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.

Citation： LI Hongmei, LEI Shuting, LIN Ling, LAI Min, LAI Hongli. Establishment of a prediction model for 2-month sputum smear conversion in patients with systemic lupus erythematosus and tuberculosis. West China Medical Journal, 2025, 40(5): 743-748. doi: 10.7507/1002-0179.202407359 Copy

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2.	郭婉如, 周琳, 何超文, 等. 影響初治涂陽肺結核治療 2 月末痰仍陽性的因素分析. 臨床肺科雜志, 2014, 19(6): 1049-1052.
3.	高曉霞, 邢寶芝. 痰涂片檢查在肺結核病診療工作中的重要作用. 中國民族民間醫藥, 2008, 17(7): 63.
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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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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.
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12.	Kiriakidou M, Ching CL. Systemic lupus erythematosus. Ann Intern Med, 2020, 172(11): Itc81-itc96.
13.	謝靜儀, 鄒瑞豐, 陳玉蘭, 等. 系統性紅斑狼瘡合并結核感染臨床特征及外周血淋巴細胞亞群分析. 中國防癆雜志, 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.	中華人民共和國國家衛生和計劃生育委員會. 肺結核診斷標準(WS 288-2017). 新發傳染病電子雜志, 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 例系統性紅斑狼瘡肺損害的臨床分析. 中日友好醫院學報, 2007, 21(3): 135-136, 140.
20.	羅春華, 李祖銘, 李國靜, 等. 系統性紅斑狼瘡患者血清膽紅素與血脂檢測結果分析. 中國實驗診斷學, 2006, 10(3): 271-273.
21.	沈薇薇, 李宗鋒, 卜秋寧, 等狼瘡性腎炎患者血清膽紅素水平的變化及意義. 臨床輸血與檢驗, 2020, 22(5): 533-537.
22.	Wójcik P, G?gotek A, ?arkovi? 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.	魏夢婷, 孫曙光. 血清膽紅素在動脈粥樣硬化中的研究進展. 中國醫學創新, 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.	高緒聰, 柴振海, 張宗鵬. 藥物性肝損傷的生物標志物及其評價的研究進展. 中國藥理學與毒理學雜志, 2012, 26(5): 692-696.
27.	顧瑾, 林明貴, 唐神結. 《抗結核藥所致藥物性肝損傷診治指南(2024 年版)》更新要點解讀. 結核與肺部疾病雜志, 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.	葉圣瑩, 秦燕. 糖尿病致肝損傷機制的研究進展. 肝臟, 2023, 28(6): 737-739.
33.	耿俊玲, 張伊楠, 潘洪秋. 結核病患者發生藥物性肝損傷風險預測模型的構建與驗證. 中國防癆雜志, 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, 何慶秋, 黃瑞霞, 等. 復治涂陽肺結核患者化療后 2 個月末痰涂片陰轉與未陰轉情況分析. 中國防癆雜志, 2013, 35(12): 965-968.
37.	葉紅英, 李益明. 糖皮質激素對血糖的影響及其處理. 中華糖尿病雜志, 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. 影響初治涂陽肺結核治療 2 月末痰仍陽性的因素分析. 臨床肺科雜志, 2014, 19(6): 1049-1052.
3. 高曉霞, 邢寶芝. 痰涂片檢查在肺結核病診療工作中的重要作用. 中國民族民間醫藥, 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. 陳潔, 張才成, 李俊明. 結核分枝桿菌感染與自身免疫病相互關系的研究進展. 廣東醫學, 2014, 35(9): 1444-1447.
12. Kiriakidou M, Ching CL. Systemic lupus erythematosus. Ann Intern Med, 2020, 172(11): Itc81-itc96.
13. 謝靜儀, 鄒瑞豐, 陳玉蘭, 等. 系統性紅斑狼瘡合并結核感染臨床特征及外周血淋巴細胞亞群分析. 中國防癆雜志, 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. 中華人民共和國國家衛生和計劃生育委員會. 肺結核診斷標準(WS 288-2017). 新發傳染病電子雜志, 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 例系統性紅斑狼瘡肺損害的臨床分析. 中日友好醫院學報, 2007, 21(3): 135-136, 140.
20. 羅春華, 李祖銘, 李國靜, 等. 系統性紅斑狼瘡患者血清膽紅素與血脂檢測結果分析. 中國實驗診斷學, 2006, 10(3): 271-273.
21. 沈薇薇, 李宗鋒, 卜秋寧, 等狼瘡性腎炎患者血清膽紅素水平的變化及意義. 臨床輸血與檢驗, 2020, 22(5): 533-537.
22. Wójcik P, G?gotek A, ?arkovi? 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. 魏夢婷, 孫曙光. 血清膽紅素在動脈粥樣硬化中的研究進展. 中國醫學創新, 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. 高緒聰, 柴振海, 張宗鵬. 藥物性肝損傷的生物標志物及其評價的研究進展. 中國藥理學與毒理學雜志, 2012, 26(5): 692-696.
27. 顧瑾, 林明貴, 唐神結. 《抗結核藥所致藥物性肝損傷診治指南(2024 年版)》更新要點解讀. 結核與肺部疾病雜志, 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. 葉圣瑩, 秦燕. 糖尿病致肝損傷機制的研究進展. 肝臟, 2023, 28(6): 737-739.
33. 耿俊玲, 張伊楠, 潘洪秋. 結核病患者發生藥物性肝損傷風險預測模型的構建與驗證. 中國防癆雜志, 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, 何慶秋, 黃瑞霞, 等. 復治涂陽肺結核患者化療后 2 個月末痰涂片陰轉與未陰轉情況分析. 中國防癆雜志, 2013, 35(12): 965-968.
37. 葉紅英, 李益明. 糖皮質激素對血糖的影響及其處理. 中華糖尿病雜志, 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

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

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