Analysis of risk factors of respiratory failure in elderly patients with pulmonary tuberculosis

doi:10.19982/j.issn.1000-6621.20230447

Abstract

Abstract:

Objective: To analyze the situation and risk factors of respiratory failure in elderly patients with pulmonary tuberculosis. Methods: Using a retrospective research method, 210 elderly pulmonary tuberculosis patients admitted to Liyang People’s Hospital in Jiangsu Province from January 2021 to June 2023 were selected as the study subjects. Among them, 100 cases with concurrent respiratory failure were selected as the observation group; 110 cases without concurrent respiratory failure were selected as the control group. Clinical data of the two groups were collected and compared, including age, gender, disease course, body mass index, smoking history, previous pulmonary disease history, classification of tuberculosis treatment, main clinical symptoms, laboratory test results, imaging test results, etc. Logistic regression model was used to analyze the risk factors of respiratory failure in elderly patients with pulmonary tuberculosis. Results: The proportion of retreated patients in the observation group was 47.0% (47/100), significantly higher than that in the control group’s 29.1% (32/110)(χ²=7.159, P=0.007); the levels of white blood cell count and procalcitonin were (11.50±2.63)×10⁹/L and (0.71±0.25) μg/L, significantly higher than those in the control group ((4.62±2.41)×10⁹/L and (0.29±0.17) μg/L), the differences were statistically significant (t values were 19.782 and 14.347, respectively, both P<0.001). The serum albumin level in the control group was (31.37±7.56) g/L, significantly higher than that in the observation group ((24.61±6.72) g/L) (t=6.821, P<0.001). Multivariate logistic regression analysis showed that retreated pulmonary tuberculosis (OR(95%CI)=1.262 (1.151-1.968)), elevated serum white blood cell count levels (OR(95%CI)=2.268(1.278-3.343)), elevated procalcitonin levels (OR(95%CI)=1.751(1.408-3.513)), and decreased serum albumin levels (OR(95%CI)=0.893(0.762-0.969)) were independent risk factors for respiratory failure in elderly pulmonary tuberculosis patients. Conclusion: Retreated pulmonary tuberculosis, increased white blood cell count and procalcitonin levels, and decreased serum albumin levels are independent risk factors for respiratory failure in elderly patients with pulmonary tuberculosis. Clinical physicians should be vigilant against these factors and take effective treatment measures to reduce the incidence of respiratory failure in elderly patients with pulmonary tuberculosis.

Key words: Tuberculosis, pulmonary, Respiration disorders, Pulmonary ventilation, Aged, Risk factors

CLC Number:

R521
R563

Zhou Xue, He Fang, Di Yicheng, Zhang Zheng, Liu Ju. Analysis of risk factors of respiratory failure in elderly patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2024, 46(3): 357-361. doi: 10.19982/j.issn.1000-6621.20230447

Figures/Tables 6

特征	观察组(100例)	对照组(110例)	统计检验值	P值
年龄(岁, $x ˉ$ ±s)	66.57±5.38	66.35±5.71	t=0.287	0.775
性别[例(构成比,%)]			χ²=0.025	0.875
男性	69(69.0)	77(70.0)
女性	31(31.0)	33(30.0)
病程(月, $x ˉ$ ±s)	3.97±1.25	2.85±1.19	t=6.650	<0.001
体质量指数( $x ˉ$ ±s)	21.26±2.51	21.53±2.27	t=0.819	0.414
吸烟史[例(构成比,%)]			χ²=0.797	0.372
有	31(31.0)	28(25.5)
无	69(69.0)	82(74.5)
肺部疾病史[例(发生率,%)]
慢性阻塞性肺疾病	9(9.0)	7(6.36)	χ²=0.517	0.472
支气管扩张	6(6.0)	5(4.55)	χ²=0.223	0.637
肺纤维化	3(3.0)	2(1.82)	χ²=0.315	0.575
肺气肿	4(4.0)	2(1.82)	χ²=0.898	0.343
肺结核治疗分类[例(构成比,%)]			χ²=7.159	0.007
初治	53(53.0)	78(70.9)
复治	47(47.0)	32(29.1)

