关键词: 生物制剂, 肿瘤坏死因子-α抑制剂, 结核, 治疗

Abstract:

Objective To investigate the clinical characteristics， treatment and prognosis of tuberculosis in patients with autoimmune diseases after tumor necrosis factor?αinhibitors. Methods Clinical data of 33 patients with TB after biologics （tumor necrosis factor?α inhibitors） treated in Guangzhou Chest Hospital from January 2019 to March 2023 were collected， including 25 males and 8 females， with a median age of 32 years. The clinical symptoms， laboratory results， imaging and tracheoscopic features， pathological features， treatment and outcome were analyzed retrospectively. Results The common clinical manifestations were cough （26/33）， sputum （23/33） and fever （17/33）. The most common cases were pulmonary tuberculosis （32/33）， bronchial tuberculosis （15/33）， mediastinum and hilar lymph node tuberculosis （11/33）. Bilateral lung spread of tuberculosis （21/33）， intrapulmonary spread of tuberculosis （bronchus， mediastinal hilar lymph nodes， pleura） （19/33）， extrapulmonary tuberculosis （18/33）， pulmonary tuberculosis with intrapulmonary or extrapulmonary tuberculosis （26/33）. Blood CD4⁺T lymphocyte test was normal （23/33）， and blood IGRA test was positive （27/33）. Pulmonary imaging miliary nodules （8/33）. The histopathology of the lymph nodes showed atypical granulomatous nodules. The duration of anti?tuberculosis treatment is 8 - 32 months. 1 case of death. Conclusion Patients with autoimmune diseases complicated with tuberculosis after the application of tumor necrosis fact?α inhibitor are more likely to have double lung lesions， which are easy to spread to lung tissues and multiple organs of the body， and have decreased immune function. Most of them need to extend the treatment course， and the prognosis is generally good after comprehensive treatment.

Key words: Biologics, tumor necrosis factor?alpha inhibitors, tuberculosis, treatment