系统性红斑狼疮合并结核48例临床特点及相关因素分析
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摘要
目的探讨系统性红斑狼疮患者结核菌感染的临床特点并分析相关因素。对象与方法回顾性分析北京协和医院1998年1月至2007年12月住院的SLE患者共2637例,SLE合并结核感染患者共56例,发病率为2.12%,其中资料完整48例,同时随机选取性别、年龄、SLE病程相似的48例SLE非结核感染患者为对照。
结果48例病例组患者中,结核病程最长24月,平均(64±117)天;结核症状在SLE治疗后(24±53)月后出现,最短出现在SLE治疗后1月;诊断历时(84±116)天。病灶分布:单纯肺结核32例,结核性脑膜炎5例,结核性心包炎2例,淋巴结结核、腹腔结核、纵隔结核、髋关节结核、肾结核各1例,病灶不明的结核4例。与对照组相比,病例组患者激素和免疫抑制剂用量较大,其中激素使用总量(强的松等效剂量,TB组20.7±22g,对照组10.8±14.6g)、近1年内激素用量(TB组6.3±4.1g,对照组4.2±3.3g)在两组间的差异有统计学意义,P值依次为0.006、0.011。同时,发热、盗汗以及血沉、C反应蛋白、纤维蛋白原的升高在两组之间的差异亦有统计学意义,而白蛋白、补体水平以及SLE相关抗体、脏器受累、激素冲击治疗等在两组之间无明显差异。
结论1、SLE患者合并的结核以肺结核为主,但肺外结核亦不少见;
2、在PPD和结核抗体阴性的情况下,SLE患者不能除外结核感染;
3、激素使用总量、近1年激素内用量可能是SLE患者感染结核的危险因素;
4、激素冲击治疗和免疫抑制剂的应用可能和结核感染无关;
5、SLE患者病程中出现不明原因的发热,尤其是高热,同时伴有盗汗、浅表淋巴结肿大及血沉、CRP或FgC升高时,结核感染高度不能除外,在没有病原学证据、PPD阴性的情况下,若除外狼疮活动,可试行抗结核治疗。
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.
Conclusion
1、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.
结果48例病例组患者中,结核病程最长24月,平均(64±117)天;结核症状在SLE治疗后(24±53)月后出现,最短出现在SLE治疗后1月;诊断历时(84±116)天。病灶分布:单纯肺结核32例,结核性脑膜炎5例,结核性心包炎2例,淋巴结结核、腹腔结核、纵隔结核、髋关节结核、肾结核各1例,病灶不明的结核4例。与对照组相比,病例组患者激素和免疫抑制剂用量较大,其中激素使用总量(强的松等效剂量,TB组20.7±22g,对照组10.8±14.6g)、近1年内激素用量(TB组6.3±4.1g,对照组4.2±3.3g)在两组间的差异有统计学意义,P值依次为0.006、0.011。同时,发热、盗汗以及血沉、C反应蛋白、纤维蛋白原的升高在两组之间的差异亦有统计学意义,而白蛋白、补体水平以及SLE相关抗体、脏器受累、激素冲击治疗等在两组之间无明显差异。
结论1、SLE患者合并的结核以肺结核为主,但肺外结核亦不少见;
2、在PPD和结核抗体阴性的情况下,SLE患者不能除外结核感染;
3、激素使用总量、近1年激素内用量可能是SLE患者感染结核的危险因素;
4、激素冲击治疗和免疫抑制剂的应用可能和结核感染无关;
5、SLE患者病程中出现不明原因的发热,尤其是高热,同时伴有盗汗、浅表淋巴结肿大及血沉、CRP或FgC升高时,结核感染高度不能除外,在没有病原学证据、PPD阴性的情况下,若除外狼疮活动,可试行抗结核治疗。
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.
Conclusion
1、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.
引文
1、Bouza E,Moya JG,Munoz P.Infections in systemic lupus erythematosus and rheumatoid arthritis.Infect Dis Clin North Am 2001:15:335-361.
