结核病合并基础疾病患者的抗结核治疗效果及肺部损伤分析

doi:10.3969/j.issn.1674-8115.2023.08.009

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (8): 1017-1023.doi: 10.3969/j.issn.1674-8115.2023.08.009

结核病合并基础疾病患者的抗结核治疗效果及肺部损伤分析

骆梦醒¹^,², 邹欣¹^,², 高雅娴¹^,², 吴小翠², 余方友², 胡洋², 曾奇兵¹(), 刘忠华¹^,²()

^1.贵州医科大学公共卫生与健康学院，环境污染与疾病监控教育部重点实验室，贵阳 550025
^2.同济大学附属上海市肺科医院结核病重点实验室，上海 200433

收稿日期:2023-04-25 接受日期:2023-05-29 出版日期:2023-08-28 发布日期:2023-08-28
通讯作者: 刘忠华，电子信箱：nllzh@126.com。为共同通信作者。
曾奇兵，电子信箱：zengqibing@gmc.edu.cn。为共同通信作者。
作者简介:骆梦醒（1998—），女，硕士生；电子信箱：lmx9806@163.com。
基金资助:
国家自然科学基金(81970009);教育部环境污染监测与疾病控制重点实验室开放基金(GMU-2022-HJZ-04)

Analysis of the effect of anti-tuberculosis treatment and lung injury in patients with tuberculosis combined with underlying disease

LUO Mengxing¹^,², ZOU Xin¹^,², GAO Yaxian¹^,², WU Xiaocui², YU Fangyou², HU Yang², ZENG Qibing¹(), LIU Zhonghua¹^,²()

^1.Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 550025, China
^2.Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China

Received:2023-04-25 Accepted:2023-05-29 Online:2023-08-28 Published:2023-08-28
Contact: LIU Zhonghua, E-mail: nllzh@126.com. Co-corresponding authors.
ZENG Qibing, E-mail: zengqibing@gmc.edu.cn. Co-corresponding authors.
Supported by:
National Natural Science Foundation of China(81970009);The Open Foundation for Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education(GMU-2022-HJZ-04)

摘要/Abstract

摘要：

目的·探讨结核病诊断时的合并症对患者预后及肺部损伤的影响。方法·采用回顾性队列研究，选择2018年1月—12月上海市肺科医院涂片阳性的结核患者，分为无合并症组和有合并症组（合并糖尿病、高血压、肝脏疾病、肾脏疾病和胆囊疾病）。利用χ²检验比较无合并症组和有合并症组结核患者的总体治疗结果和肺部损伤情况，并采用分层分析比较各合并症对结核患者预后及肺部损伤影响，使用Kaplan-Meier分析合并症与结核病预后的时间相关性。结果·纳入450例结核患者，男性323例（71.8%），女性127例（28.2%），中位年龄为33岁。其中，173例患者有合并症：糖尿病49例，高血压23例，肝脏疾病83例，肾脏疾病35例，胆囊疾病17例。无合并症的结核患者治愈率为80.5%，显著高于有合并症组（P<0.05）；诊断时患有糖尿病、高血压和肾脏疾病的结核患者治愈率显著降低是引起抗结核治疗失败的关键原因；患有糖尿病和肝脏疾病的结核患者肺部载菌量更多、肺部损伤区域更大，患有糖尿病和肾脏疾病的结核患者肺部空洞发生率更高。结论·糖尿病、高血压和肾脏疾病使肺部损伤加重导致结核病治愈率降低，诊断时临床医生及早采取干预措施，可提高结核患者的治愈率，缩短治疗时间，降低医疗成本。

关键词: 结核病, 合并症, 预后, 肺部损伤

Abstract:

