慢性肺病和结核病病史（肺结核后肺部疾病）：资源有限且艾滋病毒负担高的环境中的临床特征和住院结局。

Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden.

机构信息

Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.

出版信息

S Afr Med J. 2019 Feb 26;109(3):169-173. doi: 10.7196/SAMJ.2019.v109i3.13366.

DOI:10.7196/SAMJ.2019.v109i3.13366

PMID:30834873

Abstract

BACKGROUND

Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions.

OBJECTIVES

To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes.

METHODS

We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups.

RESULTS

During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165).

CONCLUSIONS

In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease.

摘要

背景

许多患有肺结核（PTB）的患者在结核病（TB）治疗完成后很长时间仍会持续出现呼吸道症状，这通常导致他们多次住院。

目的

描述有或没有肺结核病史的慢性肺部疾病（CLD）患者的特征，并评估其住院结局。

方法

我们对 2016 年 4 月 1 日至 10 月 31 日期间因呼吸道症状入住南非伊丽莎白港多拉恩金扎医院的 CLD 患者进行了回顾性研究。这些患者分为两组：有肺结核病史的 CLD（CLD-TB）和无肺结核病史的 CLD（CLD-NPTB）。排除当前培养阳性的结核病患者。比较两组患者的基线特征和临床结局（住院时间和院内死亡率）。

结果

研究期间，共有 4884 名患者入院，242 名患者被诊断为 CLD。在 CLD 患者中，173 名患者患有 CLD-TB，69 名患者没有肺结核病史。CLD-TB 患者在完成 TB 治疗后出现呼吸道症状的中位数时间为 41 个月（四分位距（IQR）101）。CLD-TB 患者主要为男性（59.5%），与无肺结核病史的患者相比，他们更有可能 HIV 阳性（49.7%比 8.7%；p=0.001），且在本次入院前更频繁住院（中位数 2.0（IQR 2.0）比 0；p=0.001），住院时间更长（中位数 5 天（IQR 7）比 2（4）；p=0.002）。然而，两组患者的院内死亡率无统计学差异（17.3%比 10.1%；p=0.165）。