2,Paton NI.Infections in systemic lupus erythematosus patients.Ann Acad Med Singapore 1997;26:694-700.
3、Lai-Shan Tam,Edmund K.Li,et al.Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong.Scand J Rheumatol 2002:31:296-300.
4、张奉春,何兰杰,董怡.系统性红斑狼疮与结核菌感染.风湿病学杂志,1996,1:80.
5、郝阳.我国结核病防治概况与今后工作设想.中华结核病和呼吸杂志,2004,27:433.
6、Sayarlioglu M,Inanc M,el al.Tuberculosis in Turkish patients with systemic lupus erythematosus:increased frequency of extrapulmonary localization.Lupus.2004;13(4):274-8.
7、J-G Erdozain,G Ruiz-Irastorza,et al.High risk of tuberculosis in systemic lupus erythematosus? Lupus(2006) 15,232-235.
8、Balakrishnan C,Mangat G,Mittal G,et al.Tuberculosis in patients with systemic lupus erythematosus.J Assoc Physicians India 1998;46:682-683.
9、Hou CL,Tsai YC,et al.Tuberculosis infection in patients with systemic lupus erythematosus:pulmonary and extra-pulmonary infection compared.Clin Rheumatol.2008 May;27(5):557-63.
10、SUSAN JICK,ERICS.,et al.Glucocorticoid Use,Other Associated Factors,and the Risk of Tuberculosis.Arthritis & Rheumatism(Arthritis Care &Research)Vol.55,No.1,February 15,2006,pp 19-26
11、杨程德,王晓栋,叶霜等.系统性红斑狼疮患者结核感染的临床特点及相关因素分析.中华风湿病学杂志,2005,8:476-9.
1、 Bouza E, Moya JG, Munoz P. Infections in systemic lupus erythematosus and rheumatoid arthritis. Infect Dis Clin North Am 2001;15:335-361.
2、 Insoo Kang, Sung Hwan Park,. Infectious complications in SLE after immunosuppressive therapies. Current Opinion in Rheumatology 2003,15: 528 - 534.
3、 Matthew E. Falagas & Katerina G. Manta &Gregoria I. et al. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol (2007) 26:663-670.
4、 Zonana-Nacach A, Camargo-Coronel A, Yanez P, et al. Infections in outpatients with systemic lupus erythematosus:A prospective study. Lupus 2001;10:505-510.
5、 Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 1999;78:167-175.
6、 Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 82:299-308.
7、 Edwards CJ, Lian TY, Badsha H, Teh CL, Arden N, Chng HH. Hospitalization of individuals with systemic lupus erythematosus: Characteristics and predictors of outcome. Lupus 2003; 12: 672-676.
8、 Bouza E, Moya JG, Munoz P, et al. Mortality study in Puerto Ricans with systemic lupus erythematosus. P R Health Sci J 2000;19:335 - 339.
9、 Alarcon, G. S., McGwin, G. Jr., Bastian, H. M., et al. Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual. Arthritis Rheum. 2001, 45, 191-220.
10、 Gladman DD, Hussain F, Ibanez D, et al. The nature and outcome of infection in systemic lupus erythematosus. Lupus 2002;11:234 - 239.
11、 Noel V, Lortholary O, Casassus P, et al. Risk.factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001;60:1141-4.
12、 Kang I, Park SH. Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol 2003;15:528-534.
13、Piliero P, Furie R: Functional asplenia in systemic lupus erythematosus. Semin Arthritis Rheum 1990, 2b: 185 -189.
14、 Vratsanos G, Kang I, Craft J: Systemic lupus erythematosus. In Samter's Immunologic Diseases, edn 6, vol 2. Edited by Austen KF, Frank MM, Atkinson JP, et al. Philadelphia: Lippincott Williams & Wilkins; 2001:475-495.
15、 Juarez M, MisischiaR, AlarconGS: Infections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis/ dermatomyositis. Rheum Dis Clin North Am 2003, 29:163-184.
