| Objectives:Systemic lupus erythematosus(SLE) is a typical systemic autoimmune disease. Infection had become the first cause of death in SLE patients because many factors including disease itself and therapy increased infection rates. The prevalence of TB was very high in our country. SLE patients complicated with tuberculosis in clinic were very common. It is very difficult to distinguish SLE itself from tuberculosis infection because their clinical manifestation and examination features are very similar, This make the diagnosis and treatment of SLE complicated with tuberculosis infection very difficult. Acid fast staining and culture positive for Mycobacterium tuberculosis positive are the gold standard for the diagnosis of tuberculosis infection, but they are limited for the early diagnosis of tuberculosis infection in clinical practice because acid fast staining positive rate is low and Mycobacterium tuberculosis culture cycle is very long.At present, a new tuberculosis detection technology-tuberculosis infection enzyme-linked immunospot assay(T-SPOT.TB) showed good sensitivity and specificity, they were widely used to diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis in many hospitals of the world.The research aimed at detecting suspected SLE patients with active tuberculosis infection by T-SPOT.TB and the tuberculin skin test(TST) detection, then further to make their final diagnosis and assess the significance of T-SPOT.TB, TST in the diagnosis of SLE complicated with active tuberculosis infection.At the same time, we want to know if the count of CD4 positive T cell in peripheral blood analysis results have no effect on TSPOT.TB by analyzing the relation between the count of CD4 positive T cell in peripheral blood and SLE complicated with active tuberculosis infection.Methods:Choose 105 patients suspected SLE with active tuberculosis infection from 2013 May to 2015 February in rheumatology department of Shijiazhuang peace hospital. Collected medical history, clinical data and examinations of all enrolled patients, detected T-SPOT,TST and the count of CD4 positive T cell in peripheral blood. and made the last diagnosis.Statistical methods: SPSS16.0 software was used for data processing. Measurement data were expressed as X±SE, enumeration data were expressed as percentage. Measurement data test normality with Kolmogorov-Smirnov way firstly, then t test or ANOVA way was used to comparsion among two or more samples. The comparsion of abnormal distribution measurement data or ranked data used to non-parametric test. The spearman correlation analysis was used to test correlation. 1. The sensitivity, specificity, odds ratio, accuracy, positive predictive value and negative predictive value of T-SPOT.TB and TST were calculated according to the fourfold table of diagnostic test; 2 The sensitivity, and specificity between T-SPOT and TST were compared with chi square test; 3 The patients were divided into two groups by CD4 positive cells greater than 200/ul or not, Chi square test was used to compare the ratio of active tuberculosis infection between two groups.4 Chi square test was used for comparison of T-SPOT.TB positive rate between two groups.All of statistical results were made two-sided test.We thought as statistical significance when P value less than 0.05.Results:1 Basic situation105 patients in this study were 18- 62 years. The average age was 29.45±11.59 years old. They included 12 men and 93 women. 5 patients took off group,( 3cases cunold not finish collecting clinical data, 1 cases died during follow-up,1 cases lost to follow-up), 3 patients could not make clear diagnosis during 3-19 months follow-up.This research finally enrolled in 97 patients.The 97 cases patients was enrolled in the study, they were 18-59 years. The mean age was 28.96 ± 11.23 years. these patients had 10 male and 87 female patients. 21 patients were diagnosed with active TB of infection in 97 patients, accounting for 21.6%.10 patients had pulmonary tuberculosis, accounting for 47.6%, and 14 patients had extra pulmonary tuberculosis in, accounting for 66.7%.76 patients were excluded active tuberculosis infection at last.2 the results related to SLE(1) the clinical and lab result of SLE.In 97 patients with clinical and laboratory findings:52 cases of skin and mucosa damage53.61%, osteoarthritis in 29 cases, accounting for 29.9%, 37 cases of lupus nephritis, 38.14%, serous effusion in 25 cases, accounting for 25.77%, leukopenia in 40 cases, accounting for 41.24%, 21 anti ds-DNA positive cases, accounting for 21.65%, low egg white in 17 cases, accounting for 17.53%; 21 cases of SLE patients with active tuberculosis infection: clinical and laboratory results of 11 cases, skin and mucosa damage in 52.38%, osteoarthritis in 6 cases, accounting for 28.57%, 8 cases of lupus nephritis, 38.10%, serous effusion in 5 cases, accounting for 23.81%, 8 cases of leukopenia accounted for 38.10%. Anti dsDNA positive,5 cases, accounting for 23.81%, hypoproteinemia in 7 cases, accounting for 33.33%; hypoproteinemia SLE patients are more prone to tuberculosis infectionInto the group of 97 cases of patients with systemic lupus lupus activity index(SLEDAI) 0-4 points in 12 cases, accounted for 12.37%,5-9 points in 36 cases,accounting for 37.11%,10-14 points in 41 cases, accounting for 42.27%, more than 15 points in 8 cases, 8.25%, in which light to moderate activity 77 cases,accounting for 79.38%. 