慢性阻塞性肺疾病急性加重合并活动性肺结核的临床特征、预测因素及短期预后
Clinical characteristics,predictive factors and short-term prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with active pulmonary tuberculosisin
袁建林 1冯海沜 2罗远明 3魏海龙 4葛慧青 5刘辉国 6张建初 7潘频华 8李先华 9谢秀芳 9周晖 10张嘉瑞 1彭丽阁 1蒲佳琪 1周海霞 1易群11
作者信息
- 1. 四川大学华西医院呼吸与危重症医学科(四川成都 610041)
- 2. 成都市第六人民医院体检科(四川成都 610051)
- 3. 广州医科大学呼吸系统疾病国家重点实验室(广东广州 510000)
- 4. 乐山市人民医院呼吸与危重症医学科(四川乐山 614000)
- 5. 浙江大学医学院附属邵逸夫医院呼吸与危重症医学科(浙江杭州 310000)
- 6. 华中科技大学同济医学院附属同济医院呼吸与危重症医学科(湖北武汉 430030)
- 7. 华中科技大学同济医学院附属协和医院呼吸与危重症医学科(湖北武汉 430030)
- 8. 中南大学湘雅医院呼吸与危重症医学科(湖南长沙 410000)
- 9. 内江市第一人民医院呼吸与危重症医学科(四川内江 641000)
- 10. 成都大学附属医院呼吸与危重症医学科(四川成都 610081)
- 11. 四川省肿瘤医院(四川成都 610042)
- 折叠
摘要
目的 探讨慢性阻塞性肺疾病(简称慢阻肺)急性加重住院患者合并活动性肺结核的临床特点、预测因素及短期预后.方法 收集2017年9月—2021年7月国内10家三甲医院因慢阻肺急性加重住院的患者,以慢阻肺急性加重合并活动性肺结核患者作为病例组,在慢阻肺急性加重不合并结核感染的病例中,按照4:1的比例随机选取与病例组同时期同中心住院的患者作为对照组,进行病例对照研究,比较两组患者入院时基础情况、合并症、临床表现及辅助检查、院内不良预后等指标的差异.结果 研究总共纳入14007例慢阻肺急性加重住院患者,其中慢阻肺急性加重合并活动性肺结核患者245例,发病率为1.75％.基础情况方面,病例组男性、既往一年存在急性加重病史患者比例高于对照组(P均＜0.05),年龄、体质指数(BMI)低于对照组(P均＜0.05);合并症方面,病例组高血压、糖尿病患者比例低于对照组(P均＜0.05);临床表现方面,病例组发热、咯血比例高于对照组(P均＜0.05);实验室检查方面,病例组血红蛋白、血小板计数、血清白蛋白、炎症指标(血沉、C反应蛋白)和TB-IGRA阳性比例水平高于对照组(P均＜0.05).病例组影像学出现肺大泡、肺不张、支气管扩张的比例较对照组更高.经过多因素logistic回归分析,咯血(OR=3.68,95％C1 1.15-11.79,P=0.028)、血沉增快(OR=3.88,95％CI 2.33-6.45,P＜0.001)、肺不张(OR=3.23,95％CI 1.32-7.91,P=0.01)是慢阻肺急性加重合并活动性肺结核的独立预测因素.预后指标方面,病例组院内死亡率有高于对照组的趋势(2.3％vs.1％),但总体死亡率低,差异没有统计学意义(P＞0.05),但病例组的住院时间更长[9d(6～14)vs.7d(5～11),P＜0.001],且住院费用更高[15568元(10618-21933)vs.13672元(9650-21473),P=0.037].结论 慢阻肺急性加重住院患者合并活动性肺结核并不少见,且增加住院时间及住院费用.当慢阻肺急性加重患者出现咯血、血沉增快、肺不张的情况时,应高度警惕合并活动性肺结核的可能.
Abstract
Objective To study the clinical features,predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods This study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021.AECOPD patients with active pulmonary tuberculosis were included as case group,AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group,at a ratio of 4:1.The basic information,comorbidities,clinical manifestations and auxiliary examinations,and adverse in-hospital outcomes between the two groups were compared.Results A total of 14007 inpatients with AECOPD were included in this study,and 245 patients were confirmed to have active pulmonary tuberculosis,with an incidence rate of 1.75％.In terms of basic information,the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group(P＜0.05),and the age and body mass index(BMI)were lower than those of the control group(P＜0.05);in terms of comorbidities,the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group(P＜0.05).In terms of clinical manifestations,the prevalence of fever and hemoptysis in case group was higher than that of control group(P＜0.05);as for laboratory examinations,the levels of hemoglobin,platelet count,serum albumin,inflammatory markers[erythrocyte sedimentation rate(ESR),C reactive protein]and the proportion of positive TB-IGRA were higher than that of control group(P＜0.05).The prevalence of pulmonary bullae,atelectasis and bronchiectasis in the case group was higher than that in the control group.After multivariate logistic regression analysis,hemoptysis(OR=3.68,95％CI 1.15-11.79,P=0.028),increased ESR(OR=3.88,95％CI 2.33-6.45,P＜0.001),atelectasis(OR=3.23,95％CI 1.32-7.91,P=0.01)were independent predictors of active pulmonary tuberculosis in patients with AECOPD.In terms of in-hospital outcomes,there was a trend of higher hospital mortality than the control group(2.3％vs.1％),but the difference was not statistically significant.However,the case group had longer hospital stay[9 d(6～14)vs.7 d(5～11),P＜0.001]and higher hospital costs[15568 ¥(10618～21 933)vs.(13672 ¥(9650～21 473),P=0.037].Conclusion It is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis,which increases the length of hospital stay and hospitalization costs.When AECOPD patients present with hemoptysis,elevated ESR,and atelectasis,clinicians should be highly alert to the possibility of active pulmonary tuberculosis.
关键词
慢性阻塞性肺疾病/急性加重期/活动性肺结核/预测因素/临床特征Key words
chronic obstructive pulmonary disease/acute exacerbation/active pulmonary tuberculosis/predictive factors/clinical features引用本文复制引用
基金项目
四川省科技计划重点研发项目(2022YFS0262)
国家重点研发计划课题(2016YFC1304202)
出版年
2024
NETL
NSTL
万方数据