Establishment of a prediction model for 2-month sputum smear conversion in patients with systemic lupus erythematosus and tuberculosis_West China Medical Journal

Authors：

 LI Hongmei ¹ , LEI Shuting ² , LIN Ling ¹ , LAI Min ¹ , LAI Hongli ²

1. Department of Tuberculosis, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan 610066, P. R. China;
2. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Hongmei, Email: 446527356@qq.com

Keywords：

Tuberculosis; systemic lupus erythematosus; sputum smear; prediction model

DOI：

10.7507/1002-0179.202407359

Video：

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Objective To explore the factors influencing 2-month sputum smear conversion (2m-SSC) in patients with systemic lupus erythematosus (SLE) and tuberculosis, and to establish a prediction model for 2m-SSC. Methods The initial and follow-up medical records of inpatients with SLE and sputum smear-positive tuberculosis in West China Hospital of Sichuan University from December 2013 to September 2019 were retrospectively reviewed. Single factor analyses and multivariable Firth’s logistic regression were used to determine the influencing factors of 2m-SSC, and a prediction model for 2m-SSC was established. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated to evaluate the performance of the model. Results A total of 91 patients with SLE and sputum smear-positive tuberculosis were ultimately included, with 8 cases in the non-conversion group and 83 in the conversion group. There were statistically significant differences in white blood cell count, total bilirubin, indirect bilirubin (IBIL), triglyceride, and rheumatoid factor (RF) between the two groups (P<0.05). Serum RF [odds ratio (OR)=2.271, 95% confidence interval (CI) (1.312, 4.350), P=0.003], IBIL [OR=2.363, 95%CI (1.206, 5.045), P=0.013], and glucose [OR=2.058, 95%CI (1.016, 4.280), P=0.045] were identified as risk factors unfavorable to 2m-SSC outcomes. The constructed model (including three variables: RF, IBIL, and glucose) had a good ability in predicting 2m-SSC [AUC=0.893, 95%CI (0.744, 1.000)], with a sensitivity of 87.5% and a specificity of 84.3%. Conclusion This study established a prediction model for 2m-SSC in patients with SLE and tuberculosis, and found the value of serum RF, IBIL, and glucose in predicting 2m-SSC, providing certain guidance for clinicians in treatment decisions.

