入住重症监护室的HIV阴性播散性结核病患者预后不良危险因素分析及预测模型构建

doi:10.19982/j.issn.1000-6621.20250491

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (7): 933-940.doi: 10.19982/j.issn.1000-6621.20250491

入住重症监护室的HIV阴性播散性结核病患者预后不良危险因素分析及预测模型构建

刘嘉¹, 谭晶²^,³, 田瑶²^,⁴, 傅满姣¹, 刘辉敏¹, 陈红梅¹, 翟安¹, 康怡¹, 陈亮¹, 贝承丽¹^,⁵()

¹ 长沙市中心医院(南华大学附属长沙中心医院)结核重症监护室, 长沙 410000
² 南华大学衡阳医学院临床医学系, 衡阳 421200
³ 湖南省邵阳市中心医院重症医学科, 邵阳 422000
⁴ 湖南省结核病防治所(湖南省胸科医院)内七科, 长沙 410000
⁵ 长沙市结核病研究所, 长沙 410000

收稿日期:2025-12-16 出版日期:2026-07-10 发布日期:2026-07-02
通信作者: 贝承丽,Email:345480181@qq.com
基金资助:
长沙市卫生健康委员会2023年度科研计划项目(KJ-B2023031);湖南省卫生健康委员会2023年度重点指导课题(C202303086429)

Risk factors and predictive model for poor prognosis among HIV-negative patients with disseminated tuberculosis admitted to intensive care unit

Liu Jia¹, Tan Jing²^,³, Tian Yao²^,⁴, Fu Manjiao¹, Liu Huimin¹, Chen Hongmei¹, Zhai An¹, Kang Yi¹, Chen Liang¹, Bei Chengli¹^,⁵()

¹ Tuberculosis Intensive Care Unit, Changsha Central Hospital (Changsha Central Hospital Affiliated to South China University), Changsha 410000, China
² Department of Clinical Medicine, Hengyang Medical School, University of South China, Hengyang 421200, China
³ Department of Critical Care Medicine, Central Hospital of Shaoyang City, Hunan Province, Shaoyang 422000, China
⁴ The Seventh Department of Internal Medicine, Hunan Provincial Institute of Tuberculosis Control (Hunan Provincial Chest Hospital), Changsha 410000, China
⁵ Changsha Tuberculosis Research Institute, Changsha 410000, China

Received:2025-12-16 Online:2026-07-10 Published:2026-07-02
Contact: Bei Chengli, Email: 345480181@qq.com
Supported by:
Research Plan Project of Changsha Municipal Health Commission in 2023(KJ-B2023031);Key Guidance Project of Hunan Provincial Health Commission in 2023(C202303086429)

摘要/Abstract

摘要：

目的: 探索入住重症监护室(intensive care unit,ICU)的人类免疫缺陷病毒(human immunodeficiency virus,HIV)阴性播散性结核病(disseminated tuberculosis,DTB)患者预后不良的危险因素。方法: 回顾性分析2021年1月1日至2023年12月31日长沙市中心医院结核ICU收治的204例HIV阴性播散性结核病患者的临床资料,根据转出ICU的治疗结局分为预后不良组(49例)和预后良好组(155例),比较两组患者的临床特点,采用多因素logistic回归分析播散性结核病患者预后不良的危险因素,并构建预后不良风险预测模型。结果: 204例HIV阴性播散性结核病患者中,ICU内预后不良的发生率为24.0%(49/204),多因素logistic回归分析显示:痰涂片抗酸杆菌阳性(OR=2.878,95%CI:1.128~7.348,P=0.027)、入住ICU初始抗结核治疗药物不足(OR=2.779,95%CI:1.212~6.369,P=0.016)、并发重症肺炎(OR=14.746,95%CI:4.204~51.727,P<0.001)、并发脓毒症(OR=4.023,95%CI:1.788~9.051,P<0.001)是入住ICU的HIV阴性播散性结核病患者发生预后不良的可能危险因素。基于上述危险因素构建预后不良风险预测模型,该模型的受试者工作特征曲线(receiver operating characteristic,ROC)的曲线下面积(area under the curve,AUC)为0.869(95%CI:0.815~0.923,P<0.001),敏感度为85.7%、特异度为72.3%,具有较好的预测价值。结论: 对于入住ICU的HIV阴性播散性结核病患者,痰涂片抗酸杆菌阳性、入住ICU初始抗结核治疗药物不足、并发重症肺炎、并发脓毒症更容易出现预后不良的结局,临床需早期识别上述危险因素并加以干预,以改善预后。

