初治涂阳肺结核患者预后不良的影响因素  

Influencing factors of poor prognosis in patients with initial smear-positive pulmonary tuberculosis

作　　者：王治国 李建军[2] 焦亚洲 WANG Zhiguo;LI Jianjun;JIAO Yazhou(Tuberculosis Prevention and Control Department of Tongxu County Center for Disease Control and Prevention,Kaifeng 475400 Henan,China;Department of Tuberculosis of Henan Chest Hospital,Zhengzhou 450008 Henan,China)

机构地区：[1]通许县疾病预防控制中心结核病防治科,河南开封475400 [2]河南省胸科医院结核科,河南郑州450008

出　　处：《中国民康医学》2024年第15期1-5,共5页Medical Journal of Chinese People’s Health

摘　　要：目的:分析初治涂阳肺结核患者预后不良的影响因素。方法:选取2018年1月至2022年12月通许县疾病预防控制中心收治的203例初治涂阳肺结核患者进行横断面研究,所有患者均予以2HRZE/4HR抗结核方案治疗,治疗后3个月评估预后情况,采用Logistic回归分析初治涂阳肺结核患者预后不良的影响因素。结果:203例初治涂阳肺结核患者中,预后不良55例,占27.09%(55/203),设为预后不良组,预后良好148例,设为预后良好组。预后不良组年龄≥40岁、体质量指数<18.5 kg/m^(2)、文化程度高中及以下、合并肺部感染、病情程度中重度、血清γ干扰素(IFN-γ)<10.73 pg/mL、CD3^(+)<53.86%、CD4^(+)<32.71%、CD4^(+)/CD8^(+)<0.93、白细胞介素(IL)-15≥42.85 ng/mL、序贯器官衰竭(SOFA)评分≥2.46分、急性生理与慢性健康Ⅱ(APACHEⅡ)评分≥7.82分、高分辨率CT(HRCT)评分≥42.26分等占比均高于预后良好组,差异有统计学意义(P<0.05);经Logistic回归分析结果显示,体质量指数<18.5 kg/m^(2)、血清IFN-γ<10.73 pg/mL、CD3^(+)<53.86%、CD4^(+)<32.71%、CD4^(+)/CD8^(+)<0.93、IL-15≥42.85 ng/mL、SOFA评分≥2.46分、APACHEⅡ评分≥7.82分、HRCT评分≥42.26分等均为影响初治涂阳肺结核患者预后不良的危险因素(OR>1,P<0.05)。结论:体质量指数<18.5 kg/m^(2)、血清IFN-γ<10.73 pg/mL、CD3^(+)<53.86%、CD4^(+)<32.71%、CD4^(+)/CD8^(+)<0.93、IL-15≥42.85 ng/mL、SOFA评分≥2.46分、APACHEⅡ评分≥7.82分、HRCT评分≥42.26分等均为影响初治涂阳肺结核患者预后不良的危险因素。Objective:To analyze influencing factors of poor prognosis in patients with initial smear-positive pulmonary tuberculosis.Methods:A cross-sectional study was conducted on 203 patients with initial smear-positive pulmonary tuberculosis admitted to Tongxu county center for disease control and prevention from January 2018 to December 2022.All patients were treated with 2HRZE/4HR anti-tuberculosis treatment.The prognosis was evaluated 3 months after treatment.According to the occurrence of poor prognosis,Logistic regression analysis was used to analyze the influencing factors of poor prognosis in the patients with initial smear-positive pulmonary tuberculosis.Results:Among the 203 initial smear-positive pulmonary tuberculosis patients,55 had a poor prognosis,accounting for 27.09%(55/203).They were assigned to the poor prognosis group.148 cases had good prognosis and they were assigned to the good prognosis group.The proportions of the patients with age≥40 years old,body mass index<18.5 kg/m^(2),educational level of high school or below,combined pulmonary infection,moderate to severe severity of the condition,serum IFN-γlevel<10.73 pg/mL,CD3^(+)<53.86%,CD4^(+)<32.71%,CD4^(+)/CD8^(+)<0.93,Interleukin(IL)-15≥42.85 ng/mL,Sequential organ failure assessment(SOFA)score≥2.46 points,Acute Physiology and chronic health II(APACHE II)score≥7.82 points,High resolution CT(HRCT)score≥42.26 points in the poor prognosis group was higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that body mass index<18.5 kg/m2,serum IFN-γlevel<10.73 pg/mL,CD3^(+)<53.86%,CD4^(+)<32.71%,CD4^(+)/CD8^(+)<0.93,IL-15≥42.85 ng/mL,SOFA score≥2.46 points,APACHE II score≥7.82 points and HRCT score≥42.26 points were all risk factors for poor prognosis in the patients with initial smear-positive pulmonary tuberculosis(OR>1,P<0.05).Conclusions:Body mass index<18.5 kg/m^(2),serum IFN-γlevel<10.73 pg/mL,CD3^(+)<53.86%,CD4^(+)<32.71%,CD4^(+)/CD8^(+)<0.93,

关 键 词：肺结核 初治 预后不良 影响因素 

分 类 号：R521[医药卫生—内科学]