结核病合并基础疾病患者的抗结核治疗效果及肺部损伤分析

Analysis of the effect of anti-tuberculosis treatment and lung injury in patients with tuberculosis combined with underlying disease

目的·探讨结核病诊断时的合并症对患者预后及肺部损伤的影响。方法·采用回顾性队列研究,选择2018年1月—12月上海市肺科医院涂片阳性的结核患者,分为无合并症组和有合并症组(合并糖尿病、高血压、肝脏疾病、肾脏疾病和胆囊疾病)。利用χ^(2)检验比较无合并症组和有合并症组结核患者的总体治疗结果和肺部损伤情况,并采用分层分析比较各合并症对结核患者预后及肺部损伤影响,使用Kaplan-Meier分析合并症与结核病预后的时间相关性。结果·纳入450例结核患者,男性323例(71.8%),女性127例(28.2%),中位年龄为33岁。其中,173例患者有合并症:糖尿病49例,高血压23例,肝脏疾病83例,肾脏疾病35例,胆囊疾病17例。无合并症的结核患者治愈率为80.5%,显著高于有合并症组(P<0.05);诊断时患有糖尿病、高血压和肾脏疾病的结核患者治愈率显著降低是引起抗结核治疗失败的关键原因;患有糖尿病和肝脏疾病的结核患者肺部载菌量更多、肺部损伤区域更大,患有糖尿病和肾脏疾病的结核患者肺部空洞发生率更高。结论·糖尿病、高血压和肾脏疾病使肺部损伤加重导致结核病治愈率降低,诊断时临床医生及早采取干预措施,可提高结核患者的治愈率,缩短治疗时间,降低医疗成本。

Objective·To investigate the impact of complications on the prognosis and lung injury of patients with tuberculosis..Methods·A retrospective cohort study was used for analysis,to select a total of 450 smear-positive tuberculosis(TB)patients,323 males(71.8%)and 127 females(28.2%),from January to December 2018 at Shanghai Pulmonary Hospital,Tongji University School of Medicine,which were divided into non-complication group and complication group(diabetes,hypertension,liver diseases,kidney diseases and gallbladder diseases).Overall treatment outcomes and lung injuries in TB patients with and without complications were analyzed by usingχ^(2)test.Stratified analysis of the impact of each comorbidity on the prognosis and lung injury of TB patients was performed.Kaplan-Meier analysis was used to analyze the temporal correlation between complications and tuberculosis prognosis.Results·Four hundred and fifty patients with a median age of 33 years were included,173 of whom had complications:diabetes in 49 cases,hypertension in 23 cases,liver diseases in 83 cases,kidney diseases in 35 cases,and gallbladder diseases in 17 cases.The cure rate of TB patients without complications was 80.5%,which was significantly higher than that of the group with complications(P<0.05);the significantly lower cure rate of TB patients with diabetes,hypertension and kidney diseases at diagnosis was the key cause of anti-tuberculosis treatment failure;TB patients with diabetes and liver diseases had higher lung bacterial load and larger areas of lung damage,and TB patients with diabetes and kidney diseases had higher incidence of pulmonary cavity.Conclusion·Diabetes,hypertension and kidney diseases exacerbate lung damage and lead to lower TB cure rates.Early interventions by clinicians at the time of diagnosis can improve cure rates,shorten treatment time,and reduce medical costs for TB patients.