尿毒症维持性血液透析患者合并结核分枝杆菌感染调查及其影响因素分析

Investigation of Mycobacterium tuberculosis infection in uremic patients on maintenance hemodialysis and analysis of its influencing factors

目的调查尿毒症维持性血液透析治疗患者合并结核分枝杆菌感染情况并分析其影响因素。方法选择2018年2月—2020年5月在雅安市第二人民医院及成都市公共卫生临床医疗中心接受维持性血液透析治疗的尿毒症患者315例进行研究。收集可能影响尿毒症维持性血液透析治疗患者感染结核分枝杆菌的相关因素,根据结核分枝杆菌感染情况将其分为阴性组与阳性组,采用Logistic回归分析判断各因素的影响。结果315例患者中有60例(19.05%)被确诊为感染结核分枝杆菌。多因素Logistic回归分析显示,女性、有卡介苗接种史、25羟维生素D为尿毒症维持性血液透析治疗患者合并结核分枝杆菌感染的保护性因素(P<0.05);年龄≥60岁、有结核病接触史、有吸烟史、使用抗生素超过2种及使用糖皮质激素和免疫抑制剂为危险因素(P<0.05)。结论尿毒症维持性血液透析治疗患者结核分枝杆菌感染率较高,主要与患者性别、年龄、吸烟史、结核病接触史、卡介苗接种史、25羟维生素D水平及抗生素使用种类、糖皮质激素及免疫抑制剂使用情况有关。

Objective To investigate Mycobacterium tuberculosis infection in uremic patients undergoing maintenance hemodialysis and analyze its influencing factors.Methods A total of 315 uremic patients who received maintenance hemodialysis in Ya’an Second People’s Hospital and Chengdu Public Health Clinical Medical Center from February2018 to May 2020 were selected for the study.The factors associated with M.tuberculosis infection in uremic patients on maintenance hemodialysis were collected.According to the status of M.tuberculosis infection,the patients were divided into negative group and positive group.A logistic regression analysis was performed to determine the influence of each factor.Results A total of 60(19.05%)of the 315 patients were diagnosed with M.tuberculosis infection.The multivariate logistic regression analysis showed that female history of BCG vaccination,and 25-hydroxyvitamin D were the protective factors for M.tuberculosis infection in uremic patients on maintenance hemodialysis(P<0.05).Those age ≥60 years,history of tuberculosis patient contact,smoking history,use of more than two antibiotics,use of glucocorticoid and immunosuppressant were the risk factors(P<0.05).Conclusion The rate of M.tuberculosis infection was higher in uremic patients on maintenance hemodialysis,which was mainly associated with gender,age,smoking history,history of tuberculosis patient contact,history of BCG vaccination,25-hydroxyvitamin D level,and use of antibiotics,glucocorticoid and immunosuppressant.