An association study of the comorbidity spectrum and core traditional Chinese medicine syndromes in 832 elderly patients with pulmonary tuberculosis

doi:10.19982/j.issn.1000-6621.20260160

Abstract

Abstract:

Objective: To characterize the comorbidity spectrum of elderly patients with pulmonary tuberculosis, explore its association with core traditional Chinese medicine (TCM) syndromes, and analyze differences across age and gender strata, so as to provide evidence for syndrome-disease integrated individualized management. Methods: A retrospective analysis was conducted. A total of 832 elderly patients with pulmonary tuberculosis hospitalized at Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from January 2022 to October 2024 were enrolled. Demographic data, TCM syndromes, and comorbidities were collected via electronic medical records. The distribution of comorbidities and their associations with two core syndromes—qi-yin deficiency syndrome and yin-yang deficiency syndrome—were analyzed. Stratified analyses were performed by age (60-69 years, 70-79 years, ≥80 years) and gender. Results: Among the 832 patients, the overall comorbidity prevalence was 64.66% (538/832). The top three comorbidities were hypertension (32.57% (271/832)), respiratory diseases (29.57% (246/832)), and diabetes mellitus (25.00% (208/832)). Patients with ≥3 comorbidities accounted for 21.75% (181/832). The core TCM syndromes were qi-yin deficiency syndrome (39.30% (327/832)) and yin-yang deficiency syndrome (25.36% (211/832)). Compared with patients with yin-yang deficiency syndrome, those with qi-yin deficiency syndrome had higher rates of diabetes mellitus (44.65% (146/327) vs. 28.44% (60/211); OR=2.030, 95%CI: 1.400-2.944) and respiratory diseases (44.65% (146/327) vs. 26.54% (56/211); OR=2.230, 95%CI: 1.532-3.247). In contrast, they had lower rates of chronic kidney disease (3.67% (12/327) vs. 22.27% (47/211); OR=0.133, 95%CI: 0.069-0.257), malignancy (6.73% (22/327) vs. 17.06% (36/211); OR=0.351, 95%CI: 0.199-0.619), and multimorbidity (≥3 conditions)(25.69% (84/327) vs. 34.12% (72/211); OR=0.667, 95%CI: 0.460-0.968). Conclusion: Elderly patients with pulmonary tuberculosis carry a heavy comorbidity burden. Core TCM syndromes are distinctly associated with specific comorbidities, suggesting that stratified and individualized interventions should be implemented based on syndrome-disease interactions.

Key words: Tuberculosis, pulmonary, Aged, Comorbidity, Traditional Chinese medicine syndrome, Statistical distributions

CLC Number:

R521

Feng Yinping, Luo Shuirong, Liu Zhongda, Zhang Zunjing. An association study of the comorbidity spectrum and core traditional Chinese medicine syndromes in 832 elderly patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(7): 1038-1043. doi: 10.19982/j.issn.1000-6621.20260160

