Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis

doi:10.19982/j.issn.1000-6621.20230221

Abstract

Abstract:

Objective: To investigate the nutritional status of patients with extrapulmonary tuberculosis and analyze the related factors. Methods: A total of 3223 inpatients with extrapulmonary tuberculosis from 5 tuberculosis specialized hospitals from January 1, 2020 to December 31, 2021 were selected as research subjects, including 1852 males (57.46%) and 1371 females (42.54%); the median (quartile) age was 41 (28,58) years old. The general demography characteristics and clinical characteristics of the subjects were collected (including gender, age, height, body mass, clinical diagnosis, location of extrapulmonary tuberculosis, complications, immune status, previous tuberculosis treatment history, etc.), as well as the nutrition risk screening-2002 (NRS-2002) score. All the subjects had complete medical records and information, and were definitely diagnosed with extrapulmonary tuberculosis. Nutritional risk screening was conducted when they had not yet received effective anti-tuberculosis treatment or control. The occurrence of nutritional risk in the subjects was analyzed and the influencing factors of nutritional risk in patients with extrapulmonary tuberculosis were analyzed using a multivariate logistic regression model. Results: Among the 3223 study subjects, 86.91% (2801/3223) involved only one extrapulmonary site, and 13.09% (422/3223) involved two or more sites. The NRS-2002 score of subjects fluctuated from 1 to 5, and the median (quartile) score was 3 (1, 4). A total of 1814 cases (56.28%) had nutritional risk (NRS-2002 score ≥3). Of the 422 study subjects with involvement in two or more extrapulmonary sites, 63.74% (269/422) were at nutritional risk; of the 2801 studies involving a single extrapulmonary site, 55.16% (1545/2801) had nutritional risks. Multivariate logistic regression analysis showed that low body mass index (body mass index <18.5)(OR (95%CI)=20.641 (19.745-26.307)), concomitant immunosuppression (OR (95%CI)=1.182 (1.023-1.421)), and retreatment (OR (95%CI)=1.804 (1.549-2.177)) were risk factors for nutritional risk in patients with extrapulmonary nodules. Conclusion: The incidence of nutritional risk in patients with extrapulmonary tuberculosis is relatively high, and more attention should be paid to their nutritional status in clinical treatment, especially for patients with low body mass index, combined immunosuppression, and retreatment.

Key words: Tuberculosis, Nutritional status, Risk factors, Retrospective studies, Extrapulmonary tuberculosis

CLC Number:

Ding Qin, Chen Wei, Zhang Shengkang, Ren Fei, Chen Xiaohong, Hu Chunmei, Chen Danping, Fan Lin. Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 839-844. doi: 10.19982/j.issn.1000-6621.20230221

Figures/Tables 5

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
体质量指数(以≥20.5为参照)
<18.5	6.818	0.193	15.119	0.000	20.641(19.745~26.307)
18.5~<20.5	0.484	0.496	0.954	0.329	1.078(0.916~1.270)
合并恶性肿瘤	0.387	0.946	0.167	0.683	1.639(0.618~2.772)
合并免疫抑制	1.775	1.069	5.755	0.018	1.182(1.023~1.421)
合并糖尿病	0.376	0.263	2.037	0.154	1.558(0.993~1.918)
复治	28.423	2.155	173.967	0.000	1.804(1.549~2.177)
累及2个及以上肺外部位	0.201	0.226	0.794	0.373	1.055(0.659~1.691)

