坦桑尼亚肺外结核患者中HIV血清阳性和HIV血清阴性患者生存的预测标志物。

Predictive markers of survival in HIV-seropositive and HIV-seronegative Tanzanian patients with extrapulmonary tuberculosis.

作者信息

Richter C, Koelemay M J, Swai A B, Perenboom R, Mwakyusa D H, Oosting J

机构信息

Department of Medicine, Muhimbili Medical Centre, Dar es Salaam, Tanzania.

出版信息

Tuber Lung Dis. 1995 Dec;76(6):510-7. doi: 10.1016/0962-8479(95)90526-x.

DOI:10.1016/0962-8479(95)90526-x

PMID:8593371

Abstract

SETTING

Prediction of survival in Tanzanian patients with extrapulmonary tuberculosis (TB).

OBJECTIVE

To evaluate the prognostic value of clinical and laboratory parameters on survival in human immunodeficiency virus (HIV) seropositive and HIV seronegative patients with extrapulmonary TB.

DESIGN

Over an 8-month period 192 consecutive patients with extrapulmonary TB, admitted to a major referral centre in Tanzania, were enrolled in the study. Their symptoms, signs and PPD skin test were noted. Their sera were tested for HIV and analyzed for beta-2-microglobulin content. Univariate risk factors for 12 months' survival after the start of anti-TB chemotherapy were entered into a stepwise Cox regression model. Survival probabilities were estimated according to the number of risk factors.

RESULTS

Of the 192 patients 126 (65%) were HIV-infected, and 29.7% had disseminated TB. Thirty-five patients, of whom 24 (68.6%) were HIV-positive, withdrew from the study immediately after hospital discharge. For survival analysis 157 patients remained. Within 12 months' follow-up after initiation of anti-TB therapy, the case fatality rate of the 102HHIV-infected patients was 22% and of the 55 HIV seronegative patients 2% (P < 0.001). In the HIV seropositive patients the following independent risk factors were significantly associated with a decreased probability of survival: peripheral lymphadenopathy (Hazard Rate Ratio (HRR) 5.2, 95% Confidence Interval [CI] 1. 7-16.2), a decreased activity score (bedridden > 50%/day (HRR 4.5, 95% CI 1.7-11.7), lymphopenia of < 1000/microL (HRR 4.4, 95% CI 1.7-11.8), and mycobacteraemia (HRR 4.0, 95% CI 1.2-13-.1). An anergic PPD skin test reaction proved to be another independent risk factor when the analysis was performed on 89 patients with available Mantoux test results. In the HIV seropositive patients, the 12 months' survival probabilities were 93%, 86%, 54% and 0% for presence of 0, 1, 2, and > 2 risk factors respectively.

CONCLUSION

Estimation of survival probabilities in patients with extrapulmonary TB may be possible without performing CD4 cell counts.

摘要

背景

预测坦桑尼亚肺外结核病患者的生存率。

目的

评估临床和实验室参数对人类免疫缺陷病毒（HIV）血清学阳性和血清学阴性的肺外结核病患者生存率的预后价值。

设计

在8个月的时间里，连续纳入了192例入住坦桑尼亚一家主要转诊中心的肺外结核病患者进行研究。记录他们的症状、体征和PPD皮肤试验情况。检测他们的血清HIV情况并分析β2-微球蛋白含量。将抗结核化疗开始后12个月生存的单因素风险因素纳入逐步Cox回归模型。根据风险因素数量估计生存概率。

结果

192例患者中，126例（65%）感染HIV，29.7%患有播散性结核病。35例患者出院后立即退出研究，其中24例（68.6%）为HIV阳性。进行生存分析的患者有157例。在开始抗结核治疗后的12个月随访内，102例HIV感染患者的病死率为22%，55例HIV血清学阴性患者的病死率为2%（P<0.001）。在HIV血清学阳性患者中，以下独立风险因素与生存概率降低显著相关：外周淋巴结病（风险率比（HRR）5.2，95%置信区间[CI]1.7-16.2）、活动评分降低（卧床>50%/天（HRR 4.5，95%CI 1.7-11.7））、淋巴细胞减少<1000/μL（HRR 4.4，95%CI 1.7-11.8）和菌血症（HRR 4.0，95%CI 1.2-13.1）。对89例有可用结核菌素试验结果的患者进行分析时，PPD皮肤试验无反应被证明是另一个独立风险因素。在HIV血清学阳性患者中，存在0、1、2和>2个风险因素时，12个月的生存概率分别为93%、86%、54%和0%。