Yone Eric Walter Pefura, Kengne André Pascal, Moifo Boniface, Kuaban Christopher
Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
Scand J Infect Dis. 2013 Feb;45(2):104-11. doi: 10.3109/00365548.2012.714905. Epub 2012 Sep 19.
Determinants of extrapulmonary involvement during pulmonary tuberculosis (PTB) have not been extensively investigated. We assessed the prevalence and determinants of extrapulmonary involvement during PTB in a Sub-Saharan African country with a high prevalence of both TB and human immunodeficiency virus (HIV) infection.
The medical records of patients aged ≥ 15 y, admitted for a first episode of TB to the Pneumology Service of Yaoundé Jamot Hospital, Cameroon, between 2009 and 2010 were considered. Determinants of extrapulmonary involvement were investigated through logistic regression.
A total of 984 patients (58.9% male), with a median age (25(th)-75(th) percentiles) of 32 (25-41) y were admitted for a first episode of TB, including 629 (63.9%) with isolated PTB, 127 (12.9%) with isolated extrapulmonary TB (EPTB), and 228 (23.2%) with both PTB and EPTB (PTB/EPTB). Therefore, the prevalence of EPTB among those with PTB was 26.6% (228/857). The main determinants of EPTB among patients with PTB were male sex (adjusted odds ratio (OR) 2.71, 95% confidence interval (95% CI) 1.71-4.03), HIV infection (OR 2.20, 95% CI 1.36-3.55), absence of fibrotic lung lesions (OR 1.96, 95% CI 1.23-3.14), smear-negative PTB (OR 7.20, 95% CI 4.13-12.56), anaemia (OR 1.60, 95% CI 1.03-2.50), and leukopenia (OR 2.59, 95% CI 1.12-5.98).
About a quarter of patients with PTB in this setting also have extrapulmonary involvement. EPTB is less contagious, less frequent than PTB, and less well addressed by programs in developing countries, while its identification is important for optimizing care. The presence of determinants of EPTB among patients with PTB should motivate active investigation of extrapulmonary involvement in order to improve management.
肺结核（PTB）肺外受累的决定因素尚未得到广泛研究。我们在一个结核病和人类免疫缺陷病毒（HIV）感染率均很高的撒哈拉以南非洲国家评估了PTB期间肺外受累的患病率及决定因素。
纳入2009年至2010年间因首次发作结核病入住喀麦隆雅温得贾莫特医院肺病科、年龄≥15岁患者的病历。通过逻辑回归研究肺外受累的决定因素。
共有984例患者（58.9%为男性）因首次发作结核病入院，年龄中位数（第25-75百分位数）为32（25-41）岁，其中629例（63.9%）为单纯PTB，127例（12.9%）为单纯肺外结核（EPTB），228例（23.2%）为PTB合并EPTB（PTB/EPTB）。因此，PTB患者中EPTB的患病率为26.6%（228/857）。PTB患者中EPTB的主要决定因素为男性（调整优势比（OR）2.71，95%置信区间（95%CI）1.71-4.03）、HIV感染（OR 2.20，95%CI 1.36-3.55）、无肺纤维化病变（OR 1.96，95%CI 1.23-3.14）、痰涂片阴性的PTB（OR 7.20，95%CI 4.13-12.56）、贫血（OR 1.60，95%CI 1.03-2.50）和白细胞减少（OR 2.59，95%CI 1.12-5.98）。
在这种情况下，约四分之一的PTB患者也有肺外受累。EPTB传染性较低，比PTB少见，在发展中国家的项目中较少得到关注，而其识别对于优化治疗很重要。PTB患者中存在EPTB的决定因素应促使积极调查肺外受累情况以改善管理。
