目的 探讨自身免疫疾病患者应用肿瘤坏死因子-α抑制剂后并发结核病的临床特点、治疗及预后。 方法 收集2019年1月至2023年3月期间广州市胸科医院收治的33例应用生物制剂（肿瘤坏死因子-α抑制剂）后并发结核病患者的临床资料，其中男性25例，女性8例，中位年龄32岁，回顾性分析其临床症状、实验室检查结果、影像学及气管镜特征、病理特点、治疗及转归进行综合分析。 结果 常见临床表现为咳嗽（26/33）、咳痰（23/33）、发热（17/33）。发病多见于肺结核（32/33）、支气管结核（15/33）、纵隔及肺门淋巴结结核（11/33）。结核菌双侧全肺播散（21/33），结核菌肺内组织（支气管、纵隔肺门淋巴结、胸膜）播散（19/33），肺外结核（18/33），肺结核伴肺内组织或肺外结核（26/33）。血CD4⁺T淋巴细胞检测正常（23/33），血IGRA检测阳性（27/33）。肺部影像学粟粒性结节（8/33）。淋巴结组织病理为不典型肉芽肿结节。抗结核治疗疗程8 ~ 32个月。死亡1例。 结论 自身免疫疾病应用肿瘤坏死因子-α抑制剂后并发结核病患者以双肺病灶多见，易播散到肺内组织及全身多个器官，免疫功能下降，多需延长治疗疗程，经综合治疗多预后良好。

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.