肺结核大咯血患者临床危险因素分析

Risk factors of massive hemoptysis in tuberculosis patients

目的:预测肺结核患者发生大咯血的危险因素,为临床救治策略提供参考。方法:应用单因素卡方检验及多因素二元Logistic回归分析对241例肺结核咯血患者的病历资料进行统计分析。结果:单因素显示病程≥3个月、年龄≥45岁、肺结核病灶累及肺野数≥3个、有肺结核空洞、吸烟指数≥400年支、并发支气管扩张、并发支气管结核、并发肺真菌感染、并发糖尿病、并发肝病、治疗情况等11项指标差异有统计学意义(P<0.05)。多因素显示肺结核病灶累及肺野数≥3个(OR=2.447,P=0.015)、有肺结核空洞(OR=2.486,P=0.004)、并发支气管结核(OR=3.192,P=0.002)、并发肺真菌感染(OR=3.896,P=0.005)、并发肝病(OR=3.101,P=0.006)等5项指标进入方程模式。结论 :肺结核患者发生大咯血受多因素影响,肺结核病灶累及肺野数≥3个、有肺结核空洞、并发支气管结核、并发肺真菌感染、并发肝病可能是独立危险因素。

Objective To explore the risk factors for patients with massive hemoptysis in tuberculosis and to provide a strategy for clinical treatment for tuberculosis massive hemoptysis（TMH）. Methods Chisquare test and multivariate logistics analysis were applied to analyze the medical data of 241 cases of TMH.Results Chi-squared test showed that eleven factors were found to be significantly correlated with TMH. Longer disease course（≥3 months）, lung lesions range ≥ 3 lung fields, pulmonary tuberculosis cavity, a higher smoking index（≥400 cigarettes per year） and clinical treatment were risk factors for TMH. Patients aged 45 years or older accompanied with bronchiectasia, pulmonary fungal infection, diabetes or hepatopathy had higher probabilities of developing massive hemoptysis. Multivariate analysis showed lung lesions range over 3 lung fields（OR = 2.447,P = 0.015）, pulmonary tuberculosis cavity（OR = 2.486, P = 0.004）, bronchial asthma（OR =3.192,P = 0.002）, pulmonary fungal infection（OR = 3.896, P = 0.005） and hepatopathy（OR = 3.101, P =0.006） were final risk factors for TMH. Conclusion Multiple factors contributed to patients with massive hemoptysis in tuberculosis. Lung lesions range over 3 lung fields, pulmonary tuberculous cavities, bronchial asthma, lung fungal infection and hepatopathy might be the independent risk factors for TMH.