang, Lifan [1 ,2 ,3 ]
Ma, Yanan [1 ]
Jiang, Nan [1 ,4 ]
Zou, Xiaoqing [1 ,5 ]
Zhang, Yueqiu [1 ]
Zhang, Fengchun [6 ]
Zeng, Xiaofeng [6 ]
Zhao, Yan [6 ]
Liu, Shengyun [7 ]
Zuo, Xiaoxia [8 ]
Wu, Huaxiang [9 ]
Wu, Lijun [10 ]
Li, Hongbin [11 ]
Zhang, Zhiyi [12 ]
Chen, Sheng [13 ]
Zhu, Ping [14 ]
Zhang, Miaojia [15 ]
Qi, Wencheng [16 ]
Liu, Yi [17 ]
Liu, Huaxiang [18 ]
Shi, Xiaochun [1 ,2 ]
Liu, Xiaoqing [1 ,2 ,3 ]
机构
[1] Chinese Acad Med Sci & Peking Union Med Coll, Peking Union Med Coll Hosp, Div Infect Dis, Dept Internal Med,State Key Lab Complex Severe & R, Beijing, Peoples R China
[2] Chinese Acad Med Sci & Peking Union Med Coll, Ctr TB Res, Beijing, Peoples R China
[3] Chinese Acad Med Sci, Peking Union Med Coll Hosp, Clin Epidemiol Unit, Int Epidemiol Network, Beijing, Peoples R China
[4] Chinese Acad Med Sci & Peking Union Med Coll, Med Doctor Program 44, Beijing, Peoples R China
[5] Chinese Acad Med Sci & Peking Union Med Coll, Sch Populat Med & Publ Hlth, Beijing, Peoples R China
[6] Chinese Acad Med Sci & Peking Union Med Coll, Minist Educ, Dept Rheumatol & Clin Immunol, Key Lab Rheumatol & Clin Immunol,Peking Union Med, Beijing, Peoples R China
[7] Zhengzhou Univ, Affiliated Hosp 1, Dept Rheumatol & Immunol, Zhengzhou, Peoples R China
[8] Cent South Univ, Xiangya Hosp, Dept Rheumatol & Immunol, Changsha, Peoples R China
[9] Zhejiang Univ, Affiliated Hosp 2, Sch Med, Dept Rheumatol, Hangzhou, Peoples R China
[10] Peoples Hosp Xinjiang Uygur Autonomous Reg, Dept Rheumatol, Urumqi, Peoples R China
[11] Inner Mongolia Med Univ, Affiliated Hosp, Dept Rheumatol & Immunol, Hohhot, Peoples R China
[12] Harbin Med Univ, Affiliated Hosp 1, Dept Rheumatol & Immunol, Harbin, Peoples R China
[13] Shanghai Jiao Tong Univ, Renji Hosp, Sch Med, Dept Rheumatol, Shanghai, Peoples R China
[14] Fourth Mil Med Univ, Xijing Hosp, Dept Clin Immunol, Xian, Peoples R China
[15] Nanjing Med Univ, Affiliated Hosp 1, Dept Rheumatol, Nanjing, Peoples R China
[16] Tianjin First Cent Hosp, Dept Rheumatol, Tianjin, Peoples R China
[17] Sichuan Univ, West China Hosp, Dept Rheumatol & Immunol, Chengdu, Peoples R China
[18] Shandong Univ, Qilu Hosp, Dept Rheumatol, Jinan, Peoples R China
来源
MICROBIOLOGY SPECTRUM | 2023年 / 11卷 / 03期
关键词
latent tuberculosis infection; systemic lupus erythematosus; China; T-SPOT.TB; GAMMA RELEASE ASSAYS; RHEUMATIC-DISEASES; RISK-FACTORS; INHIBITORS; ARTHRITIS;
D O I
10.1128/spectrum.00848-23
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
The objectives of this study were to screen for latent tuberculosis infection (LTBI) among patients with systemic lupus erythematosus (SLE) using the T-SPOT.TB assay and to identify factors affecting the assay results. SLE patients were enrolled from 13 tertiary hospitals in eastern, central, and western China from September 2014 to March 2016 and were screened using the T-SPOT.TB assay to detect LTBI. Basic information about the subjects was collected, including gender, age, body mass index (BMI), course of disease, evidence of previous tuberculosis, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, and the use of glucocorticoids and immunosuppressants. Univariate analysis and multivariable logistic regression were performed to identify factors affecting the results of the T-SPOT.TB assay. In all, 2,229 SLE patients were screened using the T-SPOT.TB assay, of whom 334 patients tested positive, yielding a positivity rate of 15% (95% confidence interval [CI], 13.5% to 16.5%). The positivity rate was higher in male than female patients and had an increasing trend with age. Multivariable logistic regression analysis showed that patients over 40 (odds ratio [OR], 1.65; 95% CI, 1.29 to 2.10) and with evidence of previous tuberculosis (OR, 4.43; 95% CI, 2.81 to 6.99) were more likely to have positive T-SPOT.TB results, while patients with a SLEDAI-2K score of >= 10 (OR, 0.61; 95% CI, 0.43 to 0.88), a glucocorticoid dose of >= 60 mg/d (OR, 0.62; 95% CI, 0.39 to 0.98), leflunomide (LEF) treatment (OR, 0.51; 95% CI, 0.29 to 0.88), or tacrolimus (FK506) treatment (OR, 0.40; 95% CI, 0.16 to 1.00) were more likely to have negative T-SPOT.TB results. The frequencies of CFP-10-specific gamma interferon (IFN-gamma)-secreting T cells were significantly lower in SLE patients with severe disease activity or high-dose glucocorticoids (P < 0.05). The positivity rate of the T-SPOT.TB assay was 15% among SLE patients. Severe, active SLE disease and the use of high-dose glucocorticoids and some types of immunosuppressants are likely to result in negative T-SPOT.TB results. For SLE patients with the above conditions, diagnosing LTBI based on a positive T-SPOT.TB result may lead to underestimation of the prevalence. IMPORTANCE The burden of tuberculosis and systemic lupus erythematosus in China ranks among the top three in the world. Therefore, active screening for LTBI and preventive intervention in SLE patients are of great significance in China. In view of the lack of relevant data in a large sample, we conducted a multicenter, cross-sectional study using T-SPOT.TB as a screening method for LTBI, to investigate the prevalence of LTBI and analyze the factors affecting the results of the T-SPOT.TB assay in SLE patients. Our study showed that the overall positivity rate of the T-SPOT.TB assay in SLE patients was 15.0%, which was lower than the estimated LTBI prevalence in the general population in China (similar to 20%). For SLE patients with severe, active disease, high-dose glucocorticoids, and some types of immunosuppressants, a diagnosis of LTBI based on only positive T-SPOT.TB results may lead to underestimation of the prevalence. The burden of tuberculosis and systemic lupus erythematosus in China ranks among the top three in the world. Therefore, active screening for LTBI and preventive intervention in SLE patients are of great significance in China.
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页数:10
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