16、 Kim WLJ, Min JK, Lee SH, et al. : Causes of death in Korean patients with systemic lupus erythematosus: a single center retrospective study. Clin Exp Rheumatol 1999, 17:539-545.
17、 Nived O, Sturfelt G, Wollheim F: Systemic lupus erythematosus and infection: a controlled and prospective study including an epidemiological group. Q J Med 1985, 55:271 -287.
18、 DiNubile MJ, Albornoz MA, Stumacher RJ, et al. : Pneumococcal soft-tissue infections: possible association with connective tissue diseases. J Infect Dis1991, 163:897-900.
19、 Lim E, Koh WH, Loh SF, et al. : Non-typhoidal salmonellosis in patients with systemic lupus erythematosus. A study of fifty patients and a review of the literature. Lupus 2001, 10:87-92.
20、 Tsao CH, Chen CY, Ou LS, Huang JL. Risk factors of mortality for salmonel la infection in systemic lupus erythematosus. J Rheumatol 2002;29:1214 - 1218.
21、 Wu KC, Yao TC, Yeh KW, Huang JL. Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol 2004;31:1340-1343.
22、 Mitchell SR, Nguyen PQ, Katz P: Increased risk of neisserial infections in systemic lupus erythematosus.Semin Arthritis Rheum 1990,20:174-184.
23、Lai-Shan Tam,Edmund K.Li,et al.Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong.Scand J Rheumatol 2002;31:296-300.
24、张奉春,何兰杰,董怡.系统性红斑狼疮与结核菌感染.风湿病学杂志,1996,1:80.
25、郝阳.我国结核病防治概况与今后工作设想.中华结核病和呼吸杂志,2004,27:433.
26、Sayarlioglu M,Inanc M,el al.Tuberculosis in Turkish patients with systemic lupus erythematosus:increased frequency of extrapulmonary localization.Lupus.2004;13(4):274-8.
27、J-G Erdozain,G Ruiz-Irastorza,et al.High risk of tuberculosis in systemic lupus erythematosus? Lupus(2006) 15,232-235.
28、BalakrishnanC,Mangat G,Mittal G,et al.Tuberculosis in patients with systemic lupus erythematosus.J Assoc Physicians India 1998;46:682-683.
29、Hou CL,Tsai YC,et al.Tuberculosis infection in patients with systemic lupus erythematosus:pulmonary and extra-pulmonary infection compared.Clin Rheumatol.2008 May;27(5):557-63.
30、Gaitonde S,Pathan E,Sule A,et al.:Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment.Ann Rheum Dis 2002,61:251-253.
31、Mok MY,Lo Y,Chan TM,Wong WS,Lau CS.Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy.J Rheumatol 2005;32:609-615.
32、M.Y.Mok,S.S.Y.Wong,T.M.Chan,et al.Non-tuberculous mycobacterial infection in patients with systemic lupus erythematosus.Rheumatology 2007;46:280-284
33、Ishikawa O,Abe M,Miyachi Y:Herpes zoster in Japanese patients with systemic lupus erythematosus.Clin Exp Dermatol 1999,24:327-328.
34、Sekigawa,I.,Nawata,M.,Seta,N.,et al.Cytomegalovirus infection in patients with systemic lupus erythematosus . Clin. Exp. Rheumatol. 2002,20, 559 - 564.
35、 Zandman-Goddard G, Shoenfeld Y. HIV and autoimmunity. Auto immunity Reviews 2002; 1: 329-337.
36、 Barthel HR, Wallace DJ. False positive human immunodeficiency testing in patients with systemic lupus erythematosus. Semin Arthritis Rheum 1993;23:1 -7.
37、 Palacios R, Santos J, Valdivielso P, et al. Human immunodeficiency virus infection and systemic lupus erythematosus. An unusual case and a review of the literature. Lupus 2002; 1: 60-63.
38、 H. S. Chen, W. P. Tsai, H. S. Leul, et al. Invasive fungal infection in systemic lupus erythematosus: an analysis of 15 cases and a literature review Rheumatology 2007;46:539 - 544.
