肺结核住院患者并发肺外结核状况及其与性别和年龄相关性的多中心研究

A multicenter investigation of pulmonary tuberculosis with concurrent extrapulmonary tuberculosis and its correlation with gender and age

目的探讨住院肺结核患者并发肺外结核的发生情况及其与性别、年龄的关系。方法采用观察性研究方法,由参加过统一培训的调查员从医院信息管理系统(HIS系统)收集2011年1月1日至2017年12月31日我国15省21家医疗机构360187例住院肺结核患者的性别、年龄,以及结核病灶累及部位等信息,比较分析肺结核患者并发肺外结核的发生情况及其与性别、年龄的关系。结果360187例肺结核患者中,男238910例(66.33%),女121277(33.67%),年龄中位数(四分位数)[M(Q1,Q3)]为47(28,62)岁;42987例(11.93%)并发肺外结核,并发率依次为结核性脑膜炎[2.72%(9809例)]、颈部淋巴结结核[1.93%(6966例)]、结核性腹膜炎[1.59%(5733例)]、结核性心包炎[0.94%(3399例)]、肠结核[0.94%(3380例)]等。男性肺结核患者并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、结核性心包炎、结核性多浆膜炎、腰椎结核、胸椎结核、胸壁结核的并发率分别为2.44%(5829例)、1.44%(3429例)、1.41%(3376例)、0.90%(2138例)、0.75%(1791例)、0.67%(1604例)、0.64%(1522例)、0.60%(1438例),均明显低于女性[分别为3.28%(3980例)、2.92%(3537例)、1.94%(2357例)、1.04%(1261例)、0.90%(1093例)、0.79%(960例)、0.76%(924例)、0.66%(805例)](χ2=215.235,930.541,144.480,18.061,23.272,16.442,18.585,4.976;P值均<0.05)。不同年龄组(1~岁组至≥65岁组)肺结核患者并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、肠结核、结核性心包炎、结核性多浆膜炎、腰椎结核、胸椎结核、胸壁结核、咽喉结核的并发率差异均有统计学意义(χ2=3870.549,2939.502,1830.620,673.372,115.428,319.078,52.512,19.308,439.177,136.619;P值均<0.05)。除胸椎结核的并发率未呈现出随年龄变化的趋势(χ趋势2=0.814,P=0.367),结核性心包炎呈现出随年龄增长而增高的趋势(χ趋势2=62.087,P<0.001)外,其他肺外结核的发生率均呈现出随年龄增长而降低的趋势(P值均<0.001)。多因素logistic回归分析结果显示,肺结核并发肺外结核患者的风险女性高于男性[(OR(95%CI)=1.325(1.297~1.353)];其他各年龄组风险均高于≥65岁年龄组[1~岁组、15~岁组、25~岁组、35~岁组、45~岁组、55~岁组的OR(95%CI)值分别为:4.995(4.655~5.360)、2.481(2.397~2.568)、2.053(1.982~2.126)、1.683(1.619~1.749)、1.276(1.228~1.326)、1.109(1.067~1.153)];在控制了性别的影响后,肺结核并发肺外结核患者的风险随年龄的增长而降低[OR(95%CI)=0.817(0.812~0.821)]。结论肺结核患者可并发结核性脑膜炎、颈部淋巴结结核、结核性腹膜炎、结核性心包炎和肠结核等多种肺外结核;且并发肺外结核的风险女性高于男性,并呈现出随年龄的增长而降低的趋势。

Objective To investigate the incidence of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis and its relationship with gender and age group.Methods Using observational research method,360 187 hospitalized tuberculosis patients’ gender,age and the involved position of tuberculosis were collected from hospital information management system(HIS) of 21 medical institutions in 15 provinces in China from January 1,2011 to December 31,2017 by investigators with unified training.The incidence of extrapulmonary tuberculosis and its relationship with gender and age were analyzed.Results Among 360 187 patients with tuberculosis,238 910(66.33%) were male,121 277(33.67%) were female,and the median age(quartile)(M(Q1,Q3)) was 47(28,62)years old;42 987(11.93%) cases were concurrent with extrapulmonary tuberculosis,the highest incidence was tuberculous meningitis(2.72%(9809 cases), followed by cervical lymph node tuberculosis(1.93%(6966 cases)),tuberculous peritonitis(1.59%(5733 cases)), tuberculous pericarditis(0.94%(3399 cases)) and intestinal tuberculosis(0.94%(3380 cases)) etc.The incidence of tuberculous meningitis,cervical lymph node tuberculosis,tuberculous peritonitis,tuberculous pericarditis,tuberculous polyserositis,lumbar tuberculosis,thoracic tuberculosis and chest wall tuberculosis in male tuberculosis patients were respectively 2.44%(5829 cases),1.44%(3429 cases),1.41%(3376 cases),0.90%(2138 cases),0.75%(1791 cases),0.67%(1604 cases),0.64%(1522 cases),0.60%(1438 cases),and significantly lower than that of female(respectively 3.28%(3980 cases),2.92%(3537 cases),1.94%(2357 cases),1.04%(1261 cases),0.90%(1093 cases),0.79%(960 cases),0.76%(924 cases),0.66%(805 cases))(χ2=215.235,930.541,144.480,18.061,23.272,16.442,18.585,4.976;Ps<0.05).The differences of incidences of tuberculous meningitis,cervical lymph node tuberculosis,tuberculous peritonitis,intestinal tuberculosis,tuberculous pericarditis,tuberculous polyserositis,lumbar tuberculosis,thoracic tuberculosis,chest wall tuberculosis and throat tuberculosis between different age(1-to≥65 year) groups were statistically significant(Xz=3870.549,2939.502,1830.620,673.372,115.428,319.078,52.512,19.308,439.177,136.619;Ps<0.05).Except that the incidence of thoracic tuberculosis did not change with age(χtrend2=0.814,P=0.367) and that of tuberculous pericarditis increased with increase of age(χtrend2=62.087,P<0.001),the incidence of other tuberculosis decreased with increase of age(Ps< 0.001).Multivariate logistic regression analysis showed that the risk of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis in female was significantly higher than that in male(OR(95%CI):1.325(1.297-1.353)),and the risk of other age groups was higher than that in the age group≥65 years old(1-,15-,25-,35-,45-,55-years old;OR(95%CI)=4.995(4.655-5.360),2.481(2.397-2.568),2.053(1.982-2.126),1.683(1.619-1.749),1.276(1.228-1.326),1.109(1.067-1.153).The risk of pulmonary tuberculosis concurrent with extrapulmonary tuberculosis decreased with increase of age after controlling the influence of gender(OR(95%CI)=0.817(0.812-0.821)).Conclusion The common extrapulmonary tuberculosis concurrent with pulmonary tuberculosis are tuberculous meningitis,cervical lymph node tuberculosis,tuberculous peritonitis,tuberculous pericarditis and intestinal tuberculosis,and the risk of extrapulmonary tuberculosis in female is higher than that in male,and its trends decrease with the increase of age.