References 26

[1]	Sharma SK, Mohan A, Kohli M. Extrapulmonary tuberculosis. Expert Rev Respir Med, 2021, 15(7): 931-948. doi:10.1080/17476348.2021.1927718. doi: 10.1080/17476348.2021.1927718 URL
[2]	Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings. Radiographics, 2019, 39(7): 2023-2037. doi:10.1148/rg.2019190109. doi: 10.1148/rg.2019190109 pmid: 31697616
[3]	Kang W, Liu S, Du J, et al. Epidemiology of concurrent extrapulmonary tuberculosis in inpatients with extrapulmonary tuberculosis lesions in China: a large-scale observational multi-centre investigation. Int J Infect Dis, 2022, 115: 79-85. doi:10.1016/j.ijid.2021.11.019. doi: 10.1016/j.ijid.2021.11.019 URL
[4]	Chu P, Chang Y, Zhang X, et al. Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study. Emerg Microbes Infect, 2022, 11(1): 1090-1102. doi:10.1080/22221751.2022.2054367. doi: 10.1080/22221751.2022.2054367 URL
[5]	Sárközi HK, Ianoşi MB, Ciurba BE, et al. Extrapulmonary tuberculosis-a diagnostic and therapeutic challenge. Orv Hetil, 2022, 163(19): 750-757. doi:10.1556/650.2022.32437. doi: 10.1556/650.2022.32437 URL
[6]	胡忠义, 王洪生. 肺外结核病的实验室诊断技术应用. 中华结核和呼吸杂志, 2008, 31(2):92-94. doi:10.3321/j.issn:1001-0939.2008.02.006. doi: 10.3321/j.issn:1001-0939.2008.02.006
[7]	Baykan AH, Sayiner HS, Aydin E, et al. Extrapulmonary tuberculosis: an old but resurgent problem. Insights Imaging, 2022, 13(1): 39. doi:10.1186/s13244-022-01172-0. doi: 10.1186/s13244-022-01172-0
[8]	Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings. Radiographics, 2019, 39(7): 2023-2037. doi:10.1148/rg.2019190109. doi: 10.1148/rg.2019190109 pmid: 31697616
[9]	Pang Y, An J, Shu W, et al. Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008—2017. Emerg Infect Dis, 2019, 25(3): 457-464. doi:10.3201/eid2503.180572. doi: 10.3201/eid2503.180572 pmid: 30789144
[10]	许静涌, 杨剑, 康维明, 等. 营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版). 中华临床营养杂志, 2018, 26(3): 131-135. doi:10.3760/cma.j.issn.1674-635X.2018.03.001. doi: 10.3760/cma.j.issn.1674-635X.2018.03.001
[11]	Kang W, Liu S, Du J, et al. Epidemiology of concurrent extrapulmonary tuberculosis in inpatients with extrapulmonary tuberculosis lesions in China: a large-scale observational multi-centre investigation. Int J Infect Dis, 2022, 115: 79-85. doi:10.1016/j.ijid.2021.11.019. doi: 10.1016/j.ijid.2021.11.019 URL
[12]	Li T, Yan X, Du X, et al. Extrapulmonary tuberculosis in China: a national survey. Int J Infect Dis, 2023, 128:69-77. doi:10.1016/j.ijid.2022.12.005. doi: 10.1016/j.ijid.2022.12.005 URL
[13]	Hammami F, Koubaa M, Chakroun A, et al. Comparative analysis between tuberculous meningitis and other forms of extrapulmonary tuberculosis. Germs, 2021, 11(1):23-31. doi:10.18683/germs.2021.1237. doi: 10.18683/germs.2021.1237 pmid: 33898338
[14]	Pascual-Pareja JF, Carrillo-Gómez R, Hontañón-Antoñana V, et al. Treatment of pulmonary and extrapulmonary tuberculosis. Enferm Infecc Microbiol Clin (Engl Ed), 2018, 36(8):507-516. doi:10.1016/j.eimc.2017.10.018. doi: 10.1016/j.eimc.2017.10.018
[15]	Atif M, Fatima R, Ahmad N, et al. Treatment outcomes of extrapulmonary tuberculosis in Bahawalpur, Pakistan; a record review. J Pharm Policy Pract, 2020, 13:35. doi:10.1186/s40545-020-00227-1. doi: 10.1186/s40545-020-00227-1 pmid: 32724657
[16]	谢雯霓, 邓国防, 施汶言, 等. 肺结核患者营养风险和营养指标相关性分析. 新医学, 2018, 49(10):740-744. doi:10.3969/j.issn.0253-9802.2018.10.010. doi: 10.3969/j.issn.0253-9802.2018.10.010
[17]	陈薇, 丁芹, 顾颖, 等. 上海市900例老年住院结核病患者营养状况调查分析. 中国防痨杂志, 2020, 42(7):725-730. doi:10.3969/j.issn.1000-6621.2020.07.015. doi: 10.3969/j.issn.1000-6621.2020.07.015
[18]	Kentley J, Ooi JL, Potter J, et al. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health, 2017, 22(8): 994-999. doi:10.1111/tmi.12908. doi: 10.1111/tmi.12908 pmid: 28609809
[19]	刘欣, 李健, 沈生荣. 203例肠结核营养风险筛查结果及影响因素分析. 结核与肺部疾病杂志, 2020, 1(2):29-33. doi:10.3969/j.issn.2096-8493.2020.01.007. doi: 10.3969/j.issn.2096-8493.2020.01.007
[20]	Ren Z, Zhao F, Chen H, et al. Nutritional intakes and asso-ciated factors among tuberculosis patients: a cross-sectional study in China. BMC Infect Dis, 2019, 19(1):907. doi:10.1186/s12879-019-4481-6. doi: 10.1186/s12879-019-4481-6
[21]	Luo M, Wang W, Zeng Q, et al. Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases. Exp Ther Med, 2018, 16(3):2770-2776. doi:10.3892/etm.2018.6496. doi: 10.3892/etm.2018.6496 pmid: 30210618
[22]	Jadaun P, Patil R, Ramteke S, et al. A study to assess the clinico-radiological presentation and outcome predictors in cases of tubercular meningitis. Indian J Tuberc, 2021, 68(3): 384-388. doi:10.1016/j.ijtb.2020.12.010. doi: 10.1016/j.ijtb.2020.12.010 pmid: 34099205
[23]	段鸿飞. 重视结核性脑膜炎的诊断和治疗. 中国防痨杂志, 2019, 41(1):14-17. doi:10.3969/j.issn.1000-6621.2019.01.005. doi: 10.3969/j.issn.1000-6621.2019.01.005
[24]	Frediani JK, Sanikidze E, Kipiani M, et al. Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults. Clin Nutr, 2016, 35(1): 205-212. doi:10.1016/j.clnu.2015.02.007. doi: S0261-5614(15)00050-3 pmid: 25753551
[25]	Chandrasekaran P, Saravanan N, Bethunaickan R, et al. Malnutrition: Modulator of Immune Responses in Tuberculosis. Front Immunol, 2017, 8: 1316. doi:10.3389/fimmu.2017.01316. doi: 10.3389/fimmu.2017.01316 pmid: 29093710
[26]	Kant S, Gupta H, Ahluwalia S. Significance of nutrition in pulmonary tuberculosis. Crit Rev Food Sci Nutr, 2015, 55(7): 955-963. doi:10.1080/10408398.2012.679500. doi: 10.1080/10408398.2012.679500 pmid: 24915351