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6.	Xiao X, Da G, Xie X, et al. Tuberculosis in patients with systemic lupus erythematosus-a 37-year longitudinal survey-based study. J Intern Med, 2021, 290(1): 101-115.
7.	Barber MRW, Clarke AE. Systemic lupus erythematosus and risk of infection. Expert Rev Clin Immunol, 2020, 16(5): 527-538.
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14.	Katsuyama T, Tsokos GC, Moulton VR. Aberrant T cell signaling and subsets in systemic lupus erythematosus. Front Immunol, 2018, 9: 1088.
15.	中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288-2017). 新发传染病电子杂志, 2018, 3(1): 59-61.
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17.	Fedrigo A, Dos Santos TAFG, Nisihara R, et al. The lupus patient with positive rheumatoid factor. Lupus, 2018, 27(8): 1368-1373.
18.	Wu CY, Yang HY, Luo SF, et al. From rheumatoid factor to anti-citrullinated protein antibodies and anti-carbamylated protein antibodies for diagnosis and prognosis prediction in patients with rheumatoid arthritis. Int J Mol Sci, 2021, 22(2): 686.
19.	林冰. 100 例系统性红斑狼疮肺损害的临床分析. 中日友好医院学报, 2007, 21(3): 135-136, 140.
20.	罗春华, 李祖铭, 李国静, 等. 系统性红斑狼疮患者血清胆红素与血脂检测结果分析. 中国实验诊断学, 2006, 10(3): 271-273.
21.	沈薇薇, 李宗锋, 卜秋宁, 等狼疮性肾炎患者血清胆红素水平的变化及意义. 临床输血与检验, 2020, 22(5): 533-537.
22.	Wójcik P, Gęgotek A, Žarković N, et al. Oxidative stress and lipid mediators modulate immune cell functions in autoimmune diseases. Int J Mol Sci, 2021, 22(2): 723.
23.	Salomone F, Li Volti G, Rosso C, et al. Unconjugated bilirubin, a potent endogenous antioxidant, is decreased in patients with non-alcoholic steatohepatitis and advanced fibrosis. J Gastroenterol Hepatol, 2013, 28(7): 1202-1208.
24.	魏梦婷, 孙曙光. 血清胆红素在动脉粥样硬化中的研究进展. 中国医学创新, 2021, 18(19): 184-188.
25.	Amaral EP, Vinhaes CL, Oliveira-de-Souza D, et al. The interplay between systemic inflammation, oxidative stress, and tissue remodeling in tuberculosis. Antioxid Redox Signal, 2021, 34(6): 471-485.
26.	高绪聪, 柴振海, 张宗鹏. 药物性肝损伤的生物标志物及其评价的研究进展. 中国药理学与毒理学杂志, 2012, 26(5): 692-696.
27.	顾瑾, 林明贵, 唐神结. 《抗结核药所致药物性肝损伤诊治指南(2024 年版)》更新要点解读. 结核与肺部疾病杂志, 2025, 6(2): 128-134.
28.	Tostmann A, Boeree MJ, Aarnoutse RE, et al. Antituberculosis drug-induced hepatotoxicity: concise up-to-date review. J Gastroenterol Hepatol, 2008, 23(2): 192-202.
29.	Meng F, Lan L, Wu G, et al. Impact of diabetes itself and glycemic control status on tuberculosis. Front Endocrinol (Lausanne), 2023, 14: 1250001.
30.	Lopez K, Arriaga MB, Aliaga JG, et al. Dysglycemia is associated with Mycobacterium tuberculosis lineages in tuberculosis patients of North Lima-Peru. PLoS One, 2021, 16(1): e0243184.
31.	Hodgson K, Morris J, Bridson T, et al. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology, 2015, 144(2): 171-185.
32.	叶圣莹, 秦燕. 糖尿病致肝损伤机制的研究进展. 肝脏, 2023, 28(6): 737-739.
33.	耿俊玲, 张伊楠, 潘洪秋. 结核病患者发生药物性肝损伤风险预测模型的构建与验证. 中国防痨杂志, 2024, 46(6): 699-706.
34.	Barreda NN, Arriaga MB, Aliaga JG, et al. Severe pulmonary radiological manifestations are associated with a distinct biochemical profile in blood of tuberculosis patients with dysglycemia. BMC Infect Dis, 2020, 20(1): 139.
35.	Rehman AU, Khattak M, Mushtaq U, et al. The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis. Front Public Health, 2023, 11: 1244450.
36.	梁冰, 何庆秋, 黄瑞霞, 等. 复治涂阳肺结核患者化疗后 2 个月末痰涂片阴转与未阴转情况分析. 中国防痨杂志, 2013, 35(12): 965-968.
37.	叶红英, 李益明. 糖皮质激素对血糖的影响及其处理. 中华糖尿病杂志, 2021, 13(1): 1-4.
38.	Greenland S, Mansournia MA, Altman DG. Sparse data bias: a problem hiding in plain sight. BMJ, 2016, 352: i1981.

