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中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (6): 751-759.doi: 10.19982/j.issn.1000-6621.20260029

• 论著 • 上一篇    下一篇

60岁及以上老年肺结核患者营养不良与治疗转归的影响因素分析

热依汗古丽·阿肯1,2, 木拉提江·艾买提3, 高绪胜4, 丁彩红4, 曾谊5, 陈禹6, 白燕2,7, 范琳2()   

  1. 1 新疆维吾尔自治区第六人民医院结核四科, 乌鲁木齐 830001
    2 同济大学附属上海市肺科医院结核科, 上海市感染性疾病临床研究中心(结核病),上海市结核(肺)重点实验室, 上海 200433
    3 新疆维吾尔自治区人民医院放射影像中心, 乌鲁木齐 830001
    4 山东省公共卫生临床中心结核科, 济南 250102
    5 江苏省南京市第二医院结核科, 南京 210003
    6 沈阳市第十人民医院结核科, 沈阳 110000
    7 贵州医科大学公共卫生与健康学院, 贵阳 550000
  • 收稿日期:2026-01-14 出版日期:2026-06-10 发布日期:2026-05-25
  • 通信作者: 范琳 E-mail:fanlinsj@163.com
  • 基金资助:
    国家自然科学基金项目(82170006);上海市肺科医院临床研究中心(FK1945);上海市肺科医院重点研究中心(FKLY20017);上海市肺科医院重点研究中心(SKPY2021003);新疆维吾尔自治区第六人民医院研究项目(2023015)

Analysis of influencing factors of malnutrition and treatment outcomes among elderly patients with pulmonary tuberculosis aged 60 years and above

Reyhangul·Aken 1,2, Muratjan·Amat 3, Gao Xusheng4, Ding Caihong4, Zeng Yi5, Chen Yu6, Bai Yan2,7, Fan Lin2()   

  1. 1 Fourth Department of Tuberculosis, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    2 Department of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai Infectious Diseases Clinical Research Center (Tuberculosis), Shanghai Key Laboratory of Tuberculosis (Lung), Shanghai 200433, China
    3 Radiology Center of Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi 830001, China
    4 Department of Tuberculosis, Shandong Provincial Public Health Clinical Center, Ji’nan 250102, China
    5 Department of Tuberculosis, The Second Hospital of Nanjing, Jiangsu Province, Nanjing 210003, China
    6 Department of Tuberculosis, Shenyang Tenth People’s Hospital, Shenyang 110000, China
    7 School of Public Health and Health, Guizhou Medical University, Guiyang 550000, China
  • Received:2026-01-14 Online:2026-06-10 Published:2026-05-25
  • Contact: Fan Lin E-mail:fanlinsj@163.com
  • Supported by:
    National Natural Science Foundation of China(82170006);Clinical Research Center of Shanghai Pulmonary Hospital(FK1945);Key Research Center of Shanghai Pulmonary Hospital(FKLY20017);Key Research Center of Shanghai Pulmonary Hospital(SKPY2021003);Xinjiang Uygur Autonomous Region Infectious Disease Hospital(2023015)

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摘要：

目的: 探讨老年肺结核合并营养不良患者的临床特征,分析营养不良与治疗转归的相关影响因素。方法: 采用全国多中心、回顾性、大样本队列临床研究方法,参照入组标准连续纳入2020年11月1日至2024年4月30日期间在上海市肺科医院、山东省公共卫生临床中心、江苏省南京市第二医院、沈阳市第十人民医院等4家医院收治的1401例年龄≥60岁新诊断的老年药物敏感肺结核患者作为研究对象,依据是否合并营养不良(入院48h内采用GLIM方法评估)将患者分成营养不良组和无营养不良组,随访所有患者全疗程临床信息,采用二元logistic回归模型分析营养不良患者治疗转归的影响因素。结果: 老年药物敏感肺结核患者营养不良合并率为47.61%(667/1401),营养不良组的治愈率[41.68%(278/667)]和完成疗程率[21.89%(146/667)]均明显低于无营养不良组[分别为50.27%(369/734)和26.43%(194/734)],总不良转归率[36.43%(243/667)]明显高于无营养不良组[23.30%(171/734)],差异均有统计学意义(χ2=10.383,P=0.001;χ2=3.922,P=0.048;χ2=28.959,P<0.001)。多因素logistic回归分析显示,年龄在70~79岁(OR=1.551,95%CI:1.373~1.814)、合并细菌性肺炎(OR=1.432,95%CI:1.223~1.837)、病灶范围≥3个肺野(OR=1.565,95%CI:1.058~2.316)、发生药物不良反应(OR=1.744,95%CI:1.210~2.515)均是影响老年肺结核合并营养不良患者治疗转归的危险因素。结论: 老年肺结核患者营养不良合并率高,且合并者具有不良转归率高、完成疗程率低、治愈率低等特点,临床治疗中应积极监测70~79岁、合并细菌性肺炎、病灶范围≥3个肺野、发生药物不良反应老年肺结核患者的营养状况,以进一步改善其治疗转归。

关键词: 结核,肺, 老年人, 营养不良, 治疗结果, 预后, 因素分析,统计学

Abstract:

Objective: Explore the clinical characteristics of elderly patients (aged 60 years and above) with pulmonary tuberculosis and malnutrition, as well as to analyze the factors associated with malnutrition and treatment outcomes. Methods: We conducted a multicenter, retrospective cohort study involving a large sample size. A total of 1401 newly diagnosed, drug-sensitive PTB patients aged 60 years or older were consecutively enrolled from November 1, 2020, to April 30, 2024, across four hospitals: Shanghai Pulmonary Hospital, Shandong Public Health Clinical Center, Nanjing Second Hospital (Jiangsu), and Shenyang Tenth People’s Hospital. Patients were categorized into a malnutrition group (study group) and a non-malnutrition group (control group) based on the presence of malnutrition assessed by the GLIM criteria within 24 hours of admission. Comprehensive clinical information was collected for all patients throughout their treatment course. A binary logistic regression model was employed to analyze the factors influencing treatment outcomes in these malnourished patients. Results: The prevalence of malnutrition among elderly drug-sensitive PTB patients was 47.61% (667/1401). In comparison to the non-malnutrition group, which exhibited a cure rate of 50.27% (369/734) and a treatment completion rate of 26.43% (194/734), the malnutrition group demonstrated significantly lower rates of cure (41.68% (278/667)) and treatment completion (21.89% (146/667)). Additionally, the malnutrition group had a markedly higher rate of unfavorable treatment outcomes (36.43% (243/667) vs. 23.30% (171/734)), with all differences being statistically significant (χ2=10.383, P=0.001; χ2=3.922, P=0.048; χ2=28.959, P<0.001). Multivariable logistic regression analysis identified several independent risk factors for treatment outcomes, including aged 70-79 years (OR=1.551, 95%CI: 1.373-1.814), concurrent bacterial pneumonia (OR=1.432, 95%CI: 1.223-1.837), involvement of three or more lung fields (OR=1.565, 95%CI: 1.058-2.316), and adverse drug reactions (OR=1.744, 95%CI: 1.210-2.515). Conclusion: Elderly PTB patients suffering from malnutrition are characterized by a high comorbidity rate, elevated rates of unfavorable outcomes, and low rates of treatment completion and cure. Clinical management should focus on individuals aged 70-79 years, those with concurrent bacterial pneumonia, patients with three or more lung fields affected, and those experiencing adverse drug reactions, in order to improve treatment outcomes of this vulnerable population.

Key words: Tuberculosis, pulmonary, Aged, Malnutrition, Treatment outcome, Prognosis, Factor analysis, statistics

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