北京市青年肺结核特点分析

Characteristic analysis of young tuberculosis patients in Beijing

目的探讨青年肺结核患者的特点。方法收集2016年10月—2018年4月在北京结核病控制研究所门诊登记管理的15～44岁肺结核病例共计201例。对患者的性别、职业、户籍、发病前诱因、临床症状、病原学、影像学分布、免疫学检查结果进行归纳和统计学分析。结果 201例病例中,男性117例,女性84例,男女比为1.39∶1。职业按构成比递降依次为农民53例(26.37%)、技术人员34例(16.92%)、工人25例(12.44%)、学生24例(11.94%)、待业23例(11.44%)、干部职员16例(7.96%)、教师11例(5.47%)、医护人员5例(2.49%)。非户籍人口125例(62.19%),明显多于户籍患者(37.81%)。109例(54.23%)的患者存在诱发抵抗力下降的因素。113例(56.22%)患者就诊时无明显临床症状;88例(43.78%)患者因症就诊,临床症状以咳嗽咳痰(78.41%)最为常见,其次是发热(23.86%)、咯血(15.90%)、乏力消瘦(4.48%)、咽痛(1.14%)。140例发生在单肺叶,有空洞者24例,多肺叶有空洞者24例,病变广泛者更易出现空洞,差异有统计学意义(χ~2=11.712,P<0.05)。涂阳患者56例,涂阳率27.86%,病原学检测阳性率49.25%。有症状组88例,病原学检测阳性率68.18%,明显高于无症状组(34.51%),差异有统计学意义(χ~2=22.437,P<0.05)。多肺叶和/或空洞形成组85例,病原学检测阳性率64.71%,明显高于单肺叶且无空洞组(37.93%),差异有统计学意义(χ~2=14.07,P<0.05)。99例患者进行γ-干扰素测定,87例阳性,敏感性87.88%。88例行结核菌素(PPD)试验,84例阳性,敏感性95.45%。2种检测结果敏感性比较,差异无统计学意义(χ~2=3.417,P>0.05)。结论北京市青年肺结核患者男性居多,职业分布前5位的依次是农民、技术人员、工人、学生、待业,以非户籍人口居多;多数人发病前存在诱发抵抗力下降的因素。有临床症状组和影像学累及多肺叶者和/或有空洞形成者病原学检测阳性率高。健康检查是检测城市青年肺结核的重要途径。γ-干扰素在肺结核患者中的阳性率高,与PPD试验敏感性一致,是诊断菌阴肺结核的重要辅助检查。

[Objective]To investigate the characteristics of young tuberculosis patients.[Methods]The clinical data were collected from 201 cases of young tuberculosis patients(15-44 years old) that were registered and regulated by Beijing Research Institute for Tuberculosis Control from October,2016 to April,2018. Statistical analysis was done based on the results from gender,occupation,census register,predisposing factors,clinical manifestation,etiology,imaging distribution and immunologic tests.[Results]There were 117 males and 84 females with the male-to-female ratio of 1.39∶1. The distribution of occupation in descending order by proportion was below: 53 farmers(26.37%),34 technicians(16.92%),25 workers(12.44%),24 students(11.94%),23 unemployed(11.44%),16 officers(7.96%),11 teachers(5.47%),5 medical workers(2.49%). The nonresident population was125 cases(62.19%),which was significantly more than the resident population(76 cases,37.81%). 109 patients(54.23%) were carrying risk factors which could lead to weakened immune response to infection. In 113 cases(56.22%),patients did not show evident clinical manifestation. While in the other 88 cases(43.78%),patients went to a doctor because of tuberculosis symptoms.Among them,cough and expectoration were the most common symptoms(78.41%),followed by fever(23.86%), hemoptysis(15.90%),marasmus(4.48%) and pharyngalgia(1.14%). I n 140 cases,lesions appeared in a single lobe of the lung,and 24 out of the140 had cavities. Another 24 cases out of 201 had cavities on more than one lobe. Patients with larger lesions were found easier to have cavities on lungs than patients with smaller lesions(χ~2=11.712,P<0.05). In this study,56 cases were smear positive,which represented for a positive rate of 27.86%.The etiological positive rate of the 56 cases was 49.25%. Among the 88 cases that had clinical manifestation the etiological positive rate was 68.18%,which was significantly higher than that of the group without clinical manifestation( 34. 51 %)( χ~2= 22. 437, P < 0. 05). Among the 85 cases with lung cavities or lesions on more than one lobe of lung,the etiological positive rate was 64.71%,which was significantly higher than that of the group with lesions on single lobe of lung and no lung cavity(37.93%)(χ~2=14.07,P<0.05). Interferon-γ release assay was applied for 99 cases,and 87 showed positive with a sensitivity rate of 87.88%. Out of 88 cases,PPD test showed positive in 84 cases with a sensitivity of 95.45%.There was no statistical difference(χ~2=3.417,P>0.05).[Conclusion]Most of the young tuberculosis patients in Beijing are male.The first five occupations with high population of tuberculosis in a descending order are farmer,technician,worker,student and unemployed. The incidence of tuberculosis in nonresident population are higher than that in resident population. Most of the patients have risk factors that could weakened their immune response to infection. Patients with clinical manifestation,lung cavities or lesions on more than one lobe of lung have higher etiological positive rate. Physical examination is an important way of finding tuberculosis for young people living in cities. For tuberculosis patients,the results that interferon-γ release assay and PDD test have higher positive rate suggested they are important secondary examinations in diagnosis of smear negative tuberculosis.