Objective ·To investigate the impact of complications on the prognosis and lung injury of patients with tuberculosis.. Methods ·A retrospective cohort study was used for analysis, to select a total of 450 smear-positive tuberculosis (TB) patients, 323 males (71.8%) and 127 females (28.2%), from January to December 2018 at Shanghai Pulmonary Hospital, Tongji University School of Medicine, which were divided into non-complication group and complication group (diabetes, hypertension, liver diseases, kidney diseases and gallbladder diseases). Overall treatment outcomes and lung injuries in TB patients with and without complications were analyzed by using χ² test. Stratified analysis of the impact of each comorbidity on the prognosis and lung injury of TB patients was performed. Kaplan-Meier analysis was used to analyze the temporal correlation between complications and tuberculosis prognosis. Results ·Four hundred and fifty patients with a median age of 33 years were included, 173 of whom had complications: diabetes in 49 cases, hypertension in 23 cases, liver diseases in 83 cases, kidney diseases in 35 cases, and gallbladder diseases in 17 cases. The cure rate of TB patients without complications was 80.5%, which was significantly higher than that of the group with complications (P<0.05); the significantly lower cure rate of TB patients with diabetes, hypertension and kidney diseases at diagnosis was the key cause of anti-tuberculosis treatment failure; TB patients with diabetes and liver diseases had higher lung bacterial load and larger areas of lung damage, and TB patients with diabetes and kidney diseases had higher incidence of pulmonary cavity. Conclusion ·Diabetes, hypertension and kidney diseases exacerbate lung damage and lead to lower TB cure rates. Early interventions by clinicians at the time of diagnosis can improve cure rates, shorten treatment time, and reduce medical costs for TB patients.

Key words: tuberculosis, complication, prognosis, lung damage

中图分类号:

R521.9

骆梦醒, 邹欣, 高雅娴, 吴小翠, 余方友, 胡洋, 曾奇兵, 刘忠华. 结核病合并基础疾病患者的抗结核治疗效果及肺部损伤分析[J]. 上海交通大学学报（医学版）, 2023, 43(8): 1017-1023.

LUO Mengxing, ZOU Xin, GAO Yaxian, WU Xiaocui, YU Fangyou, HU Yang, ZENG Qibing, LIU Zhonghua. Analysis of the effect of anti-tuberculosis treatment and lung injury in patients with tuberculosis combined with underlying disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(8): 1017-1023.

图/表 8

参考文献 26

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Item	Tuberculosis patients
Age/year	33.00 (25.00, 51.25)
Gender/n(%)
Male	323 (71.8)
Female	127 (28.2)
Fever/n(%)	117 (26.0)
Cough/n(%)	292 (64.9)
Hemoptysis/n(%)	52 (11.6)
Sweat/n(%)	23 (5.1)
Lose weight/n(%)	10 (2.2)
Complication/n(%)
Diabetes	49 (10.9)
Hypertension	23 (5.1)
Liver disease	83 (18.4)
Kidney disease	35 (7.8)
Gallbladder disease	17 (3.8)
Grade of sputum smear/n(%)
1+	356 (79.1)
2+	35 (7.8)
3+	44 (9.8)
4+	15 (3.3)

Item	Tuberculosis patients
Age/year	33.00 (25.00, 51.25)
Gender/n(%)
Male	323 (71.8)
Female	127 (28.2)
Fever/n(%)	117 (26.0)
Cough/n(%)	292 (64.9)
Hemoptysis/n(%)	52 (11.6)
Sweat/n(%)	23 (5.1)
Lose weight/n(%)	10 (2.2)
Complication/n(%)
Diabetes	49 (10.9)
Hypertension	23 (5.1)
Liver disease	83 (18.4)
Kidney disease	35 (7.8)
Gallbladder disease	17 (3.8)
Grade of sputum smear/n(%)
1+	356 (79.1)
2+	35 (7.8)
3+	44 (9.8)
4+	15 (3.3)

Group	Cured	Not-cured	χ² value	P value
TB with/without complications			7.293	0.007
Without	223 (80.5)	54 (19.5)
With	120 (69.4)	53 (30.6)
TB with/without diabetes			5.646	0.017
Without	223 (80.5)	54 (19.5)
With	32 (65.3)	17 (34.7)
TB with/without hypertension			7.279	0.011
Without	223 (80.5)	54 (19.5)
With	13 (56.5)	10 (43.5)
TB with/without liver disease			0.456	0.500
Without	223 (80.5)	54 (19.5)
With	64 (77.1)	19 (22.9)
TB with/without kidney disease			5.739	0.017
Without	223 (80.5)	54 (19.5)
With	22 (62.9)	13 (37.1)
TB with/without gallbladder disease			2.461	0.126
Without	223 (80.5)	54 (19.5)
With	11 (64.7)	6 (35.3)

