Risk Factors On Tuberculosis Infection In Systemic Lupus Erythematosus Patients

ObjectiveTo explore risk factors on active tuberculosis infection in systemic lupus erythematosus from drugs,clinical indicators(blood cell count,erythrocyte sedimentation rate,C-reactive protein,immunoglobulin,complement),T lymphocytes of subpopulations,and cytokines.Methods:1.Collecting clinical data of a total of 1123 patients of connective tissue disease in the First Affiliated Hospital of Nanchang University from October 2017 to October2019 were collected.2.40 cases of systemic lupus erythematosus with latent tuberculosis infection(LTBI/SLE),randomly select 40 cases of systemic lupus erythematosus without latent tuberculosis infection(Non-LTBI/SLE)as a control group,compare the medication,C-reactive protein,immunoglobulin,complement differences and erythrocyte sedimentation rate between the two groups.3.10 cases of systemic lupus erythematosus combined with active tuberculosis(TB/SLE),randomly selected 20 patients with non-active tuberculosis(Non-TB/SLE)as a control group,collected patient sera and compared medication between the two groups Status,blood cell count,erythrocyte sedimentation rate,c-reactive protein,immunoglobulin,complement,CD4 + T,CD8 + T,CD19 + B,NK cells,IL-2,IL-4,IL-6,IL-10,IL-17.Differences in TNF-? and IFN-? levels.4.10 cases of systemic lupus erythematosus combined with active tuberculosis(TB / SLE),13 cases of connective tissue disease combined with active tuberculosis(TB / CTD),collected serum of patients,and compared medication,blood cell count,erythrocyte sedimentation rate and CRP between the two groups reactive protein,immunoglobulin,complement,CD4 + T,CD8 + T,CD19 + B,NK cells,IL-2,IL-4,IL-6,IL-10,IL-17,TNF-?,IFN-gamma level difference.Results:1.The infection rates of latent tuberculosis is different in different connective tissue diseases,and women were different from men.Among them,the infection rate of latent tuberculosis in vasculitis patients is the highest,which is 48.72%.The rate in systemic lupus erythematosus is 13.12%.and the infection rate of men is higher than that of women(31.09% VS 18.22%).2.Of the 1123 cases,there were 23 case with active tuberculosis,10 cases in systemic lupus erythematosus(SLE).The prevalence of active tuberculosis in SLE was 3.36%(10/298).13 cases in other connective tissue diseases,of which the prevalence of systemic vasculitis was the highest,12.82%(5/39),followed by 3.92%(2/51)in Behcet's diseases(BD),1.40%(4/285)in rheumatoid arthritis(RA),0.61%(1/163)in undifferentiated connective tissue disease or mixed connective tissue disease(UCTD/MCTD)and 1.92%(1/52)in Sjogren's syndrome(PSS).The incidence of pulmonary tuberculosis was the highest,accounting for 70%.The majority of TB cases were female,with a male to female ratio of 5:18;the average age was 46.5 years,and there was no difference in age with 1123 cases.3.In the LTBI/SLE group and the Non-LTBI/SLE group,the Non-LTBI/SLE group has a higher erythrocyte sedimentation rate than the LTBI/SLE group,and the difference is statistically significant,the other indicators were not significantly different between the Non-LTBI/SLE and LTBI/SLE groups.4.In the TB/SLE and Non-TB/SLE groups,the proportion of patients with the average daily dose of hormones than 15 mg were 6(6/10),which were only 4(4/20)in the LTBI/SLE group,the difference was significant.Hemoglobin levels,helper inducible T lymphocytes and CD4+T/CD8+T ratios in the TB/SLE group were lower than those in the Non-TB/SLE group,while ESR,IL-6,and IL-10 and IFN-? were higher,the difference is statistically significant.There was no significant difference in the type of immunosuppressive agents,whether to use immunosuppressive agents,peripheral blood leukocyte count,lymphocyte count,neutrophil count,platelet count,c-reactive protein,immunoglobulin,complement,CD8+T cells,NK cells,B cells,IL-2,IL-4,IL-17 and TNF-? between the two groups.5.In the TB/SLE and TB/CTD groups,there was a statistically significantdifference in gender between the TB/SLE and TB/CTD groups(P = 0.046).All patients with lupus tuberculosis were female,and the ratio of male to female in connective tissue disease was 5: 8.There were no statistical differences in age,age at diagnosis,duration of disease,dosage of hormones,immunosuppression,comorbidities,and complications.Compared with TB/CTD group,TB/SLE group had higher levels of IgG and lower levels of complement.There was no statistical difference in the two groups regarding blood cell counts and inflammatory indexes.CD4 + T cells and the TNF-? level were lower in the TB/SLE group than in the TB/CTD group,while the IFN-? level were higher,and the difference is statistically significant.Other blood lymphocyte and cytokines were not statistically different between the two groups.Conclusion:1.The infection rates of latent tuberculosis differ among connective tissue diseases,and women were different from men.Among them,the infection rate of latent tuberculosis in vasculitis patients is the highest,and the infection rate of men is higher than that of women.Latent tuberculosis infection rate of systemic lupus erythematosus was 13.42%,and active tuberculosis infection was 3.36%.2.The occurrence of latent tuberculosis infection in systemic lupus erythematosus has nothing to do with medication,immunoglobulin and complement level.3.The occurrence of active tuberculosis in systemic lupus erythematosus is related to the average daily dose of hormones,and has nothing to do with the type of immunosuppressive agents and whether to use immunosuppressive agents together.The average daily dose of hormones greater than 15 mg may be its risk factor.4.The occurrence of active tuberculosis in systemic lupus erythematosus may be related to the levels of hemoglobin,helper / induced T lymphocytes(CD3 + CD4 +),CD4 + / CD8 +,IL-6 and IL-10.