关键词: 结核,肺, 冠状病毒感染, 共病现象, 疾病特征, 预后

Abstract:

Objective: This study aims to delineate the clinical presentations, radiographic features, and laboratory findings of patients co-infected with the novel coronavirus (COVID-19) and pulmonary tuberculosis, with a particular focus on assessing the prognostic implications of tuberculosis in the context of COVID-19 infection. Methods: The cohort comprised 140 patients admitted to Hunan Provincial Chest Hospital between December 2022 and January 2023 with confirmed COVID-19 infection. This group included 57 patients with isolated COVID-19 infection and 83 patients with concurrent pulmonary tuberculosis, of which 32 were diagnosed with drug-resistant tuberculosis. Comprehensive data on demographic characteristics, clinical manifestations, laboratory diagnostics, and outcomes were systematically gathered for analysis. A case-control study design was utilized. Initially, subjects were stratified into either the isolated COVID-19 group or the COVID-19 with tuberculosis co-infection group, facilitating a comparative analysis of demographic data, clinical manifestations, laboratory outcomes, and prognostic data. Subsequently, patients within the tuberculosis co-infection group were further categorized based on drug-resistance status, sputum test results, and treatment classification to refine the analytical depth. Kaplan-Meier survival analysis was employed to delineate the survival disparities between the groups. This analysis was instrumental in further identifying and evaluating the risk factors that may influence the prognosis of patients afflicted with both COVID-19 and pulmonary tuberculosis. Results: Patients co-infected with COVID-19 and tuberculosis exhibited a notably poorer prognosis, as evidenced by prolonged chest imaging recovery times (median (interquartile range, IQR)) of 8.5 (7.0, 11.5) days, compared to 7.0 (5.0, 10.0) days in the COVID-19-only group, achieving statistical significance (U=785.000, P=0.049). Furthermore, initial symptoms in the co-infected cohort were less typical, with fever presenting in only 38.6% (32/83) of cases, significantly lower than the 56.1% (32/57) observed in the COVID-19-only group (χ²=4.311, P=0.040). Radiographic findings between the groups revealed marked differences. In the isolated COVID-19 group, ground glass opacities were predominant, appearing in 52.6% (30/57) of cases, significantly exceeding the 21.7% (18/83) observed in the tuberculosis co-infected group (χ²=14.362, P<0.001). Conversely, the imaging profiles in the co-infected group were notably more complex, with patchy opacities and linear streaks being the most prevalent, identified in 91.6% (76/83) of cases—substantially higher than the 56.1% (32/57) and 28.1% (16/57) seen in the COVID-19-only group, with statistically significant differences (χ²=24.052 and 60.471, P<0.001 respectively). In patients with concurrent COVID-19 and tuberculosis, lymphocyte counts were significantly reduced at 1.0×10⁹/L (IQR: 0.7×10⁹/L to 1.6×10⁹/L), compared to 1.3×10⁹/L (IQR: 0.9×10⁹/L to 2.0×10⁹/L) in those with COVID-19 alone (U=1736.000, P=0.015). Similarly, white blood cell counts were lower in the co-infected group, recorded at 5.0×10⁹/L (IQR: 3.8×10⁹/L to 7.1×10⁹/L), versus 6.0×10⁹/L (IQR: 4.8×10⁹/L to 7.9×10⁹/L) in the COVID-19 only group, a statistically significant difference (U=1800.000, P=0.024). Neutrophil counts further supported these findings, being lower at 3.3×10⁹/L (IQR: 2.2×10⁹/L to 4.7×10⁹/L) compared to 3.6×10⁹/L (IQR: 3.0×10⁹/L to 5.2×10⁹/L) in patients with only COVID-19 (U=1865.000, P=0.049). Moreover, cytotoxic T cells (CD3⁺CD8⁺) counts were markedly reduced in the co-infected group at 344.2/μl (IQR: 239.6 to 457.3/μl), significantly lower than 567.6/μl (IQR: 437.8 to 618.6/μl) observed in the COVID-19 group (U=74.000, P=0.009). Survival analysis identified sputum positivity as a significant prognostic risk factor in these patients. Conclusion: Patients co-infected with COVID-19 and pulmonary tuberculosis experienced prolonged hospitalization and delayed recovery in chest imaging. Notably, those with sputum-positive pulmonary tuberculosis had significantly poorer prognostic outcomes.

Key words: Tuberculosis, pulmonary, Coronavirus infections, Comorbidity, Disease characteristics, Prognosis