結核病在台灣單一醫學中心五年之統計

Tuberculosis in patients with systemic lupus erythematosus: five year experience of a single center in Northern Taiwan

目的：結核病是全世界最嚴重的傳染性疾病之一。先前的研究顯示在東南亞地區（包括台灣），全身性紅斑狼瘡病人罹患結核病的盛行率高於一般民眾。本研究的目的是分析及統計近五年（2008-2013）結核病在台灣單一中心全身性紅斑狼瘡病人之臨床特徵。方法：我們回顧了西元2008年5月至西元2013年4月間，曾於國立台灣大學附設醫院接受門診或住院照護之全身性紅斑狼瘡患者的病歷，並記錄其年紀、性別、病程、藥物、死因、結核病治療結果等相關資料，並進行分析及討論。結果：本研究共計有1615位全身性紅斑狼瘡患者收案，其中有18位在研究期間內罹患結核病，其盛行率為1.11%。結核病病患平均感染年紀為50 ± 14.4歲，女性與男性的比例是13比5，且56%的患者表現為肺外結核。全身性紅斑狼瘡病患之結核病死亡率為5.5%。大部分的病人都有使用類固醇，而其平均使用劑量為每天12.1 ± 8.7毫克。結論：我們發現全身性紅斑狼瘡患者罹患結核病感染者的平均年紀，較狼瘡患者但未罹患結核病者為高。此外，對男性、遲發性全身性紅斑狼瘡、以及年紀較大且服用類固醇的全身性紅斑狼瘡患病患而言，結核病的感染極可能是個相當重要的議題。

Objective: Tuberculosis (TB) is one of the most severe infectious diseases worldwide. Previous studies have shown a higher prevalence of TB infection in patients with systemic lupus erythematosus (SLE) in South-East Asia, including Taiwan. This study aimed to analyze cases of TB in patients with SLE in a single center from 2008 to 2013. Methods: We retrospectively reviewed the medical records of patients with SLE who were followed up at National Taiwan University Hospital from May, 2008 to April, 2013, including both inpatient and outpatient departments. Age, gender, disease duration, medications, cause of death, and treatment response to TB were documented and analyzed. Results: A total of 1615 patients with SLE were enrolled in this study. TB was diagnosed in 18 patients, with a prevalence rate of 1.11%. The average age of the patients with SLE and TB was 50 ± 14.4 years, with a female to male ratio of 13:5, and 56% of the patients had extrapulmonary involvement. The patients with SLE and TB were significantly older than the non-TB group (p=0.027). The prevalence of TB was also higher in the male and patients with late-onset SLE. The TB-related mortality rate was 5.5%. Most patients received glucocorticoids, and the mean daily dosage was 12.1 ± 8.7 mg prednisolone or equivalent. Conclusion: The average age of the patients with SLE and TB was older than that of those without TB. In patients with SLE, TB may be a particularly important issue in males, patients with late-onset SLE, and in older patients with concomitant steroid use.