目的 分析耐多药/利福平耐药结核病(multidrug-resistant tuberculosis and rifampicin resistant-tuberculosis,MDR/RR-TB)患者合并外周血CD4+T淋巴细胞降低的临床特征及影响因素,为耐多药结核病防治提供依据.方法 回顾性分析2018-2020年在成都市公共卫生临床医疗中心住院的MDR/RR-TB患者311例,按外周血CD4+T淋巴细胞绝对计数水平分为CD4+T淋巴细胞降低组(CD4+T淋巴细胞＜414个/μL)和CD4+T淋巴细胞正常组(CD4+T淋巴细胞≥414个/μL).收集两组人口学特征、结核病类型、合并症、临床症状、影像学检查、治疗转归等临床资料,采用二元logistic回归方程分析MDR/RR-TB患者外周血CD4+T淋巴细胞降低的危险因素.结果 共纳入311例已完成治疗疗程的MDR/RR-TB患者,男女比例为1.68∶1,年龄[M(P25,P75)]为32(24,45)岁,CD4+T淋巴细胞计数为492.0(328.0,661.0)个/μL,CD4+T淋巴细胞＜414个/μL患者115例.CD4+T淋巴细胞降低组的高龄段患者、性别为男性、基线贫血、基线白细胞减少、基线低蛋白血症、合并慢性呼吸系统疾病、罹患血行播散性肺结核、并发结核性胸膜炎及结核性脑膜炎的患者多于正常组(P＜0.05),治疗成功率低于CD4+T淋巴细胞正常组(P=0.024).男性(OR=2.045,95%CI:1.147～3.648)、年龄(OR=1.032,95%CI:1.012～1.052)、基线贫血(OR=2.246,95%CI:1.457～3.426)、基线白细胞减少(OR=2.398,95%CI:1.387～4.148)是MDR/RR-TB患者CD4+T淋巴细胞计数降低的危险因素.结论 MDR/RR-TB患者合并CD4+T淋巴细胞降低患者更易患重症结核及并发结核性胸膜炎,且治疗成功率更低;男性、年龄增长、基线贫血、基线白细胞减少的MDR/RR-TB患者更易合并CD4+T淋巴细胞降低,临床需关注这些患者的免疫状态.
Clinical characteristics and risk factors of MDR/RR-TB patients with decreased peripheral blood CD4+T lymphocytes
Objective To explore clinical characteristics and the related factors of multidrug-resistant tuberculosis and rifampicin-resistant tuberculosis(MDR/RR-TB)patients with decreased peripheral blood CD4+T lymphocytes,providing a basis for the prevention and treatment of multidrug-resistant tuberculosis.Methods A retrospective analysis was conducted on 311 MDR/RR-TB patients hospitalized at Chengdu Public Health Clinical Center from January 2018 to December 2020.according to whether accompanied by peripheral blood CD4+T lymphocyte reduction,patients were divided into two groups,the decreased group(n=115)with CD4+T lymphocytes count＜414 cell/μL and the normal group(n=196)with CD4+T lymphocytes count≥414 cell/μL.Clinic data,including demographics,types of tuberculosis,complications,clinical symptoms,chest imaging,and treatment outcomes were collected.The binary logistic regression equation was used to analyze the risk factors of MDR/RR-TB with peripheral blood CD4+T lymphocyte reduction.Results In total,311 cases with MDR/RR-TB were enrolled,with a male-to-female ratio of 1.68∶1.The median age[M(P25,P75)]was 32(24,45)years.The median CD4+T lymphocyte count was 492.0(328.0,661.0)cells/μL,and 115 patients had CD4+T lymphocyte counts＜414 cells/μL.Compared with the normal group,the proportion of older patients,male,baseline anemia,baseline leukopenia,baseline hypoalbuminemia,combined with other chronic respiratory diseases,hematogenous disseminated pulmonary tuberculosis,tuberculous pleurisy,and tuberculous meningitis were higher(P＜0.05),while the success rate of treatment was lower in the decreased group(P=0.024).Being male(OR=2.045,95%CI:1.147-3.648),older age(OR=1.032,95%CI:1.012-1.052),baseline anemia(OR=2.246,5%CI:1.457-3.426),and baseline leukopenia(OR=2.398,95%CI:1.387-4.148)were risk factors for decreased CD4+T lymphocyte count in MDR/RR-TB patients.Conclusions MDR/RR-TB patients with decreased CD4+T lymphocytes are more likely to suffer from severe tuberculosis(hematogenic disseminated tuberculosis,tuberculous meningitis)and tuberculous pleurisy,meanwhile the success rate of treatment was lower.Male,elder age,baseline anemia,and baseline leukopenia are associated with decreased CD4+T lymphocyte count in MDR/RR-TB patients,and the immune status of these patients needs to be paid attention to in clinical work.
Multidrug-resistant tuberculosis and rifampicin resistant-tuberculosisCD4+T lymphocytesclinical characteristicsrisk factors
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