Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, P. R. China.
Center for Precision Biomedicine, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Emerg Microbes Infect. 2018 Jun 6;7(1):102. doi: 10.1038/s41426-018-0106-1.
Many environmental, host, and microbial characteristics have been recognized as risk factors for dissemination of extrapulmonary tuberculosis (EPTB). However, there are few population-based studies investigating the association between the primary sites of tuberculosis (TB) infection and mortality during TB treatment. De-identified population-based surveillance data of confirmed TB patients reported from 2009 to 2015 in Texas, USA, were analyzed. Regression analyses were used to determine the risk factors for EPTB, as well as its subsite distribution and mortality. We analyzed 7007 patients with exclusively pulmonary TB, 1259 patients with exclusively EPTB, and 894 EPTB patients with reported concomitant pulmonary involvement. Age ≥45 years, female gender, human immunodeficiency virus (HIV)-positive status, and end-stage renal disease (ESRD) were associated with EPTB. ESRD was associated with the most clinical presentations of EPTB other than meningeal and genitourinary TB. Patients age ≥45 years had a disproportionately high rate of bone TB, while foreign-born patients had increased pleural TB and HIV+ patients had increased meningeal TB. Age ≥45 years, HIV+ status, excessive alcohol use within the past 12 months, ESRD, and abnormal chest radiographs were independent risk factors for EPTB mortality during TB treatment. The epidemiologic risk factors identified by multivariate analyses provide new information that may be useful to health professionals in managing patients with EPTB.
许多环境、宿主和微生物特征已被认为是肺部外结核病（EPTB）传播的危险因素。然而，很少有基于人群的研究调查结核病（TB）感染的原发部位与 TB 治疗期间死亡率之间的关系。本研究分析了 2009 年至 2015 年美国德克萨斯州报告的基于人群的确诊 TB 患者的匿名监测数据。回归分析用于确定 EPTB 的危险因素及其亚部位分布和死亡率。我们分析了 7007 例单纯性肺结核患者、1259 例单纯性 EPTB 患者和 894 例有报告合并肺部受累的 EPTB 患者。年龄≥45 岁、女性、人类免疫缺陷病毒（HIV）阳性和终末期肾病（ESRD）与 EPTB 相关。与脑膜和泌尿生殖系统结核病以外的 EPTB 最常见临床表现相关的是 ESRD。年龄≥45 岁的患者有较高的骨结核发生率，而外国出生的患者有较高的胸腔内结核发生率，HIV 阳性患者有较高的脑膜结核发生率。年龄≥45 岁、HIV 阳性、过去 12 个月内过度饮酒、ESRD 和异常胸片是 TB 治疗期间 EPTB 死亡的独立危险因素。多变量分析确定的流行病学危险因素提供了新的信息，这些信息可能对管理 EPTB 患者的卫生专业人员有用。
