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
• 论著 · 临床研究 • 上一篇
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()
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:
曾奇兵,刘忠华
E-mail:zengqibing@gmc.edu.cn;nllzh@126.com
作者简介:
骆梦醒(1998—),女,硕士生;电子信箱:lmx9806@163.com。
基金资助:
LUO Mengxing1,2, ZOU Xin1,2, GAO Yaxian1,2, WU Xiaocui2, YU Fangyou2, HU Yang2, ZENG Qibing1(), LIU Zhonghua1,2()
Received:
2023-04-25
Accepted:
2023-05-29
Online:
2023-08-28
Published:
2023-08-28
Contact:
ZENG Qibing,LIU Zhonghua
E-mail:zengqibing@gmc.edu.cn;nllzh@126.com
Supported by:
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。
中图分类号:
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.
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) |
表1 结核患者基本资料和临床特征
Tab 1 General information and clinical characteristics of tuberculosis patients
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) |
表2 诊断时有、无合并症的结核患者治疗结果的比较 [n(%)]
Tab 2 Comparison of treatment outcomes in TB patients with and without complications at diagnosis [n(%)]
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) |
表3 诊断时仅患有1种合并症结核患者与无合并症患者治疗结果的比较 [n(%)]
Tab 3 Comparison of treatment outcomes between tuberculosis patients with only one complication at diagnosis and those without complication [n(%)]
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) |
图1 诊断时患有糖尿病(A)与高血压(B)的结核患者与无合并症结核患者的生存曲线对比
Fig 1 Comparison of survival curve between tuberculosis patients with diabetes (A) and hypertension (B) at diagnosis and tuberculosis patients without complications
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) |
表4 诊断时有、无合并症的结核患者肺部损伤的比较 [n(%)]
Tab 4 Comparison of lung injury in tuberculosis patients with and without complications at diagnosis [n(%)]
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 | Area of lung injury | χ2 value | P value | |
---|---|---|---|---|
Bilateral lung | Unilateral lung | |||
TB with/without complications | 11.112 | 0.001 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 101 (58.4) | 72 (41.6) | ||
TB with/without diabetes | 8.928 | 0.003 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 32 (65.3) | 17 (34.7) | ||
TB with/without hypertension | 2.997 | 0.083 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 14 (60.9) | 9 (39.1) | ||
TB with/without liver disease | 9.467 | 0.002 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 51 (61.5) | 32 (38.5) | ||
TB with/without kidney disease | 0.509 | 0.476 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 17 (48.6) | 18 (51.4) | ||
TB with/without gallbladder disease | 3.289 | 0.070 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 11 (64.7) | 6 (35.3) |
表5 诊断时有、无合并症的结核患者肺部损伤区域的比较 [n(%)]
Tab 5 Comparison of areas of lung injury in tuberculosis patients with and without complications at diagnosis [n(%)]
Group | Area of lung injury | χ2 value | P value | |
---|---|---|---|---|
Bilateral lung | Unilateral lung | |||
TB with/without complications | 11.112 | 0.001 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 101 (58.4) | 72 (41.6) | ||
TB with/without diabetes | 8.928 | 0.003 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 32 (65.3) | 17 (34.7) | ||
TB with/without hypertension | 2.997 | 0.083 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 14 (60.9) | 9 (39.1) | ||
TB with/without liver disease | 9.467 | 0.002 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 51 (61.5) | 32 (38.5) | ||
TB with/without kidney disease | 0.509 | 0.476 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 17 (48.6) | 18 (51.4) | ||
TB with/without gallbladder disease | 3.289 | 0.070 | ||
Without | 117 (42.2) | 160 (57.8) | ||
With | 11 (64.7) | 6 (35.3) |
Group | Cavity | χ2 value | P value | Group | Cavity | χ2 value | P value | ||
---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | ||||||
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) |
表6 诊断时有、无合并症的结核患者肺部空洞的比较 [n(%)]
Tab 6 Comparison of pulmonary cavities in tuberculosis patients with and without complications at diagnosis [n(%)]
Group | Cavity | χ2 value | P value | Group | Cavity | χ2 value | P value | ||
---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | ||||||
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) |
Group | Grade of sputum smear | χ2 value | P value | |||
---|---|---|---|---|---|---|
1+ | 2+ | 3+ | 4+ | |||
TB with complications | 11.968 | 0.007 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 129 (74.6) | 15 (8.7) | 17 (9.8) | 12 (6.9) | ||
TB with diabetes | 27.877 | 0.000 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 28 (57.1) | 4 (8.2) | 11 (22.4) | 6 (12.3) | ||
TB with hypertension | 7.640 | 0.083 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 17 (73.9) | 2 (8.7) | 2 (8.7) | 2 (8.7) | ||
TB with liver disease | 13.597 | 0.004 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 66 (79.5) | 5 (6.0) | 5 (6.0) | 7 (8.5) | ||
TB with kidney disease | 4.369 | 0.224 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 27 (77.1) | 3 (8.6) | 3 (8.6) | 2 (5.7) | ||
TB with gallbladder disease | 3.474 | 0.302 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 12 (70.6) | 2 (11.8) | 2 (11.8) | 1 (5.8) |
表7 诊断时有、无合并症的结核患者肺部载菌量情况比较 [n(%)]
Tab 7 Comparison of pulmonary bacterial load between tuberculosis patients with and without complications at diagnosis [n(%)]
Group | Grade of sputum smear | χ2 value | P value | |||
---|---|---|---|---|---|---|
1+ | 2+ | 3+ | 4+ | |||
TB with complications | 11.968 | 0.007 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 129 (74.6) | 15 (8.7) | 17 (9.8) | 12 (6.9) | ||
TB with diabetes | 27.877 | 0.000 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 28 (57.1) | 4 (8.2) | 11 (22.4) | 6 (12.3) | ||
TB with hypertension | 7.640 | 0.083 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 17 (73.9) | 2 (8.7) | 2 (8.7) | 2 (8.7) | ||
TB with liver disease | 13.597 | 0.004 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 66 (79.5) | 5 (6.0) | 5 (6.0) | 7 (8.5) | ||
TB with kidney disease | 4.369 | 0.224 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 27 (77.1) | 3 (8.6) | 3 (8.6) | 2 (5.7) | ||
TB with gallbladder disease | 3.474 | 0.302 | ||||
Without | 227 (81.9) | 20 (7.2) | 27 (9.8) | 3 (1.1) | ||
With | 12 (70.6) | 2 (11.8) | 2 (11.8) | 1 (5.8) |
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