Figures/Tables 6

References 31

[1]	World Health Organization. Global tuberculosis report 2025[R]. Geneva: World Health Organization, 2025.
[2]	Byng-Maddick R, Noursadeghi M. Does tuberculosis threaten our ageing populations?[J]. BMC Infect Dis, 2016, 16: 119. doi:10.1186/s12879-016-1451-0. pmid: 26968654
[3]	Cheng J, Sun Y N, Zhang C Y, et al. Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study[J]. Infect Dis Poverty, 2020, 9(1): 13. doi:10.1186/s40249-019-0614-9. pmid: 32005290
[4]	Wang L X, Zhang H, Ruan Y Z, et al. Tuberculosis prevalence in China, 1990—2010; a longitudinal analysis of national survey data[J]. Lancet, 2014, 383(9934): 2057-2064. doi:10.1016/S0140-6736(13)62639-2.
[5]	中华医学会结核病学分会. 老年肺结核诊断与治疗专家共识(2023版)[J]. 中华结核和呼吸杂志, 2023, 46(11): 1068-1084. doi:10.3760/cma.j.cn112147-20230921-00182.
[6]	高磊, 梁雅雪, 刘盛盛, 等. 144例老年利福平耐药肺结核患者治疗转归及影响因素分析[J]. 中国防痨杂志, 2024, 46(7): 799-807. doi:10.19982/j.issn.1000-6621.20240096.
[7]	Peltzer K. Tuberculosis non-communicable disease comorbidity and multimorbidity in public primary care patients in South Africa[J]. Afr J Prim Health Care Fam Med, 2018, 10(1): e1-e6. doi:10.4102/phcfm.v10i1.1651.
[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[J]. 结核与肺部疾病杂志, 2024, 5(4): 376-378. doi:10.19983/j.issn.2096-8493.2024022.
[9]	中华人民共和国国家中医药管理局. ZY/T 001.1-001.9 中医病证诊断疗效标准[S].1995-01-01.
[10]	Li S J, Li Y F, Song W M, et al. Population aging and trends of pulmonary tuberculosis incidence in the elderly[J]. BMC Infect Dis, 2021, 21(1): 302. doi:10.1186/s12879-021-05994-z.
[11]	Negin J, Abimbola S, Marais B J. Tuberculosis among older adults-time to take notice[J]. Int J Infect Dis, 2015, 32: 135-137. doi:10.1016/j.ijid.2014.11.018. pmid: 25809769
[12]	Velayutham B R V, Nair D, Chandrasekaran V, et al. Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB control programme in South India[J]. PLoS One, 2014, 9(3): e88045. doi:10.1371/journal.pone.0088045.
[13]	Dong Z, Wang Q Q, Yu S C, et al. Age-period-cohort analysis of pulmonary tuberculosis reported incidence, China, 2006—2020[J]. Infect Dis Poverty, 2022, 11(1): 85. doi:10.1186/s40249-022-01009-4. pmid: 35902982
[14]	Hase I, Toren K G, Hirano H, et al. Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation[J]. Drugs Aging, 2021, 38(9): 807-815. doi:10.1007/s40266-021-00880-4. pmid: 34224105
[15]	Romero-Rodríguez D P, Díaz-Alvarado C A, Rocha-González H I, et al. Control of Mycobacterium tuberculosis infection in the elderly: Is there a role for epigenetic reprogramming reversal?[J]. Biofactors, 2025, 51(1): e2151. doi:10.1002/biof.2151. pmid: 39888304
[16]	Macinko J, Andrade F C D, Nunes B P, et al. Primary care and multimorbidity in six Latin American and Caribbean countries[J]. Rev Panam Salud Publica, 2019, 43: e8. doi:10.26633/RPSP.2019.8.
[17]	Costa C D S, Flores T R, Wendt A, et al. Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil[J]. Cad Saude Publica, 2018, 34(11): e00040718. doi:10.1590/0102-311X00040718.
[18]	Pelissari D M, Diaz-Quijano F A. Impact of alcohol disorder and the use of illicit drugs on tuberculosis treatment outcomes: a retrospective cohort study[J]. Arch Public Health, 2018, 76: 45. doi:10.1186/s13690-018-0287-z.
[19]	Novotny T, Hendrickson E, Soares E C, et al. HIV/AIDS, tuberculosis, and tobacco in Brazil: a syndemic that calls for integrated interventions[J]. Cad Saude Publica, 2017, 33(Suppl 3): e00124215. doi:10.1590/0102-311X00124215.
[20]	何媚燕, 刘忠达. 老年肺结核患者营养现状及影响因素分析[J]. 浙江中西医结合杂志, 2023, 33(2): 166-168. doi:10.3969/j.issn.1005-4561.2023.02.018.
[21]	Zhang C Y, Zhao F, Xia Y Y, et al. Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study[J]. Infect Dis Poverty, 2019, 8(1): 7. doi:10.1186/s40249-019-0515-y.
[22]	鹿振辉, 张惠勇, 张洪春, 等. 我国中医药防治结核病的现状与展望[J]. 中国防痨杂志, 2020, 42(2): 88-90. doi:10.3969/j.issn.1000-6621.2020.02.002.
[23]	何媚燕, 张尊敬, 刘忠达. 中西医结合治疗肺结核的临床疗效研究[J]. 中国防痨杂志, 2022, 44(10): 1037-1042. doi:10.19982/j.issn.1000-6621.20220131.
[24]	周建民, 王胜圣, 周杰, 等. 肺结核中医证候的古文献研究[J]. 长春中医药大学学报, 2010, 26(1): 41-42.
[25]	郭晓燕, 张惠勇, 耿佩华, 等. 基于现代文献的肺结核中医证候及证候要素分布规律研究[J]. 辽宁中医杂志, 2012, 39(1): 68-70.
[26]	王胜圣, 田洋, 刘嵋松, 等. 基于中医文献检索的肺结核病中医证候规律分析[J]. 中华中医药杂志, 2011, 26(11): 2491-2493.
[27]	李玲, 王涛, 梁建琴, 等. 老年初治肺结核中医证型与细胞因子及免疫表达的相关性分析[J]. 中国医刊, 2024, 59(5): 505-508. doi:10.3969/j.issn.1008-1070.2024.05.010.
[28]	杨晓明, 刘忠达, 张尊敬, 等. 老年肺结核临床特点及中医药治疗概况[J]. 结核病与肺部健康杂志, 2018, 7(3): 213-216. doi:10.3969/j.issn.2095-3755.2018.03.014.
[29]	Stubbs B, Siddiqi K, Elsey H, et al. Tuberculosis and non-communicable disease multimorbidity: an analysis of the world health survey in 48 low- and middle-income countries[J]. Int J Environ Res Public Health, 2021, 18(5): 2439. doi:10.3390/ijerph18052439.
[30]	马赛. 加味参苓白术散辅治2型糖尿病合并肺结核临床观察[J]. 实用中医药杂志, 2024, 40(5): 895-897.
[31]	王岫峥, 张皓, 刁丽丽, 等. 加味秦艽鳖甲汤治疗2型糖尿病合并初治涂阳肺结核的临床疗效[J]. 河北医学, 2017, 23(12): 2092-2095. doi:10.3969/j.issn.1006-6233.2017.12.048.