关键词: 结核, 重症监护, 预后, 危险因素, 预测模型, 因素分析,统计学

Abstract:

Objective: This study aimed to explore the risk factors for poor prognosis among human immunodeficiency virus (HIV)-negative patients with disseminated tuberculosis (DTB) admitted to intensive care unit (ICU). Methods: The clinical data of 204 HIV-negative patients with DTB admitted to the Tuberculosis ICU of Changsha Central Hospital between January 1, 2021 and December 31, 2023 was retrospectively analyzed. Patients were divided into a poor prognosis group (n=49) and a favorable prognosis group (n=155) according to their treatment outcomes at ICU discharge. The clinical characteristics of the two groups were compared, and multivariate logistic regression analysis was used to identify risk factors for poor prognosis in patients with DTB and a risk prediction model for poor prognosis was constructed. Results: Among the 204 HIV-negative patients with DTB, the incidence of poor prognosis in the ICU was 24.0% (49/204). Multivariate logistic regression analysis revealed that positive acid-fast bacilli in sputum smear (OR=2.878, 95%CI: 1.128-7.348, P=0.027), inadequate initial antituberculosis therapy at ICU admission (OR=2.779, 95%CI: 1.212-6.369, P=0.016), and concurrent severe pneumonia (OR=14.746, 95%CI: 4.204-51.727, P<0.001), and concurrent sepsis (OR=4.023, 95%CI: 1.788-9.051, P<0.001) were possible risk factors for poor prognosis among HIV-negative patients with DTB admitted to ICU. A risk prediction model for poor prognosis was constructed based on the above risk factors. The area under the receiver operating characteristic (AUC) curve of the model was 0.869 (95%CI: 0.815-0.923, P<0.001), with a sensitivity of 85.7% and a specificity of 72.3%, indicating that the model has good predictive value. Conclusion: For HIV-negative patients with DTB admitted to ICU, positive acid-fast bacilli in sputum smear, inadequate initial antituberculosis therapy on ICU admission, and concurrent severe pneumonia and sepsis are associated with an increased risk of poor prognosis. Clinically, early identification of these risk factors and targeted interventions are required to improve patients’ clinical outcomes.

Key words: Tuberculosis, Intensive care, Prognosis, Risk factors, Prediction model, Factor analysis, statistical

中图分类号:

R521

刘嘉, 谭晶, 田瑶, 傅满姣, 刘辉敏, 陈红梅, 翟安, 康怡, 陈亮, 贝承丽. 入住重症监护室的HIV阴性播散性结核病患者预后不良危险因素分析及预测模型构建[J]. 中国防痨杂志, 2026, 48(7): 933-940. doi: 10.19982/j.issn.1000-6621.20250491

Liu Jia, Tan Jing, Tian Yao, Fu Manjiao, Liu Huimin, Chen Hongmei, Zhai An, Kang Yi, Chen Liang, Bei Chengli. Risk factors and predictive model for poor prognosis among HIV-negative patients with disseminated tuberculosis admitted to intensive care unit[J]. Chinese Journal of Antituberculosis, 2026, 48(7): 933-940. doi: 10.19982/j.issn.1000-6621.20250491