39、 Pryor BD, Bologna SG, Kahl LE: Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 1996, 39:1475-1482.
40、 Seta N, Shimizu T, Nawata M, et al. A possible novel mechanism of opportunistic infection in systemic lupus erythematosus, based on a case of toxoplasmic encephalopathy. Rheumatology 2002;41:1072 - 1073.
41、 Suh CH, Jeong YS, Park HC, et al. Risk factors for infection and role of C-reactive protein in Korean patients with systemic lupus erythematosus. Clin Exp Rheumatol 2001;19:191 - 194
42、 Hellmich B, Csernok E, de Haas M, et al. Low Fcgamma receptor III and high granulocyte colony-stimulating factor serum levels correlate with the risk of infection in neutropenia due to Felty's syndrome or systemic lupus erythematosus. Am J Med 2002;113:134-139.
43、 Yu-Shu Chen, Yao-Hsu Yang, Yu-Tsai Lin,et al. Risk of infection in hospitalised children with systemiclupus erythematosus: a 10-year follow-up. Clin Rheumatol (2004) 23: 235-238.
44、 X Bosch, A Guilabert, L Pallares, et al. Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients. Lupus (2006) 15, 584-589.
2,Paton NI.Infections in systemic lupus erythematosus patients.Ann Acad Med Singapore 1997;26:694-700.
3、Lai-Shan Tam,Edmund K.Li,et al.Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong.Scand J Rheumatol 2002:31:296-300.
4、张奉春,何兰杰,董怡.系统性红斑狼疮与结核菌感染.风湿病学杂志,1996,1:80.
5、郝阳.我国结核病防治概况与今后工作设想.中华结核病和呼吸杂志,2004,27:433.
6、Sayarlioglu M,Inanc M,el al.Tuberculosis in Turkish patients with systemic lupus erythematosus:increased frequency of extrapulmonary localization.Lupus.2004;13(4):274-8.
7、J-G Erdozain,G Ruiz-Irastorza,et al.High risk of tuberculosis in systemic lupus erythematosus? Lupus(2006) 15,232-235.
8、Balakrishnan C,Mangat G,Mittal G,et al.Tuberculosis in patients with systemic lupus erythematosus.J Assoc Physicians India 1998;46:682-683.
9、Hou CL,Tsai YC,et al.Tuberculosis infection in patients with systemic lupus erythematosus:pulmonary and extra-pulmonary infection compared.Clin Rheumatol.2008 May;27(5):557-63.
10、SUSAN JICK,ERICS.,et al.Glucocorticoid Use,Other Associated Factors,and the Risk of Tuberculosis.Arthritis & Rheumatism(Arthritis Care &Research)Vol.55,No.1,February 15,2006,pp 19-26
11、杨程德,王晓栋,叶霜等.系统性红斑狼疮患者结核感染的临床特点及相关因素分析.中华风湿病学杂志,2005,8:476-9.
1、 Bouza E, Moya JG, Munoz P. Infections in systemic lupus erythematosus and rheumatoid arthritis. Infect Dis Clin North Am 2001;15:335-361.
2、 Insoo Kang, Sung Hwan Park,. Infectious complications in SLE after immunosuppressive therapies. Current Opinion in Rheumatology 2003,15: 528 - 534.
3、 Matthew E. Falagas & Katerina G. Manta &Gregoria I. et al. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol (2007) 26:663-670.
4、 Zonana-Nacach A, Camargo-Coronel A, Yanez P, et al. Infections in outpatients with systemic lupus erythematosus:A prospective study. Lupus 2001;10:505-510.
5、 Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 1999;78:167-175.
6、 Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 82:299-308.
7、 Edwards CJ, Lian TY, Badsha H, Teh CL, Arden N, Chng HH. Hospitalization of individuals with systemic lupus erythematosus: Characteristics and predictors of outcome. Lupus 2003; 12: 672-676.
8、 Bouza E, Moya JG, Munoz P, et al. Mortality study in Puerto Ricans with systemic lupus erythematosus. P R Health Sci J 2000;19:335 - 339.