1. Alene KA, Viney K, Gray DJ, et al. Development of a risk score for prediction of poor treatment outcomes among patients with multidrug-resistant tuberculosis. PLoS One, 2020, 15(1): e0227100.
2. 郭婉如, 周琳, 何超文, 等. 影响初治涂阳肺结核治疗 2 月末痰仍阳性的因素分析. 临床肺科杂志, 2014, 19(6): 1049-1052.
3. 高晓霞, 邢宝芝. 痰涂片检查在肺结核病诊疗工作中的重要作用. 中国民族民间医药, 2008, 17(7): 63.
4. Tian J, Zhang D, Yao X, et al. Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Ann Rheum Dis, 2023, 82(3): 351-356.
5. Zhang L, Zou X, Jiang N, et al. Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study. Front Immunol, 2023, 14: 1157157.
6. Xiao X, Da G, Xie X, et al. Tuberculosis in patients with systemic lupus erythematosus-a 37-year longitudinal survey-based study. J Intern Med, 2021, 290(1): 101-115.
7. Barber MRW, Clarke AE. Systemic lupus erythematosus and risk of infection. Expert Rev Clin Immunol, 2020, 16(5): 527-538.
8. Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet, 2019, 393(10188): 2332-2343.
9. Mills KH. TLR-dependent T cell activation in autoimmunity. Nat Rev Immunol, 2011, 11(12): 807-822.
10. Shoenfeld Y, Vilner Y, Coates AR, et al. Monoclonal anti-tuberculosis antibodies react with DNA, and monoclonal anti-DNA autoantibodies react with Mycobacterium tuberculosis. Clin Exp Immunol, 1986, 66(2): 255-261.
11. 陈洁, 张才成, 李俊明. 结核分枝杆菌感染与自身免疫病相互关系的研究进展. 广东医学, 2014, 35(9): 1444-1447.
12. Kiriakidou M, Ching CL. Systemic lupus erythematosus. Ann Intern Med, 2020, 172(11): Itc81-itc96.
13. 谢静仪, 邹瑞丰, 陈玉兰, 等. 系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析. 中国防痨杂志, 2022, 44(9): 911-916.
14. Katsuyama T, Tsokos GC, Moulton VR. Aberrant T cell signaling and subsets in systemic lupus erythematosus. Front Immunol, 2018, 9: 1088.
15. 中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288-2017). 新发传染病电子杂志, 2018, 3(1): 59-61.
16. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol, 2019, 71(9): 1400-1412.
17. Fedrigo A, Dos Santos TAFG, Nisihara R, et al. The lupus patient with positive rheumatoid factor. Lupus, 2018, 27(8): 1368-1373.
18. Wu CY, Yang HY, Luo SF, et al. From rheumatoid factor to anti-citrullinated protein antibodies and anti-carbamylated protein antibodies for diagnosis and prognosis prediction in patients with rheumatoid arthritis. Int J Mol Sci, 2021, 22(2): 686.
19. 林冰. 100 例系统性红斑狼疮肺损害的临床分析. 中日友好医院学报, 2007, 21(3): 135-136, 140.
20. 罗春华, 李祖铭, 李国静, 等. 系统性红斑狼疮患者血清胆红素与血脂检测结果分析. 中国实验诊断学, 2006, 10(3): 271-273.
21. 沈薇薇, 李宗锋, 卜秋宁, 等狼疮性肾炎患者血清胆红素水平的变化及意义. 临床输血与检验, 2020, 22(5): 533-537.
22. Wójcik P, Gęgotek A, Žarković N, et al. Oxidative stress and lipid mediators modulate immune cell functions in autoimmune diseases. Int J Mol Sci, 2021, 22(2): 723.
23. Salomone F, Li Volti G, Rosso C, et al. Unconjugated bilirubin, a potent endogenous antioxidant, is decreased in patients with non-alcoholic steatohepatitis and advanced fibrosis. J Gastroenterol Hepatol, 2013, 28(7): 1202-1208.
24. 魏梦婷, 孙曙光. 血清胆红素在动脉粥样硬化中的研究进展. 中国医学创新, 2021, 18(19): 184-188.
25. Amaral EP, Vinhaes CL, Oliveira-de-Souza D, et al. The interplay between systemic inflammation, oxidative stress, and tissue remodeling in tuberculosis. Antioxid Redox Signal, 2021, 34(6): 471-485.
26. 高绪聪, 柴振海, 张宗鹏. 药物性肝损伤的生物标志物及其评价的研究进展. 中国药理学与毒理学杂志, 2012, 26(5): 692-696.
27. 顾瑾, 林明贵, 唐神结. 《抗结核药所致药物性肝损伤诊治指南(2024 年版)》更新要点解读. 结核与肺部疾病杂志, 2025, 6(2): 128-134.
28. Tostmann A, Boeree MJ, Aarnoutse RE, et al. Antituberculosis drug-induced hepatotoxicity: concise up-to-date review. J Gastroenterol Hepatol, 2008, 23(2): 192-202.
29. Meng F, Lan L, Wu G, et al. Impact of diabetes itself and glycemic control status on tuberculosis. Front Endocrinol (Lausanne), 2023, 14: 1250001.
30. Lopez K, Arriaga MB, Aliaga JG, et al. Dysglycemia is associated with Mycobacterium tuberculosis lineages in tuberculosis patients of North Lima-Peru. PLoS One, 2021, 16(1): e0243184.
31. Hodgson K, Morris J, Bridson T, et al. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology, 2015, 144(2): 171-185.
32. 叶圣莹, 秦燕. 糖尿病致肝损伤机制的研究进展. 肝脏, 2023, 28(6): 737-739.
33. 耿俊玲, 张伊楠, 潘洪秋. 结核病患者发生药物性肝损伤风险预测模型的构建与验证. 中国防痨杂志, 2024, 46(6): 699-706.
34. Barreda NN, Arriaga MB, Aliaga JG, et al. Severe pulmonary radiological manifestations are associated with a distinct biochemical profile in blood of tuberculosis patients with dysglycemia. BMC Infect Dis, 2020, 20(1): 139.
35. Rehman AU, Khattak M, Mushtaq U, et al. The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis. Front Public Health, 2023, 11: 1244450.
36. 梁冰, 何庆秋, 黄瑞霞, 等. 复治涂阳肺结核患者化疗后 2 个月末痰涂片阴转与未阴转情况分析. 中国防痨杂志, 2013, 35(12): 965-968.
37. 叶红英, 李益明. 糖皮质激素对血糖的影响及其处理. 中华糖尿病杂志, 2021, 13(1): 1-4.
38. Greenland S, Mansournia MA, Altman DG. Sparse data bias: a problem hiding in plain sight. BMJ, 2016, 352: i1981.

West China Medical Journal

Latest ArticlesEstablishment of a prediction model for 2-month sputum smear conversion in patients with systemic lupus erythematosus and tuberculosis

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