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

doi:10.3969/j.issn.1674-8115.2023.08.009

Abstract

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

CLC Number:

R521.9

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.

Figures/Tables 8

TrendMD

References 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)