Chu Yue, Soodeen-Lalloo Adiilah K, Huang Jin, Yang Guanghong, Chen Fengfang, Yin Hongyun, Sha Wei, Huang Xiaochen, Shi Jingyun, Feng Yonghong
Shanghai Key Laboratory of Tuberculosis, School of Medicine, Clinical and Research Centre of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Department of Radiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Front Med (Lausanne). 2019 Jul 17;6:163. doi: 10.3389/fmed.2019.00163. eCollection 2019.
The age-associated characteristic of computed tomography (CT) images of tuberculosis (TB) and the reason for male bias in TB are still not clear. We compared the CT images, clinical inflammatory indices and sputum bacterial counts between 594 non-smoking men and women with newly diagnosed TB with matched large span of ages from 15 to 92 years old. Logistic regression analyses were used to identify the cavity-associated factors of men and women, separately and in combination. Sputum bacterial counts, ratio of cavities, lung injury scores, and level of C reactive protein were significantly higher in men than in women with ages from 15 to 74, but not in cases older than 75. In CT images, thick walled cavity, cicatricial emphysema and parenchymal bands were present in men at ages of 15-74 more than matched women. Ratios of cases with lobular emphysema and pleural effusion were higher in men after age of 56. While ratios of cases with parenchymal bands, calcification, pleural effusion, pleural thickening, lobular emphysema and bronchovascular distortion increased with aging, those of centrilobular nodules, micronodules and tree in bud decreased with aging in men. Erythrocyte sedimentation rate (ESR) increased with aging, but no differences were found between men and women in ESR or T-SPOT TB tests. Higher complement C4 and lower body mass index in men and positive result in anti-TB antibody test in women were strongly associated with the presence of cavity. The sex bias in TB is age-associated. TB prevention, treatment and research should take differences of sex and age into account.
肺结核（TB）计算机断层扫描（CT）图像的年龄相关特征以及TB男性偏多的原因仍不清楚。我们比较了594名年龄跨度从15岁到92岁、新诊断为TB的非吸烟男性和女性的CT图像、临床炎症指标及痰菌计数。采用逻辑回归分析分别及综合确定男性和女性与空洞相关的因素。在15岁至74岁的人群中，男性的痰菌计数、空洞比例、肺损伤评分及C反应蛋白水平显著高于女性，但75岁以上人群中无此差异。在CT图像中，15至74岁男性出现厚壁空洞、瘢痕性肺气肿及实质条索的情况多于匹配的女性。56岁以后男性小叶性肺气肿和胸腔积液病例的比例更高。虽然实质条索、钙化、胸腔积液、胸膜增厚、小叶性肺气肿及支气管血管扭曲病例的比例随年龄增长而增加，但男性中，小叶中心结节、微结节及树芽征的比例随年龄增长而降低。红细胞沉降率（ESR）随年龄增长而升高，但男性和女性在ESR或结核感染T细胞检测方面未发现差异。男性较高的补体C4和较低的体重指数以及女性结核抗体检测阳性结果与空洞的存在密切相关。TB中的性别偏倚与年龄相关。TB的预防、治疗及研究应考虑性别和年龄差异。