图/表 6

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因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	统计检验值	P值
一般情况
年龄[岁, $\bar{x}±s$]	56.2±19.1	59.8±18.6	55.1±19.2	t=1.509	0.133
男性[例(构成比,%)]	150(73.5)	36(73.5)	114(73.5)	χ²=0.000	0.991
吸烟[例(构成比,%)]	85(41.7)	21(42.9)	64(41.3)	χ²=0.038	0.846
饮酒[例(构成比,%)]	54(26.5)	15(30.6)	39(25.2)	χ²=0.568	0.451
症状持续时间[月,M(Q₁,Q₃)]	1.0(0.7,4.0)	2.0(0.8,5.5)	1.0(0.5,3.0)	Z=-2.143	0.032
APACHE Ⅱ评分[分, $\bar{x}±s$]	20.4±8.3	25.1±8.4	18.9±7.7	t=4.812	<0.001
NRS 2002评分[分, $\bar{x}±s$]	4.9±1.3	5.1±1.5	4.8±1.3	t=1.664	0.098
既往基础疾病
慢性肺病[例(构成比,%)]	49(24.0)	12(24.5)	37(23.9)	χ²=0.008	0.930
糖尿病[例(构成比,%)]	48(23.5)	12(24.5)	36(23.2)	χ²=0.033	0.856
慢性肾脏病[例(构成比,%)]	43(21.1)	15(30.6)	28(18.1)	χ²=3.524	0.060
慢性肝病[例(构成比,%)]	34(16.7)	9(18.4)	25(16.1)	χ²=0.134	0.714
自身免疫性疾病[例(构成比,%)]	32(15.7)	9(18.4)	23(14.8)	χ²=0.351	0.554
血液系统疾病[例(构成比,%)]	24(11.8)	9(18.4)	15(9.7)	χ²=2.708	0.100
实体肿瘤[例(构成比,%)]	8(3.9)	1(2.0)	7(4.5)	χ²=0.605	0.437
基线实验室资料
降钙素原[ng/ml,M(Q₁,Q₃)]	0.9(0.2,4.8)	3.0(0.7,11.9)	0.6(0.1,3.7)	Z=-3.588	<0.001
C反应蛋白[mg/l,M(Q₁,Q₃)]	59.4(27.4,100.6)	80.4(48.5,118.0)	50.0(23.9,96.5)	Z=-2.815	0.005
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	7.9(5.5,11.5)	10.0(5.7,16.3)	7.4(5.3,10.3)	Z=-2.475	0.013
血红蛋白[g/L,M(Q₁,Q₃)]	91.0(73.0,109.0)	93.0(73.5,111.0)	90.0(73.0,108.0)	Z=-0.584	0.559
白蛋白[g/L,M(Q₁,Q₃)]	27.0(24.0,31.0)	25.0(23.0,28.0)	28.0(24.0,32.0)	Z=-2.734	0.006

因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	χ²值	P值
浸润性肺结核	98(48.0)	19(38.8)	79(51.0)	2.217	0.136
血行播散性肺结核	80(39.2)	16(32.7)	64(41.3)	1.165	0.280
空洞性肺结核	60(29.4)	19(38.8)	41(26.5)	2.724	0.099
痰涂片抗酸杆菌阳性	44(21.6)	17(34.7)	27(17.4)	6.567	0.010
痰分枝杆菌培养阳性	62(30.4)	16(32.7)	46(29.7)	0.156	0.693
≥2个部位肺外结核	81(39.7)	18(36.7)	63(40.6)	0.238	0.626
肠结核	106(52.0)	27(55.1)	79(51.0)	0.255	0.614
中枢神经系统结核	78(38.2)	17(34.7)	61(39.4)	0.342	0.558
复治结核病	52(25.5)	11(22.4)	41(26.5)	0.314	0.575
耐药结核病	15(7.4)	5(10.2)	10(6.5)	0.770	0.380
并发肝功能不全	90(44.1)	25(51.0)	65(41.9)	1.246	0.264
并发肾功能不全	70(34.3)	24(49.0)	46(29.7)	6.154	0.013
并发呼吸衰竭	118(57.8)	33(67.3)	85(54.8)	2.389	0.122
并发重症肺炎	108(52.9)	46(93.9)	62(40.0)	43.379	<0.001
并发脓毒症	67(32.8)	33(67.3)	34(21.9)	34.809	<0.001

因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	χ²值	P值
入住ICU初始抗结核治疗药物不足	44.1(90/204)	61.2(30/49)	38.7(60/155)	7.655	0.006
抗结核药物不良反应	69.7(138/198)	80.4(37/46)	66.4(101/152)	3.271	0.071

变量	赋值	变量	赋值
症状持续时间(月)	原值纳入	痰涂片抗酸杆菌结果	阴性=0,阳性=1
APACHEⅡ评分(分)	<20=0,≥20=1	入住ICU初始抗结核治疗药物不足	无=0,有=1
降钙素原(ng/ml)	<2=0,≥2=1	并发肾功能不全	无=0,有=1
C反应蛋白(mg/L)	原值纳入	并发重症肺炎	无=0,有=1
白细胞计数(×10⁹/L)	原值纳入	并发脓毒症	无=0,有=1
白蛋白(g/L)	>30=0,≤30=1

因素	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR(95%CI)值
痰涂片抗酸杆菌阳性	1.057	0.478	4.889	0.027	2.878(1.128~7.348)
入住ICU初始抗结核治疗药物不足	1.022	0.423	5.831	0.016	2.779(1.212~6.369)
并发重症肺炎	2.691	0.640	17.663	<0.001	14.746(4.204~51.727)
并发脓毒症	1.392	0.414	11.324	<0.001	4.023(1.788~9.051)

入住重症监护室的HIV阴性播散性结核病患者预后不良危险因素分析及预测模型构建

Risk factors and predictive model for poor prognosis among HIV-negative patients with disseminated tuberculosis admitted to intensive care unit

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