应用生物制剂治疗儿童结核病的评价

Y. Kara, M. C. Kizil, Merve İşeri Nepesov, Aslı Kavaz Tufan, N. Çetin, Y. Aydemir, Z. Barış, Hilal Kaya Erdoğan, Ömer Kılıç, E. Dinleyici
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引用次数: 2

摘要

目的:抗肿瘤坏死因子药物增加结核病的风险。在这项研究中,我们旨在调查使用抗肿瘤坏死因子药物的患者中结核病的发病率。方法:选取115例接受抗肿瘤坏死因子药物治疗的患儿作为研究对象。回顾性分析所有病例的临床和流行病学特征。结果:115例使用抗肿瘤坏死因子药物的患者纳入研究。病例的诊断如下:青少年类风湿性关节炎76例(66%),溃疡性结肠炎11例(9.6%),克罗恩病7例(6%),强直性脊柱炎6例(5.2%),FMF 5例(4.3%),牛皮癣4例(% 3.5%)。患者使用的药物分布为;依那西普74(64.3%)、英夫利昔单抗17(14.8%)、阿达木单抗17(14.8%)、阿那金那5(4.3%)和canakinumab 2(%1.7)。据了解,经疫苗接种卡和卫生部疫苗接种随访系统确认,所有病例均在两个月大时接种过卡介苗。所有病例均行TST, 7例(5.6%)患者TST反应为15mm。17例诊断为潜伏性结核的患者开始使用异烟肼(INH)预防治疗9个月。所有病例均未检出活动性肺结核。结论:所有接受抗肿瘤坏死因子治疗的患者都需要进行结核病评估。尽管在治疗开始时未发现结核病,但在治疗期间应根据现行指南继续进行定期结核病筛查,包括接触史、症状、体格检查、胸部x线检查和TST/IGRA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of tuberculosis in children using biological agent therapy
Purpose: Anti-TNF drugs increase the risk of tuberculosis. In this study we aimed to investigate the incidence of tuberculosis in patients using anti-TNF drugs.Methods: One hundred and fifteen pediatric cases which were received anti-TNF drugs were included in the study. The clinical and epidemiological characteristics of the cases were analyzed retrospectively.Results: One hundred and fifteen cases using anti-TNF drugs were included in the study. The diagnoses of the cases were as follows; Juvenile Rheumatoid Arthritis 76 (66%), Ulcerative Colitis 11 (9.6%), Crohn's 7 (6%), Ankylosing Spondylitis 6 (5.2%), FMF 5 (4.3%), Psoriasis 4 (%3.5). The distribution of the agents used by the patients was; etanercept 74 (64.3%), infliximab 17 (14.8%), adalimumab 17 (14.8%), anakinra 5 (4.3%), and canakinumab 2 (%1.7). It was learned that all cases had BCG vaccinations when they were two months old, confirmed by the vaccination cards and the ministry of health's vaccination follow-up system. TST was performed in all of the cases and TST response was measured as <5mm in 89 (77.4%), 5-9 mm in 11 (8.7%), 10-14 mm in 8 (7.4%), >15 mm in 7 (5.6%) cases. Isoniazid (INH) prophylaxis was started for nine months in 17 cases with the diagnosis of latent tuberculosis. Active tuberculosis was not detected in any of the cases.Conclusion: All patients receiving anti-TNF need to be evaluated for tuberculosis. Although it is not detected at the beginning of the treatment, regular tuberculosis screening should be continued during the treatment with contact history, symptoms, physical examination, chest X-ray, and TST/IGRA in light of current guidelines.
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