Group	Cured	Not-cured	χ² value	P value
TB with/without complications			7.293	0.007
Without	223 (80.5)	54 (19.5)
With	120 (69.4)	53 (30.6)
TB with/without diabetes			5.646	0.017
Without	223 (80.5)	54 (19.5)
With	32 (65.3)	17 (34.7)
TB with/without hypertension			7.279	0.011
Without	223 (80.5)	54 (19.5)
With	13 (56.5)	10 (43.5)
TB with/without liver disease			0.456	0.500
Without	223 (80.5)	54 (19.5)
With	64 (77.1)	19 (22.9)
TB with/without kidney disease			5.739	0.017
Without	223 (80.5)	54 (19.5)
With	22 (62.9)	13 (37.1)
TB with/without gallbladder disease			2.461	0.126
Without	223 (80.5)	54 (19.5)
With	11 (64.7)	6 (35.3)

Group	Cured	Not-cured	χ² value	P value
TB with/without diabete			7.341	0.007
Without	223 (80.5)	54 (19.5)
With	15 (57.7)	11 (42.3)
TB with/without hypertension			14.413	0.001
Without	223 (80.5)	54 (19.5)
With	2 (25.0)	6 (75.0)
TB with/without liver disease			0.534	0.465
Without	223 (80.5)	54 (19.5)
With	38 (76.0)	12 (24.0)
TB with/without kidney disease			2.756	0.149
Without	223 (80.5)	54 (19.5)
With	8 (61.5)	5 (38.4)
TB with/without gallbladder disease			0.355	0.627
Without	223 (80.5)	54 (19.5)
With	5 (71.4)	2 (28.5)

结核病合并基础疾病患者的抗结核治疗效果及肺部损伤分析

Analysis of the effect of anti-tuberculosis treatment and lung injury in patients with tuberculosis combined with underlying disease

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参考文献 26

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Metrics

Lung injury	TB without complications	TB with complications	χ² value	P value
Area of lung injury			11.112	0.001
Bilateral lung	117 (42.2)	101 (58.4)
Unilateral lung	160 (57.8)	72 (41.6)
Cavity			10.323	0.001
Yes	72 (26.0)	70 (40.5)
No	205 (74.0)	103 (59.5)
Effusion			0.606	0.436
Yes	46 (16.6)	24 (13.9)
No	231 (83.4)	149 (86.1)
Nodule			0.793	0.373
Yes	88 (31.8)	62 (35.8)
No	189 (68.2)	111 (64.2)
Grade of sputum smear			11.968	0.007
1+	227 (81.9)	129 (74.6)
2+	20 (7.2)	15 (8.7)
3+	27 (9.8)	17 (9.8)
4+	3 (1.1)	12 (6.9)

Group	Cavity		χ² value	P value	Group	Cavity		χ² value	P value
Group	Yes	No	χ² value	P value	Group	Yes	No	χ² value	P value
TB with/without complications			10.323	0.001	TB with/without liver disease			1.369	0.242
Without	72 (26.0)	205 (74.0)			Without	72 (26.0)	205 (74.0)
With	70 (40.5)	103 (59.5)			With	27 (32.5)	56 (67.5)
TB with/without diabetes			32.610	0.000	TB with/without kidney disease			5.968	0.015
Without	72 (26.0)	205 (74.0)			Without	72 (26.0)	205 (74.0)
With	33 (67.4)	16 (32.6)			With	16 (45.7)	19 (54.3)
TB with/without hypertension			0.000	0.992	TB with/without gallbladder disease			3.589	0.088
Without	72 (26.0)	205 (74.0)			Without	72 (26.0)	205 (74.0)
With	6 (26.1)	17 (73.9)			With	8 (47.1)	9 (52.9)

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