军人结核患者的临床特征、实验室特征及预后因素

Q3 Medicine

Indian Journal of Tuberculosis Pub Date : 2025-01-01 DOI:10.1016/j.ijtb.2024.10.006

Hamida Kwas , Hayfa Rajhi , Harish Rangareddy

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引用次数: 0

摘要

背景：军旅结核病（TB）是肺结核的一种严重形式。在免疫功能正常的患者中并不常见。在这项研究中，我们的目的是调查军队结核病的特征（临床、生物学和放射学），并确定在突尼斯东南部结核病流行的患者人群中与不利结果相关的因素。方法回顾性研究2006年至2023年间诊断为军人结核病的患者。通过多因素logistic回归分析确定与预后不良独立相关的因素。结果在研究期间诊断的结核病例中，军旅性结核（TB）占1.8% （n = 36）。观察到显著的女性优势，占队列的66.6%。患者中位年龄为47.5±11.33岁。主要临床表现为咳嗽（88.8%）、食欲不振（77.7%）、发热（58.3%）。放射学上，83.3%的患者表现为典型的军事型，尽管只有36.1%的患者在直接涂片镜检中痰样呈阳性。值得注意的是，所有患者的艾滋病毒血清学检测均为阴性。55.5%的病例伴有肺外结核累及。所有患者均接受一线抗结核药物治疗，77.7% （n = 28）的患者预后良好。然而，16.6% （n = 6）的患者死于该病。与不良结局显著相关的因素包括年龄≥65岁(优势比(OR) = 0.39；p = 0.03)，糖尿病(OR = 0.13；p = 0.046)、发热(OR = 2.89；p = 0.01)，入院时血氧饱和度≤92% (OR = 3.2；p = 0.001)。结论：我们的研究发现高龄、糖尿病、基线发热和入院时低血氧饱和度是军人结核患者预后不良的重要预测因素。这些发现强调了早期识别和有针对性地管理高危个体以改善临床结果的必要性。

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Clinical profile, laboratory characteristics and prognostic factors in patients with miliary tuberculosis

Background

Miliary tuberculosis (TB) is a severe form of pulmonary TB. It is uncommon in immunocompetent patients. In this study, we aimed to investigate features of miliary TB (clinical, biological, and radiological) and to determine factors associated with unfavorable outcomes in a population of patients in the South East Tunisia where TB remains endemic.

Methods

This is a retrospective study including patients diagnosed with miliary TB between 2006 and 2023. Factors independently associated with poor prognosis were determined by multivariate logistic regression analysis.

Results

Miliary tuberculosis (TB) accounted for 1.8% (n = 36) of all TB cases diagnosed during the study period. A notable female predominance was observed, comprising 66.6% of the cohort. The median age of patients was 47.5 ± 11.33 years. The predominant clinical manifestations included cough (88.8%), loss of appetite (77.7%), and fever (58.3%). Radiologically, a typical miliary pattern was present in 83.3% of patients, although only 36.1% had positive sputum samples on direct smear microscopy. Notably, all patients tested negative for HIV serology. Extrapulmonary TB involvement was documented in 55.5% of cases. All patients were treated with first-line anti-TB medications, and the outcome was favorable in 77.7% (n = 28) of patients. However, 16.6% (n = 6) of patients succumbed to the disease. Factors significantly associated with unfavorable outcomes included age ≥65 years (odds ratio (OR) = 0.39; p = 0.03), diabetes (OR = 0.13; p = 0.046), presence of fever (OR = 2.89; p = 0.01), and oxygen saturation ≤92% at admission (OR = 3.2; p = 0.001).

Conclusion

Our study identified advanced age, diabetes, fever at baseline, and low oxygen saturation on admission as significant predictors of poor prognosis in patients with miliary tuberculosis. These findings highlight the need for early identification and targeted management of high-risk individuals to improve clinical outcomes.

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来源期刊

Indian Journal of Tuberculosis Medicine-Infectious Diseases

CiteScore

2.80

自引率

0.00%

发文量

103

期刊介绍： Indian Journal of Tuberculosis (IJTB) is an international peer-reviewed journal devoted to the specialty of tuberculosis and lung diseases and is published quarterly. IJTB publishes research on clinical, epidemiological, public health and social aspects of tuberculosis. The journal accepts original research articles, viewpoints, review articles, success stories, interesting case series and case reports on patients suffering from pulmonary, extra-pulmonary tuberculosis as well as other respiratory diseases, Radiology Forum, Short Communications, Book Reviews, abstracts, letters to the editor, editorials on topics of current interest etc. The articles published in IJTB are a key source of information on research in tuberculosis. The journal is indexed in Medline