关键词: 结核,胃肠, 腹膜炎,结核性, 肠穿孔, 因素分析,统计学

Abstract:

Objective: To explore the risk factors for concurrent intestinal perforation in patients with abdominal tuberculosis. Methods: The clinical data of 37 abdominal tuberculosis patients with concurrent intestinal perforation (intestinal perforation group) treated in Chengdu Public Health Clinical Medical Center from January 2013 to December 2020 were analyzed retrospectively. Thirty-nine abdominal tuberculosis patients without intestinal perforation were randomly selected with random number table as the control group during the same period. Univariate and multivariate logistic regression analysis were conducted to summarize the risk factors of abdominal tuberculosis patients with intestinal perforation. Results: Thirty-five patients received surgical treatment and two patients did not receive surgical treatment due to septic shock in the intestinal perforation group. Eight patients died and the mortality rate was 21.6%. The control group patients were all successfully treated and discharged from hospital. Among intestinal perforation group, 54.1% (20/37) had a history of tuberculosis ≤3 months, 29.7% (11/37) had AIDS, 64.9% (24/37) had anemia,86.5% (32/37) had hypoproteinemia, 51.4% (19/37) CD4⁺ T lymphocyte count <150 cells/μl, 45.9% (17/37) had intestinal obstruction, 73.0% (27/37) had abdominal symptoms as initial symptoms. Among the control group, 79.5% (31/39) had a history of tuberculosis ≤3 months, 5.1% (2/39) had AIDS, 33.3% (13/39) had anemia, 43.6% (17/39) had hypoproteinemia, 7.7% (3/39) CD4⁺ T lymphocyte count <150 cells/μl, 20.5% (8/39) had intestinal obstruction, 46.2% (18/39) had abdominal symptoms as initial symptoms.The differences between the two groups were statistically significant (χ² values were 5.564, 8.104, 6.541, 15.263, 17.565, 5.564, 5.650, respectively, all P values <0.05). Abdominal symptoms as initial symptoms, intestinal obstruction, hypoproteinemia, CD4⁺ T lymphocyte count< 150 cells/μl were independent risk factors for intestinal perforation in patients with abdominal tuberculosis (OR=23.828,95%CI:2.946-192.744; OR=10.292,95%CI:1.607-65.899; OR=43.455,95%CI:3.697-510.796; OR=25.706,95%CI:2.231-296.223). A history of tuberculosis ≤3 months was protective factor for intestinal perforation in patients with abdominal tuberculosis (OR=0.026,95%CI:0.003-0.247). Conclusion: Abdominal symptoms as initial symptoms, intestinal obstruction, hypoproteinemia, CD4⁺ T lymphocyte count <150 cells/μl were independent risk factors for intestinal perforation in patients with abdominal tuberculosis. When these risk factors were present in patients with abdominal tuberculosis, we should be alert to the risk of intestinal perforation.

Key words: Tuberculosis,gastrointestinal, Peritonitis,tuberculous, Intestinal perforatio, Factor analysis,statistical