病原学阳性住院肺结核患者并发肺外结核的流行特征及其影响因素研究

Study on epidemiological characteristics and influencing factors of pathogen positive hospitalized pulmonary tuberculosis patients with extrapulmonary tuberculosis

目的分析病原学阳性住院肺结核患者并发肺外结核的流行特征及其影响因素。方法采用整群抽样的方法,收集湖南省胸科医院2016年住院的病原学阳性肺结核患者诊疗信息,共纳入2532例。描述其肺外结核的并发率、并发部位及分布特征等。采用单因素和多因素logistic回归模型,分析性别、年龄、职业、现住址、婚姻状况、吸烟史、饮酒史、治疗史、痰涂片结果、血行播散性肺结核、糖尿病、利福平耐药等因素对并发肺外结核的影响。结果 2532例患者中,574例并发肺外结核,并发率为22.7%。114例(19.9%,114/574)患者的肺外结核同时发生于≥2个组织或器官;肺外结核前五位好发部位和并发率分别为颈部淋巴结(12.1%,306/2532)、咽喉(3.9%,98/2532)、腹部(2.6%,65/2532)、心包(2.4%,62/2532)和肠(1.3%,33/2532)。6~19岁、20~39岁、40~59岁、60~90岁组肺外结核并发率分别为32.6%(42/129)、31.1%(216/695)、20.3%(201/991)、16.0%(115/717),随年龄增加呈现降低趋势(χ2趋势=51.731,P<0.001)。多因素logistic分析显示,以60~90岁组为参考,6~19岁组(OR=2.64,95%CI:1.46~4.78)、20~39岁组(OR=2.32,95%CI:1.73~3.12)、40~59岁组(OR=1.42,95%CI:1.10~1.85)肺外结核并发率较高;痰涂片阳性患者(以痰涂片阴性或未查痰为参考,OR=1.29,95%CI:1.05~1.58)、血行播散性肺结核患者(以无血行播散性肺结核为参考,OR=5.91,95%CI:2.94~11.86)、未并发糖尿病患者(以并发糖尿病为参考,OR=1.64,95%CI:1.20~2.22)肺外结核并发率较高。结论病原学阳性住院肺结核患者并发肺外结核比例较高,并发淋巴结结核的比例高于其他部位。肺结核患者中年龄越小肺外结核并发率越高,应重视对痰涂片阳性、血行播散性肺结核和无糖尿病患者肺外结核的检查。

Objective To analyze the epidemiological characteristics and influencing factors of extrapulmonary tuberculosis(EPTB)in pathogen positive pulmonary tuberculosis(PTB)patients in Hunan Province. Methods The cluster sampling method was used to collect the diagnosis and treatment information of pathogen positive inpatient PTB patients in Hunan Chest Hospital in 2016,totally 2532 cases were included.The incidence,location,frequency,etc.of EPTB in PTB patients were described.Univariate and multivariate logistic regression analyses were carried to explore the association between sex,age,occupation,place of residence,marital status,smoking history,drinking history,treatment history,sputum smear results,hematogenous disseminated tuberculosis,diabetes,rifampicin resistance with EPTB. Results 574(22.7%)EPTB patients were found among2532 cases of pathogen positive PTB,114(19.9%,114/574)of EPTB occurred in two or more tissues or organs.The top five forms of EPTB occurred on cervical lymph nodes(12.1%,306/2532),larynx(3.9%,98/2532),abdomen(2.6%,65/2532),pericardium(2.4%,62/2532),and intestinal(1.3%,33/2532).The incidence rate of EPTB in age groups of 6-19 years old,20-39 years old,40-59 years old,60-90 years old were 32.6%(42/129),31.1%(216/695),20.3%(201/991),16.0%(115/717),respectively,trend Chi-square test showed that the incidence of EPTB decreased with the increase of patients’ age(χt2 rend=51.731,P<0.001).Multivariate analysis showed that the incidence rate of EPTB in patients of 6-19 years old(OR=2.64,95%CI:1.46-4.78),20-39 years old(OR=2.32,95%CI:1.73-3.12),40-59 years old(OR=1.42,95%CI:1.10-1.85;60-90 years old as age group reference),sputum smear positive(sputum smear negative or untested group as reference,OR=1.29,95%CI:1.05-1.58),hematogenous disseminated tuberculosis(without hematogenous disseminated tuberculosis group as reference,OR=5.91,95%CI:2.94-11.86)and non-diabetic group(with diabetes group as reference,OR =1.64,95% CI:1.20-2.22)was significantly higher than that of the reference group.Conclusion The proportion of hospitalized PTB patients with EPTB is relatively high,with lymphatic tuberculosis higher than other forms of EPTB.The younger patients have a higher incidence of EPTB.Attention should also be paid to EPTB screening in patients with smear-positive,hematogenous disseminated tuberculosis and non-diabetic tuberculosis.