Guler Selma Ates, Bozkus Fulsen, Inci Mehmet Fatih, Kokoglu Omer Faruk, Ucmak Hasan, Ozden Sevinc, Yuksel Murvet
Department of Infectious Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
Med Princ Pract. 2015;24(1):75-9. doi: 10.1159/000365511. Epub 2014 Oct 17.
It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients.
A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study.
Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000).
There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.
本研究旨在评估免疫功能正常的成年患者中肺外结核（EPTB）与肺结核（PTB）相比的人口统计学因素和临床特征。
在土耳其一家三级护理医院的门诊，于5年期间（2007 - 2012年）共纳入427例临床、放射学和组织病理学确诊的结核病患者。患者数据通过回顾性获取。在这427例患者中，55例同时患有PTB和EPTB且正在使用类固醇或曾服用免疫抑制药物的患者被排除在研究之外。
在372例患者中，227例（61%）为男性，168例（45.2%）患有EPTB；204例（54.8%）患者患有PTB。EPTB最常见的发病部位是淋巴结（n = 45，12.1%）、胸膜（n = 40，10.7%）和脑（n = 7，1.8%）。最常见的症状是咳嗽（n = 174，46.7%）、盗汗（n = 127，34.1%）和发热（n = 123，33%）。与EPTB患者相比，PTB患者接受卡介苗接种的可能性较小（优势比0.41，95%置信区间0.2 - 0.63；p < 0.001）。EPTB患者中有81例（48.2%）为男性，PTB患者中有146例（71.6%）为男性。肺部受累在男性中（n = 146，71.6%）比在女性中（n = 58，28.2%；p = 0.000）更常见。
我们的研究中EPTB发病率较高。EPTB的早期诊断对治疗至关重要，对于生活在结核病流行地区的免疫功能正常患者，应牢记结核病的非典型表现。尤其应对女性进行EPTB的检查。
