Clinical characteristics and related factors of patients with secondary tuberculosis after malignant tumors

doi:10.3969/j.issn.1000-6621.2019.03.003

Abstract

Abstract:

Objective To investigate the clinical characteristics and related factors of tuberculosis secondary to malignant tumors. Methods The clinical data of 163 cases of tuberculosis secondary to malignant tumors (referred as the observation group) admitted to Xi’an Chest Hospital from January 2014 to June 2018 were collected. In addition, 100 cases of tuberculosis and 100 cases of malignant tumors with complete clinical data during the same period were selected as the control group. The incidence, clinical characteristics, laboratory results, diagnosis and risk factors of tuberculosis secondary to malignant tumors were analyzed. Results The average age of the patients in the observation group was (62.50±9.02) years, which was higher than that of the patients with tuberculosis alone ((53.67±7.64) years), and the difference was statistically significant (t=2.65, P=0.014). In the observation group, the most common malignant tumor was lung cancer (36.20% (59/163)), and lung tuberculosis (47.85% (78/163)) was the most common secondary tuberculosis. The first diagnosis rate of tuberculosis in the observation group was 31.90% (52/163), which was lower than that in the simple tuberculosis group (62.00% (62/100)), and the difference was statistically significant (χ ²=22.86, P=0.000). The positive rate of pure protein derivative test of tuberculin in observation group was 41.72% (68/163), which was lower than that in simple tuberculosis group (66.00% (66/100)); the positive rate of etiology and/or pathology examination (68.71% (112/163)) was higher than that in simple tuberculosis group (53.00% (53/100)); and the differences were statistically significant (χ ²=8.78 and 7.11, respectively; Ps<0.05). Patients who aged over 60 years, with a history of tuberculosis, with poor tumor staging (TNM Ⅲ or Ⅳ), had not received cancer treatment, and had received chemotherapy before in the observation group were 73.01% (119/163), 22.70% (37/163), 78.53% (128/163), 35.58% (58/163) and 58.28% (95/163), respectively, which were higher than those in the simple malignant tumors (61.00% (61/100), 12.00% (12/100), 67.00% (67/10), 22.00% (22/100), and 49.00% (49/100)); the differences were statistically significant (χ ² values were 4.14, 4.27, 4.30, 5.40, and 4.23 respectively, all Ps<0.05). Conclusion Compared with simple tuberculosis patients, tuberculosis patients secondary to malignant tumors are older, and have lower first diagnostic rate of tuberculosis. They are diagnosed mostly according to etiology and pathology. Age ≥60 years old, previous history of tuberculosis, poor staging of tumors, no previous anti-tumor therapies and previous chemotherapy are associated with secondary tuberculosis in patients with malignant tumors.

Key words: Neoplasms, Tuberculosis, Comorbidity, Disease attributes, Case-control studies

Juan-wen LIAN,Jia-ling XU,Tao HUA,Jie DING,Yu FAN. Clinical characteristics and related factors of patients with secondary tuberculosis after malignant tumors[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 254-259. doi: 10.3969/j.issn.1000-6621.2019.03.003

Figures/Tables 3

临床指标	观察组 (163例)	单纯结核病组 (100例)	统计值	P值
平均年龄(岁, $x ˉ$ ±s)	62.50±9.02	53.67±7.64	t=2.65	0.014
血红蛋白(g/L, $x ˉ$ ±s)	114.50±7.99	115.89±9.51	t=0.38	0.709
白蛋白(g/L, $x ˉ$ ±s)	31.69±4.21	33.54±3.75	t=1.32	0.203
性别[例(构成比,%)]			χ²=1.50	0.219
男	105(64.42)	58(58.00)
女	58(35.58)	42(42.00)
吸烟[例(构成比,%)]			χ²=1.52	0.207
是	99(60.74)	53(53.00)
否	64(39.26)	47(47.00)
发热[例(构成比,%)]			χ²=4.20	0.040
有	104(63.80)	51(53.00)
无	59(36.20)	48(48.00)
乏力[例(构成比,%)]			χ²=5.03	0.025
有	68(41.72)	28(28.00)
无	95(58.28)	72(72.00)
体质量减轻[例(构成比,%)]			χ²=16.18	0.000
有	78(47.85)	23(23.00)
无	85(52.15)	77(77.00)

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检测方法	观察组 (163例)	单纯结核病组 (100例)	χ²值	P值
PPD试验[例(阳性率,%)]	68(41.72)	66(66.00)	8.78	0.003
结核抗体检测[例(阳性率,%)]	103(63.19)	71(71.00)	1.67	0.194
T-SPOT.TB[例(阳性率,%)]	124(76.07)	79(79.00)	0.30	0.583
病原学和(或)病理检查[例(阳性率,%)]	112(68.71)	53(53.00)	7.11	0.008

临床指标	观察组 (163例)	单纯恶性肿瘤组 (100例)	χ²值	P值
年龄(岁)			4.14	0.042
≥60	119(73.01)	61(61.00)
<60	44(26.99)	39(39.00)
吸烟			0.64	0.425
是	101(61.96)	57(57.00)
否	62(38.04)	43(43.00)
性别			0.94	0.334
男	99(60.73)	61(61.00)
女	64(39.27)	39(39.00)
既往结核病史			4.27	0.031
有	37(22.70)	12(12.00)
无	126(77.30)	88(88.00)
TNM分期			4.30	0.038
Ⅰ~Ⅱ	35(21.47)	33(33.00)
Ⅲ~Ⅳ	128(78.53)	67(67.00)
ECOG评分			1.88	0.170
0~1	111(68.10)	76(76.00)
2分以上	52(31.90)	24(24.00)
肿瘤治疗			5.40	0.020
是	105(64.42)	78(78.00)
否	58(35.58)	22(22.00)
手术治疗			3.29	0.070
是	49(30.06)	41(41.00)
否	114(69.94)	59(59.00)
放疗			0.03	0.879
是	34(20.86)	21(21.00)
否	129(79.14)	79(79.00)
化疗			4.23	0.040
是	95(58.28)	49(49.00)
否	68(41.72)	51(51.00)