昆明医科大学学报2025，Vol.46Issue(2)：103-109,7.DOI:10.12259/j.issn.2095-610X.S20250215
病毒性肝炎合并肺结核患者并发肺外结核的影响因素
Factors Influencing the Development of Extra-Pulmonary Tuberculosis in Patients with Viral Hepatitis Complicated by Pulmonary Tuberculosis
摘要
Abstract
Objective To investigate the factors influencing the development of extra-pulmonary tuberculosis(EPTB)in patients with viral hepatitis complicated by pulmonary tuberculosis(PTB).Methods A retrospective analysis was conducted on 427 patients with Hepatitis B Virus(HBV)and Hepatitis C Virus(HCV)infections complicated by PTB admitted to the tuberculosis department of Kunming Third People's Hospital from January 2015 to December 2020.Patients were divided into the EPTB complication group(n=72)and the non-EPTB complication group(n=355)based on the presence of EPTB.Clinical treatment data of patients were collected.Univariate and multivariate Logistic regression analyse were used to screen independent risk factors for EPTB as predictive factors.A nomogram prediction model was established for Extrapulmonary Tuberculosis(EPTB)complications in patients with viral hepatitis and Pulmonary Tuberculosis(PTB),evaluated using the Hosmer-Lemeshow test and ROC curve analysis.Results Among the 427 patients,292(68.3%)were male and 135(31.7%)were female,with 72 cases of EPTB,resulting in an incidence rate of 16.86%.In the EPTB group,there were 34 males(47.2%)and 38 females(52.8%).The types of EPTB included tuberculous pleuritis(21 cases,29%),tuberculous peritonitis(16 cases,22%),lymph node tuberculosis(13 cases,18%),tuberculous encephalitis(5 cases,6%),intestinal tuberculosis(6 cases,8%),bone tuberculosis(5 cases,6%),pelvic tuberculosis(3 cases,4%),and genitourinary tuberculosis(3 cases,4%).Multivariate logistic regression analysis showed that gender(OR=0.425,95%CI:0.250-0.722,P=0.02),low triglyceride(TG)levels(OR=0.837,95%CI:0.717-0.978,P=0.025),the tuberculosis-specific antigen A(ESAT-6)(OR=1.007,95%CI:1.003～1.011 were independent influencing factors for EPTB in patients with PTB complicated by HBV and HCV infections.The optimal cutoff value for the nomogram model is 0.192,with a sensitivity of 0.611,specificity of 0.710,Youden index of 0.741,positive likelihood ratio of 2.103,and negative likelihood ratio of 0.548.The Hosmer-Lemeshow test yielded χ2=2.631,P=0.955.ROC curve analysis showed an AUC of 0.693,95%CI:0.629 1～0.7574.Conclusion The prediction model based on gender,low TG levels and ESAT-6 can well predict the occurrence of EPTB to some extent,providing a reference for clinical treatment.关键词
病毒性肝炎/肺结核/肺外结核/影响因素Key words
Viral hepatitis/Pulmonary tuberculosis/Extra-pulmonary tuberculosis/Influencing factor分类
医药卫生引用本文复制引用
沈凌筠,李龙芬,施春晶,李文明,黄媛卿,张华杰,罗云,李杰,刘立..病毒性肝炎合并肺结核患者并发肺外结核的影响因素[J].昆明医科大学学报,2025,46(2):103-109,7.基金项目
云南省科技厅地方高校联合专项基金(202401BA070001-063) （202401BA070001-063）
昆明市卫健委科研课题项目(2023-03-02-019 （）
2023-03-08-012) （）