9、 Alarcon, G. S., McGwin, G. Jr., Bastian, H. M., et al. Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual. Arthritis Rheum. 2001, 45, 191-220.
10、 Gladman DD, Hussain F, Ibanez D, et al. The nature and outcome of infection in systemic lupus erythematosus. Lupus 2002;11:234 - 239.
11、 Noel V, Lortholary O, Casassus P, et al. Risk.factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001;60:1141-4.
12、 Kang I, Park SH. Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol 2003;15:528-534.
13、Piliero P, Furie R: Functional asplenia in systemic lupus erythematosus. Semin Arthritis Rheum 1990, 2b: 185 -189.
14、 Vratsanos G, Kang I, Craft J: Systemic lupus erythematosus. In Samter's Immunologic Diseases, edn 6, vol 2. Edited by Austen KF, Frank MM, Atkinson JP, et al. Philadelphia: Lippincott Williams & Wilkins; 2001:475-495.
15、 Juarez M, MisischiaR, AlarconGS: Infections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis/ dermatomyositis. Rheum Dis Clin North Am 2003, 29:163-184.
16、 Kim WLJ, Min JK, Lee SH, et al. : Causes of death in Korean patients with systemic lupus erythematosus: a single center retrospective study. Clin Exp Rheumatol 1999, 17:539-545.
17、 Nived O, Sturfelt G, Wollheim F: Systemic lupus erythematosus and infection: a controlled and prospective study including an epidemiological group. Q J Med 1985, 55:271 -287.
18、 DiNubile MJ, Albornoz MA, Stumacher RJ, et al. : Pneumococcal soft-tissue infections: possible association with connective tissue diseases. J Infect Dis1991, 163:897-900.
19、 Lim E, Koh WH, Loh SF, et al. : Non-typhoidal salmonellosis in patients with systemic lupus erythematosus. A study of fifty patients and a review of the literature. Lupus 2001, 10:87-92.
20、 Tsao CH, Chen CY, Ou LS, Huang JL. Risk factors of mortality for salmonel la infection in systemic lupus erythematosus. J Rheumatol 2002;29:1214 - 1218.
21、 Wu KC, Yao TC, Yeh KW, Huang JL. Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol 2004;31:1340-1343.
22、 Mitchell SR, Nguyen PQ, Katz P: Increased risk of neisserial infections in systemic lupus erythematosus.Semin Arthritis Rheum 1990,20:174-184.
23、Lai-Shan Tam,Edmund K.Li,et al.Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong.Scand J Rheumatol 2002;31:296-300.
24、张奉春,何兰杰,董怡.系统性红斑狼疮与结核菌感染.风湿病学杂志,1996,1:80.
25、郝阳.我国结核病防治概况与今后工作设想.中华结核病和呼吸杂志,2004,27:433.
26、Sayarlioglu M,Inanc M,el al.Tuberculosis in Turkish patients with systemic lupus erythematosus:increased frequency of extrapulmonary localization.Lupus.2004;13(4):274-8.
27、J-G Erdozain,G Ruiz-Irastorza,et al.High risk of tuberculosis in systemic lupus erythematosus? Lupus(2006) 15,232-235.
28、BalakrishnanC,Mangat G,Mittal G,et al.Tuberculosis in patients with systemic lupus erythematosus.J Assoc Physicians India 1998;46:682-683.
29、Hou CL,Tsai YC,et al.Tuberculosis infection in patients with systemic lupus erythematosus:pulmonary and extra-pulmonary infection compared.Clin Rheumatol.2008 May;27(5):557-63.
30、Gaitonde S,Pathan E,Sule A,et al.:Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment.Ann Rheum Dis 2002,61:251-253.
31、Mok MY,Lo Y,Chan TM,Wong WS,Lau CS.Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy.J Rheumatol 2005;32:609-615.
32、M.Y.Mok,S.S.Y.Wong,T.M.Chan,et al.Non-tuberculous mycobacterial infection in patients with systemic lupus erythematosus.Rheumatology 2007;46:280-284
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