Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, China.
Sci Rep. 2024 May 2;14(1):10108. doi: 10.1038/s41598-024-59679-z.
Pulmonary tuberculosis (TB) can result in irreversible damage and lead to tuberculous destructive lung (TDL), a severe chronic lung disease that is associated with a high mortality rate. Additionally, pulmonary hypertension (PH) is a hemodynamic disorder that can be caused by lung diseases. The objective of this study is to investigate the risk factors associated with PH in active TB patients diagnosed with TDL. We conducted a retrospective review of the medical records of 237 patients who were diagnosed with TDL, active pulmonary tuberculosis, and underwent echocardiography at the Third People' Hospital of Shenzhen from January 1, 2016, to June 30, 2023. Univariate and multivariate logistic regression analyses were performed to identify factors that correlated with the development of pulmonary hypertension. Univariate and multivariate logistic regression analyses revealed that several factors were associated with an increased risk of pulmonary hypertension (PH) in individuals with tuberculosis destroyed lung (TDL). These factors included age (OR = 1.055), dyspnea (OR = 10.728), D-dimer (OR = 1.27), PaCO2 (OR = 1.040), number of destroyed lung lobes (OR = 5.584), bronchiectasis (OR = 3.205), and chronic pleuritis (OR = 2.841). When age, D-dimer, PaCO2, and number of destroyed lung lobes were combined, the predictive value for PH in patients with TDL was found to be 80.6% (95% CI 0.739-0.873),with a sensitivity of 76.6% and specificity of 73.2%. Advanced age, elevated D-dimer levels, hypercapnia, and severe lung damage were strongly correlated with the onset of PH in individuals with active pulmonary tuberculosis (PTB) and TDL. Furthermore, a model incorporating age, D-dimer, PaCO2, and the number of destroyed lung lobes might be valuable in predicting the occurrence of PH in patients with active PTB and TDL.
肺结核（TB）可导致不可逆转的损伤，并导致结核性破坏性肺病（TDL），这是一种严重的慢性肺部疾病，与高死亡率相关。此外，肺动脉高压（PH）是一种由肺部疾病引起的血液动力学障碍。本研究的目的是研究诊断为 TDL 的活动性肺结核患者中与 PH 相关的危险因素。我们对 2016 年 1 月 1 日至 2023 年 6 月 30 日在深圳市第三人民医院接受 TDL、活动性肺结核和超声心动图检查的 237 名患者的病历进行了回顾性审查。进行了单变量和多变量逻辑回归分析，以确定与肺动脉高压发展相关的因素。单变量和多变量逻辑回归分析显示，一些因素与肺结核破坏性肺病（TDL）患者发生肺动脉高压（PH）的风险增加有关。这些因素包括年龄（OR=1.055）、呼吸困难（OR=10.728）、D-二聚体（OR=1.27）、PaCO2（OR=1.040）、破坏肺叶数（OR=5.584）、支气管扩张（OR=3.205）和慢性胸膜炎（OR=2.841）。当将年龄、D-二聚体、PaCO2 和破坏肺叶数结合起来时，发现 TDL 患者 PH 的预测值为 80.6%（95%CI 0.739-0.873），敏感性为 76.6%，特异性为 73.2%。高龄、D-二聚体水平升高、高碳酸血症和严重的肺部损伤与活动性肺结核（PTB）和 TDL 患者 PH 的发生密切相关。此外，纳入年龄、D-二聚体、PaCO2 和破坏肺叶数的模型可能对预测活动性 PTB 和 TDL 患者 PH 的发生有价值。
