血行播散型肺结核合并结核性脑膜炎患者低T3综合征发生率及其对短期预后的影响

Incidence of low T3 syndrome in patients with hematogenous disseminated pulmonary tuberculosis complicated with tuberculous meningitis and it′s impact on short-term prognosis

目的探讨民族地区血行播散型肺结核合并结核性脑膜炎患者的低血清三碘甲状腺原氨酸(T3)综合征发生率,及T3水平对于预后的判断价值。方法选择新疆维吾尔自治区胸科医院符合诊断标准的血行播散型肺结核合并结核性脑膜炎患者,根据患者入院30 d的全因死亡情况,将患者分为死亡组和存活组。比较2组患者基线资料,将具有统计学差异的指标纳入多因素回归分析,评估血行播散型肺结核合并结核性脑膜炎患者不良预后的预测指标。结果共纳入573例患者,其中低T3综合征患者259例,低T3综合征发生率为45.2%。单因素分析显示,死亡组患者与存活组患者的年龄、急性生理与慢性健康评分(APACHEⅡ)评分、T3水平、高脂血症发生率、低T3综合征发生率差异有统计学意义。多因素回归分析显示,血清T3水平(OR=0.256,95%CI:0.141~0.467)、年龄(OR=1.106,95%CI:1.028~1.201)和APACHEⅡ评分(OR=1.458,95%CI:1.096~1.985)是患者死亡的独立危险因素。结论血行播散型肺结核合并结核性脑膜炎患者的低T3综合征发生率较高,低T3水平是患者短期不良预后的预测因素。

Objective To explore the incidence of low-T3 syndrome in patients with hematogenous disseminated pulmonary tuberculosis and tubercular meningitis and predictive value of T3 level for the prognosis.Methods Patients with hematogenous disseminated pulmonary tuberculosis and tubercular meningitis were retrospectively included into this study.Patients were divided into the dead group and the surviving group according to the incidence of all-cause death within 30 d.Univariate analysis was used to find differences between the two groups in baseline values.Then multiple logistic regression analysis was adopted to discover the predictive value for the poor prognosis in patients with hematogenous disseminated pulmonary tuberculosis and tubercular meningitis.Results A total of 573 patients were included into this study,in which 259 patients suffered from low-T3 syndrome(with an incidence of 45.2%).Univariate analysis showed that the dead group had a higher age and acute physiology and chronic health evaluation(APACHEⅡ)score,a lower T3 level,a higher incidence of hyperlipoidemia and low-T3 syndrome compared with the surviving group.Multiple logistic regression analysis showed that T3 level(OR=0.256,95%CI:0.141-0.467),age(OR=1.106,95%CI:1.028-1.201)and left ventricular ejection fraction(OR=1.458,95%CI:1.096-1.985)were the independent risk factors for the poor prognosis in patients hematogenous disseminated pulmonary tuberculosis and tubercular meningitis.Conclusions The incidence of low-T3 syndrome in patients with hematogenous disseminated pulmonary tuberculosis and tubercular meningitis is high and serum T3 level is an important predictive factor for short-term poor prognosis.