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中国防痨杂志 ›› 2025, Vol. 47 ›› Issue (10): 1350-1357.doi: 10.19982/j.issn.1000-6621.20250133

• 论著 • 上一篇    下一篇

老年肺结核合并贫血患者的临床特征及抗结核疗效分析

陈露露1, 骆梦醒1, 邹欣1, 姚欣1, 徐玉艳1(), 刘忠华2()   

  1. 1贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳 561113
    2同济大学附属上海市肺科医院结核(肺)重点实验室,上海市结核(肺)重点实验室,上海 200433
  • 收稿日期:2025-04-02 出版日期:2025-10-10 发布日期:2025-09-29
  • 通信作者: 刘忠华,Email:nllzh@126.com;徐玉艳,Email:xuyuyan@gmc.edu.cn
  • 基金资助:
    国家自然科学基金(81970009);教育部环境污染监测与疾病控制实验室开放基金(GMU-2023-HJZ-04)

Analysis of clinical characteristics and anti-tuberculosis treatment effectiveness of elderly patients with pulmonary tuberculosis complicated with anemia

Chen Lulu1, Luo Mengxing1, Zou Xin1, Yao Xin1, Xu Yuyan1(), Liu Zhonghua2()   

  1. 1School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
    2Key Laboratory of Tuberculosis (Lung) of Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai Key Laboratory of Tuberculosis (Lung), Shanghai 200433, China
  • Received:2025-04-02 Online:2025-10-10 Published:2025-09-29
  • Contact: Liu Zhonghua, Email:nllzh@126.com;Xu Yuyan, Email:xuyuyan@gmc.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81970009);Open Fund of the Laboratory for Environmental Pollution Monitoring and Disease Control of the Ministry of Education(GMU-2023-HJZ-04)

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摘要：

目的: 探讨老年肺结核合并贫血患者的临床特征及抗结核治疗效果,为老年肺结核患者的防控及治疗提供参考依据。方法: 选取2018—2020年上海市肺科医院就诊的≥60岁的肺结核患者,分为贫血组与非贫血组,比较两组患者的临床特征及治疗结果,进一步根据贫血的严重程度进行分层分析,并采用Kaplan-Meier法评估生存差异。采用Cox回归模型及限制性立方样条分析贫血与老年肺结核患者治疗结果的关联,并进行亚组分析。结果: 纳入的904例老年肺结核患者中,贫血患者316例,非贫血患者588例。随着贫血严重程度(非贫血、轻度贫血和中/重度贫血)的增加,老年肺结核患者肺部受累≥3个肺野[72.28%(425/588) vs. 78.32%(224/286) vs. 96.67%(29/30);H=8.028,P=0.005]、空洞[22.11%(130/588) vs. 38.81%(111/286) vs. 46.67%(14/30);H=31.651,P<0.001]及痰培养阳性的比例[41.84%(246/588) vs. 61.19%(175/286) vs. 86.67%(26/30);H=42.564,P<0.001]更高。与非贫血患者相比,贫血患者的治疗成功率下降了14.88%[84.18%(495/588) vs. 69.30%(219/316);χ2=28.154,P<0.001),其中36个月内中/重度贫血患者的累积生存率最低[99.66%(586/588) vs. 96.85%(277/286) vs. 86.67%(26/30);χ2=24.290,P<0.001]。Cox回归分析及趋势性检验结果显示,调整混杂因素后,贫血是老年肺结核患者预后不良的危险因素之一(HR=1.515,95%CI:1.091~2.104),随着贫血严重程度的升高,患者不良结局的发生风险增加(HR=1.449,95%CI:1.115~1.883)。限制性立方样条结果显示,贫血与老年肺结核患者不良结局的发生呈线性剂量-反应关系(χ2=35.040,P总趋势<0.001;χ2=1.700,P非线性=0.191)。进一步亚组分析结果仍稳健,贫血对老年肺结核患者预后的影响在性别(P交互=0.219)、年龄(P交互作用=0.151)及耐药情况(P交互作用=0.810)上均无明显交互作用。结论: 老年肺结核合并贫血患者肺部损伤更严重,治疗成功率及累积生存率低,特别是中/重度贫血患者。临床治疗中应重视老年肺结核患者贫血的筛查及干预,以进一步减少不良结局的发生。

关键词: 结核, 贫血, 老年人, 疾病特征, 治疗结果

Abstract:

Objective: To explore the clinical characteristics and anti-tuberculosis treatment outcomes of elderly patients with pulmonary tuberculosis complicated with anemia to provide a reference for the prevention, control and treatment of pulmonary tuberculosis complicated with anemia. Methods: Elderly pulmonary tuberculosis patients aged 60 and above who visited Shanghai Pulmonary Hospital from 2018 to 2020 were selected and divided into anemia group and non-anemia group to compare their clinical characteristics and treatment outcomes. Further stratified analysis was conducted based on patients' severity of anemia, and Kaplan-Meier method was used to evaluate their survival difference. Cox regression model and restricted cubic spline were used to analyze the association between anemia and treatment outcomes, and subgroup analysis was performed. Results: A total of 904 elderly patients with pulmonary tuberculosis were included, among whom 316 were anemic and 588 were non-anemic. With the increase of severity of anemia (non-anemia, mild anemia, moderate to severe anemia), the proportion of patients with ≥3 lung fields involved (72.28% (425/588) vs. 78.32% (224/286) vs. 96.67% (29/30); H=8.028, P=0.005), cavities (22.11% (130/588) vs. 38.81% (111/286) vs. 46.67% (14/30); H=31.651, P<0.001), and positive sputum culture (41.84% (246/588) vs. 61.19% (175/286) vs. 86.67% (26/30); H=42.564, P<0.001) increased. Compared with non-anemia patients, the treatment success rate of anemia patients decreased by 14.88% (84.18% (495/588) vs. 69.30% (219/316); χ2=28.154, P<0.001), and the cumulative survival rate of patients with moderate to severe anemia within 36 months was the lowest (99.66% (586/588) vs. 96.85% (277/286) vs. 86.67% (26/30); χ2=24.290, P<0.001). Cox regression analysis and trend test results showed that after adjusting for confounding factors, anemia was one of the risk factors for poor prognosis (HR=1.515, 95%CI: 1.091-2.104), and the risk of adverse outcomes increased with the severity of anemia (HR=1.449, 95%CI: 1.115-1.883). The restricted cubic spline results showed that there was a linear dose-response relationship between anemia and adverse outcomes (χ2=35.040, Poverall trend<0.001; χ2=1.700, Pnonlinearity=0.191). Further subgroup analysis results were still robust, and there was no significant interaction between anemia and prognosis in terms of gender (Pinteraction=0.219), age (Pinteraction=0.151), and drug resistance (Pinteraction=0.810). Conclusion: Elderly pulmonary tuberculosis patients with anemia have more severe lung damage, lower treatment success rate and cumulative survival rate, especially those with moderate to severe anemia. In clinical treatment, attention should be paid to the screening and intervention of anemia in elderly pulmonary tuberculosis patients to further reduce the occurrence of adverse outcomes.

Key words: Tuberculosis, Anemia, Aged, Disease attributes, Treatment outcome

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