An Analysis Of Clinical Features And Risk Factors For Tuberculosis Infections In 48 Patients With Systemic Lupus Erythematosus

Objectives To investigate the clinical features of tuberculosis(TB) infection in patients with systemic lupus erythematosus(SLE) and to identify the correlated risk factors.Methods We retrospectively reviewed 2637 patients with SLE who were admitted to Peking Union Medical College Hospital form January 1998 through December 2007.Fifty-six patients who developed TB were identified while only forty-eight with integral medical records were enrolled in this study.Another forty-eight age,sex and course-matched SLE patients without TB were evaluated as a control group.Results Of the 48 TB-infected SLE patients with TB,the longest TB course was 24 months,the average was(64±117) days.The presenting TB symptoms began(24±53) months' after the immunosuppressive therapy for SLE,with the shortest latency period of one month.The diagnosis procedure spent(84±116) days.Among the 48 TB-infected patients,32 had solitary pulmonary TB,5 with meningitis,2 with pericarditis and 1 each with lymphadenitis,peritonitis,mediastinitis,hip joint and renal infection.TB foci were undefined in 4 patients.Compared with control group,the total dose of corticosteroids (prednisone equivalent,20.7±22g vsl0.8±14.6)and the cumulative dose of corticosteroids with one past year(6.3±4.1g vs 4.2±3.3g) were significantly higher in TB infection group,the P value is 0.006 and 0.011 respectively.Incidence of fever,night sweat and ESR,C reactive protein,Fibrinogen level were significantly increased in TB group,while level of serum albumin,complements,SLE—related autoantibodies,SLE organ involvement and steroid pulse therapy didn't show any statistic difference.Conclusion1,Pulmonary TB is the most common type in SLE patients,but the extra-pulmonary infections are not seldom;2,We can not except TB infections in SLE patients if the PPD test and the anti-tuberculosis antibody were negative;3,The total dose of corticosteroids and the cumulative dose of corticosteroids in one past year were possibly important determinants for increased risk of TB infection in patients with SLE;4,corticosteroids pulse therapy and the use of immunosuppressor may have no relationship with TB infection in patients with SLE;5,SLE patients who have symptoms of fever(especially high fever),night sweat and high level of ESR,C reactive protein and Fibrinogen,TB infection should be considered, excluding SLE activity,we can also use anti-tubercuolosis drugs if there were no tubercle bacillus be proved and the PPD test was negative.