病毒性肝炎合并肺结核患者并发肺外结核的影响因素  

Factors Influencing the Development of Extra-Pulmonary Tuberculosis in Patients with Viral Hepatitis Complicated by Pulmonary Tuberculosis

作　　者：沈凌筠 李龙芬 施春晶 李文明 黄媛卿 张华杰 罗云 李杰 刘立 SHEN Lingjun;LI Longfen;SHI Chunjing;LI Wenming;HUANG Yuanqing;ZHANG Huajie;LUO Yun;LI Jie;LIU Li(Department of Comprehensive Tuberculosis,Kunming Third People’s Hospital/Yunnan Provincial Clinical Center for Infectious Diseases,Kunming Yunnan 650041,China;Health Examination Center,Kunming Third People’s Hospital/Yunnan Provincial Clinical Center for Infectious Diseases,Kunming Yunnan 650041,China;Department of Hepatology,Kunming Third People’s Hospital/Yunnan Provincial Clinical Center for Infectious Diseases,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院/云南省传染性疾病临床医学中心综合结核病科,云南昆明650041 [2]昆明市第三人民医院/云南省传染性疾病临床医学中心体检中心,云南昆明650041 [3]昆明市第三人民医院/云南省传染性疾病临床医学中心肝三科,云南昆明650041

出　　处：《昆明医科大学学报》2025年第2期103-109,共7页Journal of Kunming Medical University

基　　金：云南省科技厅地方高校联合专项基金(202401BA070001-063);昆明市卫健委科研课题项目(2023-03-02-019,2023-03-08-012)。

摘　　要：目的探讨病毒性肝炎合并肺结核患者并发肺外结核(extra-pulmonary tuberculosis,EPTB)的影响因素。方法回顾分析昆明市第三人民医院2015年1月至2020年12月结核科收治的病毒性肝炎乙型(hepatitis B virus,HBV)和病毒性肝炎丙型(hepatitis C virus,HCV)合并肺结核(pulmonary tuberculosis,PTB)的患者427例,以是否并发EPTB分为并发EPTB组(n=72)和未并发EPTB组(n=355)。收集患者的临床资料,采用单因素、多因素Logistic回归筛选并发EPTB的独立危险因素作为预测因子,建立病毒性肝炎合并PTB患者并发EPTB的列线图预测模型,选用Hosmer-Lemeshow检验、ROC曲线评价。结果427名患者中男292例(68.3%),女135例(31.7%),并发EPTB72例,发生率16.86%。其中,EPTB中男34例(47.2%),女38例(52.8%),结核性胸膜炎21例(29%),结核性腹膜炎16例(22%),淋巴结结核13例(18%),结核性脑炎5例(6%),肠结核6例(8%),骨结核5例(6%),盆腔结核3例(4%)泌尿系统结核3例(4%)。多因素Logistic回归示,性别(OR=0.425,95%CI:0.250~0.722,P=0.02)、低水平甘油三脂(TG)(OR=0.837,95%CI:0.717~0.978,P=0.025)、结核特异性抗原A(ESAT-6)(OR=1.007,95%CI:1.003~1.011是PTB合并HBV、HCV感染并发EPTB的独立影响因素。列线图模型的最佳截断值0.192,对应的灵敏度0.611、和特异度0.710、约登指数0.741、阳性似然比2.103、阴性似然比0.548。Hosmer-Lemeshow检验,χ2=2.631,P=0.955。ROC曲线分析显示AUC:0.693,95%CI:0.6291~0.7574)。结论基于性别、低水平TG、ESAT-6建立的预测模型能一定程度上预测是否并发EPTB,为临床治疗工作提供参考。Objective To investigate the factors influencing the development of extra-pulmonary tuberculosis(EPTB)in patients with viral hepatitis complicated by pulmonary tuberculosis(PTB).Methods A retrospective analysis was conducted on 427 patients with Hepatitis B Virus(HBV)and Hepatitis C Virus(HCV)infections complicated by PTB admitted to the tuberculosis department of Kunming Third People’s Hospital from January 2015 to December 2020.Patients were divided into the EPTB complication group(n=72)and the non-EPTB complication group(n=355)based on the presence of EPTB.Clinical treatment data of patients were collected.Univariate and multivariate Logistic regression analyse were used to screen independent risk factors for EPTB as predictive factors.A nomogram prediction model was established for Extrapulmonary Tuberculosis(EPTB)complications in patients with viral hepatitis and Pulmonary Tuberculosis(PTB),evaluated using the Hosmer-Lemeshow test and ROC curve analysis.Results Among the 427 patients,292(68.3%)were male and 135(31.7%)were female,with 72 cases of EPTB,resulting in an incidence rate of 16.86%.In the EPTB group,there were 34 males(47.2%)and 38 females(52.8%).The types of EPTB included tuberculous pleuritis(21 cases,29%),tuberculous peritonitis(16 cases,22%),lymph node tuberculosis(13 cases,18%),tuberculous encephalitis(5 cases,6%),intestinal tuberculosis(6 cases,8%),bone tuberculosis(5 cases,6%),pelvic tuberculosis(3 cases,4%),and genitourinary tuberculosis(3 cases,4%).Multivariate logistic regression analysis showed that gender(OR=0.425,95%CI:0.250-0.722,P=0.02),low triglyceride(TG)levels(OR=0.837,95%CI:0.717-0.978,P=0.025),the tuberculosis-specific antigen A(ESAT-6)(OR=1.007,95%CI:1.003~1.011 were independent influencing factors for EPTB in patients with PTB complicated by HBV and HCV infections.The optimal cutoff value for the nomogram model is 0.192,with a sensitivity of 0.611,specificity of 0.710,Youden index of 0.741,positive likelihood ratio of 2.103,and negative likelihood ratio of 0.548.The Hosmer-Le

关 键 词：病毒性肝炎 肺结核 肺外结核 影响因素 

分 类 号：R521[医药卫生—内科学] R575[医药卫生—临床医学]