Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose city, Tokyo, Japan.
Medicine (Baltimore). 2022 May 13;101(19):e29297. doi: 10.1097/MD.0000000000029297.
Patients with pulmonary tuberculosis (TB) sometimes show persistent severe inflammation for more than 1 month, even if TB treatment is effective. Although this inflammation can be improved through continuous antituberculous therapy, the risk factors for persistent inflammation remain unclear. Therefore, we sought to study the characteristics of patients with persistent severe inflammation.
We retrospectively analyzed 147 hospitalized adult patients with C-reactive protein (CRP) levels of 5 mg/dL or more on admission to Fukujuji Hospital from April 2019 to March 2021. The patients were divided into 2 groups: 40 patients (27.2%) had CRP levels of 5 mg/dL or more at 4 weeks after admission (persistent inflammation group), and 107 patients (72.8%) had CRP levels that fell below 5 mg/dL within 4 weeks of admission (improved inflammation group).
The median CRP level on admission in the persistent inflammation group was 10.8 mg/dL (interquartile range 9.1-14.5), which was higher than that in the improved inflammation group (median 8.2 mg/dL [6.5-12.1], P = .002). Patients in the persistent inflammation group had a higher prevalence of large cavities, defined as cavities ≥4 cm in diameter, on chest computed tomography (CT) (n = 20 [50.0%] vs n = 12 [11.2%], P < .001).
This study showed that 27.2% of patients who had high or moderate inflammation on admission did not achieve low CRP levels within 4 weeks after admission. Risk factors for persistent severe inflammation in patients with TB were presence of a large cavity (cavity diameter ≥4 cm) on chest CT and a high CRP level on admission. Therefore, in a patient with a large cavity on chest CT and/or CRP ≥9.0 mg/dL on admission, long-term inflammation may occur despite antituberculous therapy if other diseases are ruled out.
患有肺结核（TB）的患者有时会出现持续严重的炎症超过 1 个月，即使抗结核治疗有效。尽管这种炎症可以通过持续的抗结核治疗得到改善，但持续炎症的危险因素仍不清楚。因此，我们试图研究持续性严重炎症患者的特征。
我们回顾性分析了 2019 年 4 月至 2021 年 3 月期间福聚寺医院因 C 反应蛋白（CRP）水平≥5mg/dL 入院的 147 例成年患者。患者分为两组：40 例（27.2%）患者在入院后 4 周 CRP 水平仍≥5mg/dL（持续性炎症组），107 例（72.8%）患者在入院后 4 周内 CRP 水平降至＜5mg/dL（改善炎症组）。
持续性炎症组入院时 CRP 中位数为 10.8mg/dL（四分位距 9.1-14.5），高于改善炎症组（中位数 8.2mg/dL [6.5-12.1]，P=.002）。胸部 CT 显示持续性炎症组大空洞（定义为直径≥4cm 的空洞）的发生率较高（n=20[50.0%]vs n=12[11.2%]，P＜.001）。
本研究表明，入院时存在高或中度炎症的患者中，有 27.2%在入院后 4 周内未能达到低 CRP 水平。TB 患者持续性严重炎症的危险因素包括胸部 CT 上存在大空洞（空洞直径≥4cm）和入院时 CRP 水平较高。因此，如果排除其他疾病，胸部 CT 上存在大空洞和/或入院时 CRP≥9.0mg/dL 的患者，即使接受抗结核治疗，也可能长期存在炎症。
