慢性肾脏疾病合并肺结核患者发病风险预测分析

Risk predictors of pulmonary tuberculosis in patients with chronic kidney disease

目的分析慢性肾脏疾病(chronic kidney disease,CKD)合并肺结核患者发病风险预测因素,并构建风险预测模型,为临床上CKD患者防治肺结核提供理论依据。方法采用分层抽样方式随机抽取泰州市人民医院收治的289例CKD患者为调查对象,根据患者是否合并肺结核分为实验组(n=65,CKD合并肺结核)和对照组(n=224例,CKD),统计所有患者年龄、性别、CKD分期、既往结核史等临床资料,采用单因素分析和logistic回归分析CKD患者发生肺结核的影响因素;根据回归结果建立CKD患者发生肺结核症的风险预测模型,采用ROC曲线对该模型效能进行预测。结果289例CKD患者中合并肺结核65例(22.49%),胸部X线表现为54例浸润型肺结核、5例空洞型肺结核、4例干酪性肺炎、2例结核性胸膜炎;CKD合并肺结核主要临床表现为低热、纳差、乏力36例,咳嗽、咳痰18例,高热9例,胸水2例;结核分枝杆菌培养阳性为23例(35.38%);两组患者年龄、CKD分期、既往结核史、免疫抑制、营养不良、透析治疗、贫血、低蛋白血症间差异无统计学意义(P<0.05);多因素logistic回归分析,结果显示免疫抑制、营养不良、透析治疗是CKD发生肺结核的独立危险因素(P<0.05);CKD患者发生肺结核的风险预测模型为P=1/[1+e-^((-0.496+0.839×(免疫抑制)+0.892×(营养不良)+1.247×(透析治疗))];采用ROC曲线对该回归模型预测效能进行分析,结果表明CKD患者采用风险预测模型预测发生肺结核的AUC为0.779,95%CI:0.668~0.889。结论CKD发生肺结核的风险较高,对于免疫抑制、营养不良、透析治疗的CKD患者发生肺结核的风险较高,应根据患者具体情况,采取针对性措施进行预防,可降低CKD患者发生肺结核的风险。

Objective The risk prediction factors of patients with chronic kidney disease(CKD)complicated with pulmonary tuberculosis were analyzed,and the risk prediction model was constructed to provide theoretical basis for the prevention and treatment of pulmonary tuberculosis in patients with CKD.Methods Stratified sampling was used to randomly select 289 patients with CKD admitted to our hospital as the investigation objects.According to whether patients complicated with tuberculosis,they were divided into experimental group(n=65,CKD complicated with tuberculosis)and control group(n=224,CKD).Univariate analysis and logistic regression were used to analyze the influencing factors of pulmonary tuberculosis in PATIENTS with CKD.According to the regression results,the risk prediction model of pulmonary tuberculosis in CKD patients was established,and the ROC curve was used to predict the efficacy of the model.Results Among 289 patients with CKD,65 cases(22.49%)had pulmonary tuberculosis.Chest X-ray showed 54 cases of infiltrating pulmonary tuberculosis,5 cases of voiding pulmonary tuberculosis,4 cases of caseous pneumonia and 2 cases of tuberculous pleurisy.The main clinical manifestations of CKD complicated with pulmonary tuberculosis were low fever,poor appetite and fatigue in 36 cases,cough and expectoration in 18 cases,high fever in 9 cases and pleural effusion in 2 cases.Mycobacterium tuberculosis culture was positive in 23 cases(35.38%).There were no significant differences in age,CKD stage,past tuberculosis history,low immunity,malnutrition,dialysis treatment,anemia and hypoproteinemia between 2 groups(P<0.05).Multivariate logistic regression analysis showed that low immunity,malnutrition and dialysis treatment were independent risk factors for pulmonary tuberculosis in CKD(P<0.05).Risk of tuberculosis in patients with CKD prediction model for P=1/(1+e-^((0.496+0.839×(low immunity)+0.892×(malnutrition)+1.247×(dialysis))];ROC curve was used to analyze the predictive efficacy of the regression model.The results showed that the AUC of pulmonary tuberculosis predicted by the risk prediction model was 0.779,95%Cl(0.668-0.889)for CKD patients.Conclusion The risk of tuberculosis in CKD is higher,low immunity,malnutrition,dialysis treatment of CKD patients is high risk for tuberculosis,according to the specific situation of the patients,take targeted measures to prevention,can reduce the risk of tuberculosis in patients with CKD.