结核病与心脏瓣膜病的相关性研究  

Relevance research between tuberculosis and valvular heart disease

作　　者：鲁进 尹伶[1] 黄汉平[3] LU Jin;YIN Ling;HUANG Hanping(Medical College,Wuhan University of Science&Technology,Wuhan,Hubei 430065,China;Department of Infectious Disease,Ezhou Third Hospital,Ezhou,Hubei 436000,China)

机构地区：[1]武汉科技大学医学院,湖北武汉430065 [2]鄂州市第三医院感染性疾病科,湖北鄂州436000 [3]武汉市医疗救治中心结核科,湖北武汉430032

出　　处：《中国热带医学》2019年第11期1072-1076,共5页China Tropical Medicine

基　　金：国家科技重大专项(No.2015ZX10003001-001)

摘　　要：目的通过病例对照分析肺结核病与心脏瓣膜病之间是否有关联,早期评估结核病对心脏瓣膜病的影响,及时治疗,从而降低心脏瓣膜病发病率。方法回顾性分析鄂州市第三医院2015年1月-2018年2月住院治疗的患者临床资料,通过分层抽样方法从结核科抽取住院患者425例作为观察组,从心血管科抽取370例作为对照组,均接受心脏多普勒三维彩超检查,统计患者心脏瓣膜病发生情况,依据各年龄组调查分析结果,同时分析初治和复治肺结核病与心脏瓣膜疾病之间的关联,以及通过比较入院查痰涂片阳性与阴性的患者与心脏瓣膜病的关联。结果结核科心脏瓣膜病发生率48.24%(205/425)低于心血管科患者心脏瓣膜病发生率54.05%(200/370),差异无统计学意义(P≥0.05)。结核科11~60岁心脏瓣膜病累积发生频率Σf 46.35%较心血管科Σf 22.50%高。从结核科取中青年组(18~55岁)166例患者进行随机分组比较,显示有心脏瓣膜病者68例,无心脏瓣膜病者98例,复治肺结核患者心脏瓣膜病发生率为55.88%(38/68),与初治肺结核病的30.61%(30/98)比较差异有统计学意义(P<0.01),提示结核病是心脏瓣膜病发生的危险因素之一(OR=2.87,95%CI 1.52~5.41);肺结核患者中痰涂片阳性者心脏瓣膜病发病率为45.10%(23/51),与痰涂片阴性的39.13%(45/115)比较差异有统计学意义(P<0.01),提示结核菌活动对于心脏瓣膜病形成存在一定的关联(OR=1.28,95%CI 1.10~1.49)。结论心脏瓣膜病老年多发,而结核病是心脏瓣膜病发生的危险因素之一。Objective Through case-control analysis of the relationship between tuberculosis and heart valvular disease,so as to early assess the impact of tuberculosis on heart valvular disease,timely treatment,thereby reducing the incidence of heart valvular disease.Methods The clinical data of hospitalized patients in Ezhou Third Hospital from January 2015 to February 2018 were retrospectively analyzed,by means of stratified sampling in random sampling,it selected from the 425 cases of tuberculosis department as observation group,and selected hospitalized patients from 370 cases of Cardiovascular Department as control group.All patients underwent 3D Doppler echocardiography,statistics of heart valve disease in patients,then according to survey results of each age group,and we comparatively analyze the association with valvular heart disease between first-time treatment and retreatment pulmonary tuberculosis.Results The incidence of cardiac valvular disease in patients with tuberculosis was 48.24%(205/425)lower than that in cardiovascular department 54.05%(200/370)(P≥0.05).Of 11-60 years old,Department of Tuberculosis with heart valve disease cumulative frequency Σf 46.35%was higher than Department of Cardiology Σf 22.50%.We took 166 cases of patients within 18 to 55 years of age,and that 68 patients with valvular heart disease and 98 patients without valvular heart disease.The incidence of valvular heart disease in patients with retreatment pulmonary tuberculosis was 55.88%(38/68),which was statistically significant compared with 30.61%(30/98)of first-time treatment pulmonary tuberculosis(P<0.01),which suggested that tuberculosis was one of the risk factors of heart valve disease(OR=2.87,95%CI 1.52-5.41);the incidences of heart valve disease in sputum smear positive patients with tuberculosis were 45.10%(23/51)and 39.13%(45/115)with sputum smear negative respectively(P<0.01),which suggested that the activity of TB was associated with valvular heart disease(OR=1.28,95%CI 1.10-1.49).Conclusion Heart valve disease multip

关 键 词：结核 肺结核 心脏瓣膜病 关联 

分 类 号：R521[医药卫生—内科学]