初治肺结核合并慢性阻塞性肺疾病患者耐药的临床特征及危险因素分析

Analysis of Clinical Characteristics and Risk Factors for Drug Resistance in Newly-Treated Patients with Pulmonary Tuberculosis Complicated with Chronic Obstructive Pulmonary Disease.

作者信息

Ma Liangliang, Gao Maolong

机构信息

Department of Infectious Diseases, Beijing Geriatric Hospital, Beijing, 100095, People's Republic of China.

Department of Science and Technology, Beijing Geriatric Hospital, Beijing, 100095, People's Republic of China.

出版信息

Infect Drug Resist. 2022 Aug 25;15:4861-4869. doi: 10.2147/IDR.S358121. eCollection 2022.

DOI:10.2147/IDR.S358121

PMID:36045874

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9423120/

Abstract

OBJECTIVE

To analyze the clinical characteristics and risk factors of drug resistance of newly-treated chronic obstructive pulmonary disease (COPD) complicated pulmonary tuberculosis (PTB).

METHODS

A total of 489 newly-treated PTB patients admitted to Beijing Geriatric hospital were retrospectively enrolled in this study. Of these, 138 patients with COPD were allocated to the study group, and the remaining 351 patients without COPD were allocated to the control group. The baseline information, clinical characteristics of PTB and drug resistance of were compared between the two groups. Logistic regression was used to explore the correlation between drug resistance and COPD complications.

RESULTS

Patients complicated with COPD had a higher proportion of respiratory failure, cough, fever and night sweats, chest short breath, and emaciation between the study group and the control group (<0.05). In terms of medical history, patients complicated with COPD also had a higher proportion of childhood TB history, cough, tuberculosis exposure rate, dust exposure rate, and malnutrition (<0.05). There were significantly more patients with pulmonary cavities and a delayed diagnosis of TB in the study group than in the control group (<0.05). The single drug resistance rates of isoniazid, ethambutol, rifampicin, pyrazinamide, and rifapentine, and drug resistance with any two or more drugs in the study group were significantly higher than those in the control group (<0.05). Multivariate Logistic regression analysis showed that smoking, extrapulmonary tuberculosis, tuberculosis exposure history, malnutrition, pulmonary cavity, and delayed TB diagnosis were risk factors for drug resistance in newly-treated COPD complicated PTB patients.

CONCLUSION

The symptoms of COPD complicated PTB were more serious. Smoking history, extrapulmonary tuberculosis, tuberculosis exposure history, malnutrition, pulmonary cavity, and delayed diagnosis of tuberculosis were risk factors for TB resistance in these patients.

摘要

目的

分析新诊断的慢性阻塞性肺疾病（COPD）合并肺结核（PTB）的临床特征及耐药危险因素。

方法

回顾性纳入北京老年医院收治的489例新诊断的PTB患者。其中，138例合并COPD的患者被分配到研究组，其余351例未合并COPD的患者被分配到对照组。比较两组患者的基线信息、PTB的临床特征及耐药情况。采用Logistic回归分析探讨耐药与COPD并发症之间的相关性。

结果

研究组与对照组相比，合并COPD的患者呼吸衰竭、咳嗽、发热盗汗、胸闷气短及消瘦的比例更高（<0.05）。在病史方面，合并COPD的患者儿童期结核病史、咳嗽、结核暴露率、粉尘暴露率及营养不良的比例也更高（<0.05）。研究组肺部空洞及结核病延迟诊断的患者明显多于对照组（<0.05）。研究组异烟肼、乙胺丁醇、利福平、吡嗪酰胺及利福喷丁的单药耐药率以及两种或更多种药物的耐药率均显著高于对照组（<0.05）。多因素Logistic回归分析显示，吸烟、肺外结核、结核暴露史、营养不良、肺部空洞及结核病延迟诊断是新诊断的COPD合并PTB患者耐药的危险因素。