Ann Rheum Dis：抗TNF治疗增加分枝杆菌病发生率
2013-01-09 Ann Rheum Dis CMT 程蓓 翻译
美国一项研究显示，在使用抗肿瘤坏死因子（TNF）药物治疗的患者中，分枝杆菌病发生率增高，且非结核分枝杆菌（NTM）病与类风湿关节炎（RA）相关。论文发表于《风湿病年鉴》[Ann Rheum Dis 2013，72（1）：37]杂志。 研究纳入确诊炎性疾病者8418例（60%罹患RA），均于2000-2008年期间接受了抗TNF治疗。 结果为，抗TNF相
美国一项研究显示，在使用抗肿瘤坏死因子（TNF）药物治疗的患者中，分枝杆菌病发生率增高，且非结核分枝杆菌（NTM）病与类风湿关节炎（RA）相关。论文发表于《风湿病年鉴》[Ann Rheum Dis 2013，72（1）：37]杂志。
研究纳入确诊炎性疾病者8418例（60%罹患RA），均于2000-2008年期间接受了抗TNF治疗。
结果为，抗TNF相关的NTM病及肺结核的发生率分别为74例/10万人-年和49例/10万人-年，依那西普、英夫利昔单抗和阿达木单抗相关的上述两种病发生率分别为35例/10万人-年和17例/10万人-年、116例/10万人-年和83例/10万人-年、122例/10万人-年和91例/10万人-年。在未接受抗TNF治疗RA患者及一般人群中，NTM病及肺结核发生率分别为19.2例/10万人-年和8.7例/10万人-年、4.1例/10万人-年和2.8例/10万人-年。在所有接受抗TNF治疗者中，与未感染者相比，发生NTM者年龄较大（平均年龄68岁对50岁，P＜0.01），更易罹患RA（100%对60%，P＜0.01）；而发生肺结核者更易罹患糖尿病（37%对16%，P=0.02）或慢性肾脏病（25%对6%，P=0.02）。
Mycobacterial diseases and antitumour necrosis factor therapy in USA
Objective In North America, tuberculosis and nontuberculous mycobacterial (NTM) disease rates associated with antitumour necrosis factor α (anti-TNFα) therapy are unknown.
Methods At Kaiser Permanente Northern California, the authors searched automated pharmacy records to identify inflammatory disease patients who received anti-TNF therapy during 2000–2008 and used validated electronic search algorithms to identify NTM and tuberculosis cases occurring during anti-TNF drug exposure.
Results Of 8418 anti-TNF users identified, 60% had rheumatoid arthritis (RA). Among anti-TNF users, 18 developed NTM and 16 tuberculosis after drug start. Anti-TNF associated rates of NTM and tuberculosis were 74 (95% CI: 37 to 111) and 49 (95% CI: 18 to 79) per 100 000 person-years, respectively. Rates (per 100, 000 person-years) for NTM and tuberculosis respectively for etanercept were 35 (95% CI: 1 to 69) and 17 (95% CI: 0 to 41); infliximab, 116 (95% CI: 30 to 203) and 83 (95% CI: 10 to 156); and adalimumab, 122 (95% CI: 3 to 241) and 91 (95% CI: 19 to 267). Background rates for NTM and tuberculosis in unexposed RA-patients were 19.2 (14.2 to 25.0) and 8.7 (5.3 to 13.2), and in the general population were 4.1 (95% CI 3.9 to 4.4) and 2.8 (95% CI 2.6 to 3.0) per 100, 000 person-years. Among anti-TNF users, compared with uninfected individuals, NTM case-patients were older (median age 68 vs 50 years, p<0.01) and more likely to have RA (100% vs 60%, p<0.01); whereas, tuberculosis case-patients were more likely to have diabetes (37% vs 16%, p=0.02) or chronic renal disease (25% vs 6%, p=0.02).
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#分枝杆菌#
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#发生率#
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#抗TNF治疗#
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#抗TNF#
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#TNF#
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