结核病对2019冠状病毒病患者病情和病毒核酸转阴影响的初步分析

Preliminary analysis of the effect of tuberculosis on disease status and virus nucleic acid negative conversion in patients with COVID-19

目的通过比较2019冠状病毒病(COVID-19)患者合并与不合并结核病两组的临床特征、实验室检查结果及病毒核酸转阴时间,明确结核病是否会加重COVID-19患者病情和延长病毒核酸转阴时间。方法收集2020年10月—2021年1月青岛市明确诊断为COVID-19感染患者的人口学特征和临床变量。按COVID-19患者是否合并结核病进行分组,比较两组患者的人口学特征、实验室检查结果及核酸转阴时间等临床变量,分析结核病对COVID-19患者病情和核酸转阴的影响。结果共纳入COVID-19患者42例,其中合并结核病患者共8例。COVID-19患者合并结核病所占比例较合并高血压、糖尿病等慢性基础疾病高(19.0%对16.7%对14.3%)。所有患者中常见的症状为咳嗽(33.3%)和发热(28.6%),且咳嗽和发热在COVID-19合并结核病组患者中更常见,差异均具有统计学意义(P<0.05)。COVID-19合并结核病组的淋巴细胞计数、辅助T细胞数(CD3、CD4)及CD4/CD8均较COVID-19组低,差异均具有统计学意义(P<0.05)。重症患者在COVID-19合并结核病组中所占比率(27.5%)明显高于无结核病组(2.9%),且差异具有统计学意义(P<0.05)。COVID-19合并结核病患者的核酸转阴时间比无结核病患者明显延长(23.5 d对16.5 d),差异具有统计学意义(P<0.05)。结论结核病加重了COVID-19患者病情,延长了患者核酸转阴时间。因此,在COVID-19大流行时期应加强对COVID-19患者结核感染的筛查,加强对结核病患者的管理和治疗。

Objective To determine whether tuberculosis aggravates COVID-19 and prolongs the time of virus nucleic acid conversion by comparing the clinical characteristics,laboratory results,and the time to nucleic acid conversion of COVID-19 patients with and without tuberculosis.Methods This study was a retrospective case-control study in 42 patients with COVID-19 in Qingdao.Demographic data and clinical variables were retrospectively collected from patients with a definite diagnosis of COVID-19 infection in Qingdao from October 2020 to January 2021.COVID-19 patients were compared in terms of complication with tuberculosis.The effects of tuberculosis on disease status and nucleic acid conversion of COVID-19 patients were analyzed accordingly.Results The prevalence of tuberculosis(19.0%)was higher than chronic diseases such as hypertension(16.7%)and diabetes mellitus(14.3%)in COVID-19 patients.The common symptoms were cough(33.3%)and fever(28.6%).Cough and fever were more common in the COVID-19 patients complicated with tuberculosis compared with the patients without tuberculosis(all P<0.05).The lymphocyte count,helper T cell count(CD3,CD4),and CD4/CD8 ratio were lower in the COVID-19 patients complicated with tuberculosis than in the patients without tuberculosis(P<0.05).The proportion of severe cases in the COVID-19 patients complicated with tuberculosis was significantly higher than that in the patients without tuberculosis(27.5%vs 2.9%,P<0.05).The time to nucleic acid negative conversion was significantly longer in the COVID-19 patients complicated with tuberculosis than that in the patients without tuberculosis(23.5 vs 16.5 days)(P<0.05).Conclusions Tuberculosis aggravates the condition of COVID-19 patients and prolongs the time to nucleic acid conversion.Screening,management,and treatment of tuberculosis should be strengthened in COVID-19 patients during COVID-19 pandemic.