综合性医院结核分枝杆菌血培养阳性患者的临床特征分析

Clinical characteristics of patients with positive blood culture for Mycobacterium tuberculosis in a general hospital

目的回顾性分析结核分枝杆菌(Mycobacterium tuberculosis,M.tb)血培养阳性患者的临床资料和实验室特征。方法收集并分析2009年1月至2017年1月复旦大学附属华山医院怀疑播散性结核病患者的临床资料。将M.tb血培养阳性患者纳入血培养阳性组,M.tb血培养阴性患者纳入血培养阴性组。比较两组临床特征、实验室检查和临床结局等指标。统计学处理采用t检验、Mann-Whitney U检验和Fisher确切概率法。结果共有5 589例疑似M.tb感染患者送外周血结核分枝杆菌培养,有26例分枝杆菌血培养阳性,经菌种鉴定有6例为非结核分枝杆菌,因此最终20例播散性结核患者纳入M.tb血培养阳性组;将同期收治的22例血培养阴性的播散性结核患者纳入血培养阴性组。血培养阳性组与血培养阴性组的年龄[(49.1±10.1)岁比(38.3±17.1)岁,t=2.460,P=0.018],以"发热待查"入院比例[65.0%(13/20)比13.6%(3/22),P=0.001],以"局灶感染"入院比例[30.0%(6/20)比86.4%(19/22),P=0.001],伴基础疾病比例[75.0%(15/20)比22.7%(5/22),P=0.002],患血液系统疾病比例[35.0%(7/20)比4.5%(1/22),P=0.018]和患实体肿瘤比例[20%(4/20)比0(0/22),P=0.043]差异均有统计学意义。在实验室检查方面,血培养阳性组中性粒细胞百分比、淋巴细胞百分比、单核细胞百分比、中性粒细胞与淋巴细胞比例、血红蛋白水平、ESR、C反应蛋白水平、降钙素原水平和T-SPOT.TB阳性率与血培养阴性组比较差异均有统计学意义(均P<0.05)。结论临床上年龄较大且伴有血液系统疾病或实体肿瘤的播散性结核患者,当其中性粒细胞计数和炎症指标增高而淋巴细胞计数和血红蛋白水平减低时,外周血M.tb培养更易阳性。

Objective To retrospectively analyze the clinical and laboratory characteristics of patients with positive blood culture results for Mycobacterium tuberculosis (M.tb). Methods The clinical laboratory database of patients suspected with disseminated tuberculosis from January 2009 to January 2017 in Huashan Hospital affiliated with Fudan University were collected and analyzed. The clinical manifestations, laboratory characteristics and outcomes between disseminated tuberculosis patients with positive blood culture (positive blood culture group) for M. tb and negative results (negative blood culture group) were compared. T test, Mann-Whitney U test and Fisher exact test were used for statistical analysis. Results A total of 5 589 patients suspected with M. tb infection had peripheral blood culture for mycobacterium. Positive blood culture for M. tb was found in 26 disseminated tuberculosis patients, while 6 patients finally identified as nontuberculous mycobacterium (NTM) with species identification, and 22 disseminated tuberculosis patients with negative blood culture results were enrolled during the same period as control. The mean age ([49.1±10.1] years old vs[38.3±17.1] years old, t=2.460, P=0.018), the proportion of diagnosed with fever of unknown origin at admission (FUO)(65.0%[13/20] vs 13.6%[3/22], P=0.001), the proportion of diagnosed with focal infection (30.0%[6/20] vs 86.4%[19/22], P=0.001), the proportion of patients with other diseases (75.0%[15/20] vs 22.7%[5/22], P=0.002), the proportion of patients with hematological diseases (35.0%[7/20] vs 4.5%[1/22], P=0.018) and the proportion of patients with tumor (20%[4/20] vs 0[0/22], P=0.043) in the positive blood culture group were significantly different from those in the negative blood culture group. Laboratory examinations of the percentage of neutrophils, the percentage of lymphocytes, the percentage of monocytes, the value of neutrophil/lymphocyte, the level of hemoglobin, the level of erythrocyte sedimentation rate, the level of C-reactive protein, the level of procalcitonin and the positive rate of T-SPOT.TB in positive blood culture groups were significantly different from those in negative blood culture group (all P<0.05). Conclusions Peripheral blood M. tb culture is more likely to be positive for those elder disseminated tuberculosis patients with hematological diseases or tumors, and those with increase of neutrophil counts and inflammation markers but reduction of lymphocyte counts and hemoglobin.