未经证实:慢性肾脏病(CKD)患者中结核病(TB)的多种表现可能导致诊断困难,延迟治疗,甚至死亡。因此,这项研究调查了CKD合并TB患者的临床特征和死亡危险因素.
UNASSIGNED:这项回顾性研究纳入了重庆市两个三级医疗中心在6年内诊断为活动性结核病的167例患者。收集有和没有CKD的患者的抗结核治疗的临床特征和结果,并分析各变量的预测死亡率值。
未经批准:在167名患者中,66.7%(44/66)血液透析(HD),41.1%(21/51)预HD,32.0%(16/50)非CKD患者有肺外结核。胸膜和淋巴结是CKD患者的常见部位。CKD患者咳嗽和咯血的临床表现比非CKD患者少见,13.7%(16/117)的CKD患者甚至没有任何临床症状。结核菌素皮肤试验阳性率,HD患者痰中TB聚合酶链反应和抗酸杆菌低于HD前和非CKD患者(p<0.05)。CKD患者在抗结核治疗期间更容易出现胃肠道和神经系统副作用。非CKD的死亡率,HD前和HD患者为6.1%,31.9%和37.3%,分别。多因素Cox分析显示年龄≥40岁(HR:5.871;p=0.019),低蛋白血症(HR:2.879;p=0.004),CKD4-5期(HR:4.719;p=0.018)和HD(HR:6.13;p=0.005)与死亡率相关。
未经证实:CKD合并结核病患者临床表现不典型,死亡率高。年龄,低蛋白血症,CKD4-5期和HD是死亡率的独立预测因子。
UNASSIGNED: The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB.
UNASSIGNED: This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed.
UNASSIGNED: Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients (p<0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; p=0.019), hypoalbuminemia (HR:2.879; p=0.004), CKD stage 4-5 (HR:4.719; p=0.018) and HD (HR:6.13; p=0.005) were associated with mortality.
UNASSIGNED: CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4-5, and HD were independent predictors of mortality.