年龄组(岁)	肺阴亏虚证	阴虚火旺证	气阴两虚证	阴阳两虚证	肺脾气虚证	肺肾阴虚证	痰热壅肺证	痰瘀阻肺证	合计
60~69	39(10.92)	21(5.88)	147(41.18)	81(22.69)	24(6.72)	13(3.64)	14(3.92)	18(5.05)	357(42.91)
70~79	24(8.39)	28(9.79)	101(35.31)	75(26.22)	21(7.34)	9(3.15)	15(5.24)	13(4.56)	286(34.37)
≥80	17(8.99)	12(6.35)	79(41.80)	55(29.10)	2(1.06)	9(4.76)	7(3.70)	8(4.24)	189(22.72)
合计	80(9.62)	61(7.33)	327(39.30)	211(25.36)	47(5.65)	31(3.73)	36(4.33)	39(4.68)	832(100.00)

性别	肺阴亏虚证	阴虚火旺证	气阴两虚证	阴阳两虚证	肺脾气虚证	肺肾阴虚证	痰热壅肺证	痰瘀阻肺证	合计
男性	55(8.97)	43(7.01)	246(40.13)	156(25.45)	28(4.57)	26(4.24)	30(4.89)	29(4.74)	613(73.68)
女性	25(11.42)	18(8.22)	81(36.99)	55(25.11)	19(8.68)	5(2.28)	6(2.74)	10(4.56)	219(26.32)
合计	80(9.62)	61(7.33)	327(39.30)	211(25.36)	47(5.65)	31(3.73)	36(4.33)	39(4.68)	832(100.00)

项目	60~69岁组 (357例)	70~79岁组 (286例)	≥80岁组 (189例)	合计 (832例)	χ²值	P值
共病类型
高血压	95(26.61)	95(33.22)	81(42.86)	271(32.57)	14.934	<0.01
呼吸系统疾病	114(31.93)	85(29.72)	47(24.87)	246(29.57)	2.967	0.227
糖尿病	87(24.37)	69(24.13)	52(27.51)	208(25.00)	0.829	0.661
心血管疾病	82(22.97)	61(21.33)	53(28.04)	196(23.56)	2.969	0.227
消化系统疾病	45(12.61)	37(12.94)	22(11.64)	104(12.50)	0.181	0.913
恶性肿瘤	33(9.24)	30(10.49)	15(7.94)	78(9.38)	0.886	0.642
慢性肾脏病	26(7.28)	20(6.99)	21(11.11)	67(8.05)	3.107	0.211
脑血管疾病	22(6.16)	18(6.29)	16(8.47)	56(6.73)	1.177	0.555
风湿免疫系统疾病	13(3.64)	14(4.90)	6(3.17)	33(3.97)	1.058	0.589
共病数量
≥1种共病	226(63.31)	184(64.34)	128(67.72)	538(64.66)	1.077	0.584
无共病	131(36.69)	102(35.66)	61(32.28)	294(35.34)	1.077	0.584
多重共病(≥3种)	74(20.73)	66(23.08)	41(21.69)	181(21.75)	0.515	0.773

项目	男性组(613例)	女性组(219例)	合计(832例)	χ²值	P值
共病类型
高血压	195(31.81)	76(34.70)	271(32.57)	0.615	0.433
呼吸系统疾病	190(31.00)	56(25.57)	246(29.57)	2.280	0.131
糖尿病	149(24.31)	59(26.94)	208(25.00)	0.597	0.440
心血管疾病	147(23.98)	49(22.37)	196(23.56)	0.231	0.631
消化系统疾病	83(13.54)	21(9.59)	104(12.50)	2.303	0.129
恶性肿瘤	62(10.11)	16(7.31)	78(9.38)	1.498	0.221
慢性肾脏病	45(7.34)	22(10.05)	67(8.05)	1.594	0.207
脑血管疾病	44(7.18)	12(5.48)	56(6.73)	0.741	0.389
风湿免疫系统疾病	29(4.73)	4(1.83)	33(3.97)	3.573	0.059
共病数量
≥1种共病	401(65.42)	137(62.56)	538(64.66)	0.577	0.447
无共病	212(34.58)	82(37.44)	294(35.34)	0.577	0.447
多重共病(≥3种)	133(21.70)	48(21.92)	181(21.75)	0.005	0.946

共病类型	例数	构成比(%)
仅1种共病
呼吸系统疾病	84	38.53
心血管疾病	35	16.06
糖尿病	30	13.76
高血压	29	13.30
恶性肿瘤	23	10.55
其他	17	7.80
合并	218	100.00
2种共病(139例)
高血压+呼吸系统疾病	42	30.22
糖尿病+心血管疾病	16	11.51
高血压+慢性肾脏病	15	10.79
高血压+恶性肿瘤	11	7.91
其他	55	39.57
合计	139	100.00