21 cases diagnosed for active TB infection in SLEDAI score 0-4 points in 2 cases,9.52%, 5-9 in 6 cases, accounting for 28.57%, 10-14 points in 12 cases, accounted for 57.14%, more than 15 points in 1 cases, accounted for 4.76%, in which light to moderate activity were 18 cases,accounted for 85.7%;selected cases mostly mild to moderate activity in patients with SLE, between the two groups no significant difference.(2) the treatment of SLE.Into the group of 97 cases of SLE patients with steroid treatment in 95 cases, which has been the application of 500 mg / day more than methylprednisolone methylprednisolone pulse therapy in 6 cases, accounting for 6.19%, application of at least one immunosuppressive therapy for 3 months above 65 cases, 67.01% in proportion, which combined more than two kinds of immune inhibitor treatment for more than 3 months in 13 cases, accounting for 13.4%.21 cases diagnosis activity sle corticosteroids therapy in patients with tuberculous infection were treatment was in 20 cases, which has been the application of 500 mg / day more than methylprednisolone methylprednisolone pulse therapy(n=1),(4.76%, the application of at least one immunosuppressive therapy for 3 months above in 14 cases, accounted for 66.67%, the combined use of two or more immunosuppressive treatment for more than 3 months in 7 cases, 33.33%, two groups of patients in the used hormone impact and application of at least one immunosuppressive treatment 3 months above had no significant difference, and in the combined application of two or more immunosuppressive therapy for more than 3 months of the unity and activities of tuberculosis infection group were increased signifycantly.3 The results of T-SPOT.TB and TSTIn 97 patients,26 patients were T-SPOT.TB positive,including 20 patients with the active tuberculosis infection and 6 patients without active tuberculosis infection. 14 patients were TST positive in97 patients,including 10 patients with the active tuberculosis infection and 4 patients without active tuberculosis infection. The sensitivity of T-SPOT.TB was 95.2% and that of TST was 47.6%, their specificity was respectively 92.1% and 94.7%. The ratio of T-SPOT.TB and TST was respectively 233.33 and 16.36, their coincidence rate was respectively 92.8% and 84.5%. The positive predictive value of T-SPOT.TB was 76.9% and the value of TST was 71.4%, their negative predictive value was respectively 98.6% and 86.7%. The sensitivity of T-SPOT was 47.6%, this was higher than that of TST(χ2=6.7823,P< 0.01),the difference has statistical significance. There was no significant difference between the specificity of T-SPOT.TB(92.1%) and TST(94.7%)(χ2=0.534, P> 0.05).4 The relationship between CD4-positive-Tlymphocyte and tuberculosis infectionThe 97 patients were divided into two groups according to the count of CD4+T cell in peripheral blood: group A has 36 cases(the number of CD4+T is less than 200 cells per microliter) in; group B has 61 cases(the number of CD4+T is no less than 200 cells per microliter). 14 patients were diagnosed active tuberculosis infection in group A, accounting for 38.9%. 7 patients were diagnosed active tuberculosis infection in group B, accounting for 11.5%.5 The relationship between CD4-positive-Tlymphocyte and T-SPOT.TBThe ratio of active tuberculosis in group A(38.9%) was significantly higher than that in group B(11.5%).The X 2 value was 4.321, and the P value was less than 0.05. The difference has statistical significance. 10 cases were TSPOT.TB positive in Group A,accounting for 27.8%.16 cases were TSPOT.TB positive in Group A, accounting for 26.2%.There was no significant difference between A group and B group.Conclusion:1 The SLE patients with active tuberculosis infection have mild to moderate disease activity, and they have hypoproteinemia. The SLE patients with two or more immunosuppressive agents for more than 3 months are more likely to suffer active tuberculosis infection.2 The sensitivity of T-SPOT.TB for diagnosing active SLE complicated with active tuberculosis infections is better than TST. The specificity of between T-SPOT.TB and TST was no significant difference.3 The SLE patiehts that CD4-positive-Tlymphocyte was less than 200/ul would be apt to suffering active tuberculosis infection.4 The CD4-positive-Tlymphocyte in peripheral blood does not affect the detection of T-SPOT.TB. |
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