指标	观察组(100例)	对照组(110例)	统计检验值	P值
白细胞计数(×10⁹/L, $x ˉ$ ±s)	11.50±2.63	4.62±2.41	t=19.782	<0.001
降钙素原(μg/L, $x ˉ$ ±s)	0.71±0.25	0.29±0.17	t=14.347	<0.001
血清白蛋白(g/L, $x ˉ$ ±s)	24.61±6.72	31.37±7.56	t=6.821	<0.001
血红蛋白(g/L, $x ˉ$ ±s)	82.75±28.73	102.24±30.59	t=4.746	<0.001
血小板计数(×10⁹/L, $x ˉ$ ±s)	208.32±58.22	196.87±54.53	t=1.472	0.143
血红细胞沉降率(mm/1 h, $x ˉ$ ±s)	32.25±11.70	29.60±10.62	t=1.721	0.087
C-反应蛋白(mg/L, $x ˉ$ ±s)	51.64±16.35	34.76±14.18	t=8.010	<0.001
脑钠肽(pg/ml, $x ˉ$ ±s)	486.52±161.53	293.06±120.82	t=9.884	<0.001
痰涂片抗酸杆菌染色[例(构成比,%)]			χ²=4.757	0.029
阳性	79(79.0)	72(65.5)
阴性	21(21.0)	38(34.5)

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
复治肺结核	1.132	0.508	4.381	0.029	1.262(1.151~1.968)
白细胞计数	1.913	0.622	5.228	0.018	2.268(1.278~3.343)
降钙素原	1.249	0.576	8.963	<0.001	1.751(1.408~3.513)
血清白蛋白	1.391	0.627	8.542	<0.001	0.893(0.762~0.969)