类型	例数	构成比(%)
累及2个及以上肺外部位	422	13.09
累及单个肺外部位	2801	86.91
结核性胸膜炎	905	32.31
淋巴结结核	330	11.80
结核性脑膜炎	125	4.46
结核性腹膜炎	54	1.93
肠结核	48	1.71
泌尿系统结核	34	1.21
骨与关节结核	99	3.53
皮肤结核	11	0.39
支气管结核	1090	38.91
结核性心包炎	19	0.68
喉结核	58	2.07
其他部位结核	28	1.00
合计	3223	100.00

类型	例数	NRS-2002评分≥3分		NRS-2002评分<3分
类型	例数	例数	构成比(%)	例数	构成比(%)
累及单个肺外部位	2801	1545	55.16	1256	44.84
结核性胸膜炎	905	525	58.01	380	41.99
淋巴结结核	330	158	47.88	172	52.12
结核性脑膜炎	125	80	64.00	45	36.00
结核性腹膜炎	54	33	61.11	21	38.89
肠结核	48	37	77.08	11	22.92
泌尿系统结核	34	13	38.24	21	61.76
骨与关节结核	99	53	53.54	46	46.46
皮肤结核	11	1	9.09	10	90.91
支气管结核	1090	589	54.04	501	45.96
结核性心包炎	19	10	52.63	9	47.37
喉结核	58	30	51.72	28	48.28
其他部位结核	28	16	57.14	12	42.86
两个及以上肺外部位	422	269	63.74	153	36.26
合计	3223	1814	56.28	1409	43.72

因素	NRS-2002评分≥3分		NRS-2002评分<3分		χ²值	P值
因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别					3.661	0.056
男性	1069	58.93	783	55.57
女性	745	41.07	626	44.43
年龄组(岁)					4.020	0.004
18~39	898	49.50	648	45.99
40~59	441	24.31	502	35.63
60~79	399	22.00	227	16.11
≥80	76	4.19	32	2.27
体质量指数					2432.000	<0.01
<18.5	852	46.97	0	0.00
18.5~<20.5	758	41.79	17	1.21
≥20.5	204	11.24	1392	98.79
合并糖尿病					6.414	0.010
是	146	8.05	150	10.65
否	1668	91.95	1259	89.35
合并恶性肿瘤					58.370	<0.01
是	828	45.64	456	32.36
否	986	54.36	953	67.64
合并免疫抑制					5.467	0.020
是	564	31.09	493	34.99
否	1250	68.91	916	65.01
治疗分类					15.120	<0.01
初治	1112	61.30	957	67.92
复治	702	38.70	452	32.08
累及肺外部位					10.990	<0.01
单个	1545	85.17	1256	89.14
2个及以上	269	14.83	153	10.86

变量	赋值
因变量
营养风险评分	NRS-2002评分≥3分=1;NRS-2002评分<3分=0
自变量
年龄组	18~39岁=0;40~59岁=1;60~79岁=2;≥80岁=3
体质量指数	≥20.5=0;18.5~<20.5=1;<18.5=2
合并糖尿病	否=0;是=1
合并恶性肿瘤	否=0;是=1
合并免疫抑制	否=0;是=1
治疗分类	初治=0;复治=1
累及肺外部位	单个=0;2个及以上=1