References 20

[1]	Pezzella AT. History of Pulmonary Tuberculosis. Thorac Surg Clin, 2019, 29(1):1-17. doi:10.1016/j.thorsurg.2018.09.002. pmid: 30454916
[2]	刘秋月, 潘丽萍, 骆宝建, 等. 超氧化物歧化酶及常用生物标志物检测对继发性肺结核并发呼吸衰竭的诊断价值. 中国防痨杂志, 2018, 40(1): 68-72.doi:10.3969/j.issn.1000-6621.2018.01.016.
[3]	曹晓琳. 影响肺结核并发呼吸衰竭患者预后的危险因素分析. 实用医院临床杂志, 2019, 16(1): 68-71. doi:10.3969/j.issn.1672-6170.2019.01.022.
[4]	Tendolkar MS, Tyagi R, Handa A. Review of advances in diagnosis and treatment of pulmonary tuberculosis. Indian J Tuberc, 2021, 68(4):510-515. doi:10.1016/j.ijtb.2021.07.002. pmid: 34752322
[5]	王玉红, 王智慧, 李晓倩, 等. 初治、复治肺结核患者细胞免疫功能与营养状况比较. 中国热带医学, 2019, 19(2): 132-135. doi:10.13604/j.cnki.46-1064/r.2019.02.08.
[6]	Fekadu G, Chow DY, You JHS. The pharmacotherapeutic management of pulmonary tuberculosis: an update of the state-of-the-art. Expert Opin Pharmacother, 2021, 23(1): 139-148. doi:10.1080/14656566.2021.1967930.
[7]	张敬华, 德杰, 杨燕英, 等. 老年与青年空洞型肺结核CT征象比较. 中华老年多器官疾病杂志, 2022, 21(7): 496-499. doi:10.11915/j.issn.1671-5403.2022.07.107.
[8]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 2017-11-09.
[9]	高孟秋. 《WS 288—2017肺结核诊断》新标准中关于临床诊断患者判定的解析. 中国防痨杂志, 2018, 40(3): 243-246. doi:10.3969/j.issn.1000-6621.2018.03.005.
[10]	刘秋月, 李琦, 骆宝建, 等. 降钙素原、超敏C反应蛋白、红细胞沉降率及S100A9对肺结核合并肺部细菌感染的影响. 中国医药导报, 2019, 16(11):116-119.
[11]	刘秋月, 骆宝建, 韩芬, 等. 继发性肺结核伴呼吸衰竭患者外周血炎性标志物水平变化及其临床意义. 中国医刊, 2020, 55(1):39-42. doi:10.3969/j.issn.1008-1070.2020.01.011.
[12]	杜建, 韩喜琴, 舒薇, 等. 复治菌阳肺结核患者治疗成功后再次复发的危险因素分析. 中国防痨杂志, 2019, 41(6): 624-631. doi:10.3969/j.issn.1000-6621.2019.06.007.
[13]	孙金昊, 陶磊, 贺向红, 等. GeneXpert MTB/RIF系统、MGIT-960快速培养系统及药敏检测肺结核患者痰标本、支气管肺泡灌洗液标本阳性率比较及耐药分析. 临床军医杂志, 2022, 50(12): 1275-1277,1281. doi:10.16680/j.1671-3826.2022.12.19.
[14]	梁建英, 杜元平, 张昌艳, 等. 肺结核患者血清中PCT、CRP、IgG抗PPD-IgG和白细胞计数的临床诊断意义. 标记免疫分析与临床, 2018, 25(7): 997-1000, 1004. doi:10.11748/bjmy.issn.1006-1703.2018.07.019.
[15]	Bosch DE, Mathias PC, Krumm N, et al. Elevated white blood cell count does not predict Clostridium difficile nucleic acid testing results. Clin Infect Dis, 2021, 73(4):699-705. doi:10.1093/cid/ciab106. pmid: 33564820
[16]	黄忠峰, 陈佳, 阮树松, 等. PCT与IL-6和hs-CRP对肺结核合并肺部普通细菌感染的诊断价值. 中华医院感染学杂志, 2020, 30(11): 1669-1672. doi:10.11816/cn.ni.2020-191721.
[17]	尹春阳, 方刚, 黄莉莉, 等. 有或无营养风险的老年肺结核住院患者相关临床指标的对比研究. 中国防痨杂志, 2020, 42(12): 1305-1309. doi:10.3969/j.issn.1000-6621.2020.12.010.
[18]	张如云, 张静, 雷轩. 血清白蛋白、SOFA评分及APACHEⅡ评分对重症肺结核患者预后的评估价值. 临床肺科杂志, 2023, 28(3): 399-401. doi:10.3969/j.issn.1009-6663.2023.03.015.
[19]	Hariharan P, Nadkarni A. Insight of fetal to adult hemoglobin switch: Genetic modulators and therapeutic targets. Blood Rev, 2021, 49:100823. doi:10.1016/j.blre.2021.100823.
[20]	楼建军, 赵黎明, 任云珠. NRS2002评分和血清白蛋白值与门诊肺结核患者病情的相关性. 中国微生态学杂志, 2019, 31(10): 1207-1210. doi:10.13381/j.cnki.cjm.201910021.

组别	例数	喘憋	咳痰	咯血	胸痛	发热
观察组	100	83(83.0)	92(92.0)	21(21.0)	64(64.0)	78(78.0)
对照组	110	35(31.8)	87(31.8)	11(10.0)	65(59.1)	82(74.5)
χ²值		55.741	6.937	4.907	0.533	0.345
P值		<0.001	0.008	0.027	0.465	0.557

组别	例数	病灶范围>3个肺野	纤维化	空洞	浸润性病变
观察组	100	53(53.0)	61(61.0)	34(34.0)	64(64.0)
对照组	110	40(36.4)	48(43.6)	24(21.8)	76(69.1)
χ²值		5.876	6.326	3.888	0.611
P值		0.015	0.012	0.049	0.434

变量	赋值	变量	赋值
呼吸衰竭	0=是;1=否	C-反应蛋白	原值纳入
病程	原值纳入	脑钠肽	原值纳入
肺结核治疗分类	0=初治;1=复治	血清白蛋白	原值纳入
喘憋	0=有;1=无	血红蛋白	原值纳入
咳痰	0=有;1=无	痰涂片抗酸杆菌染色	0=阳性;1=阴性
咯血	0=有;1=无	病灶范围>3个肺野	0=是;1=否
白细胞计数	原值纳入	纤维化	0=有;1=无
降钙素原	原值纳入	空洞	0=有;1=无