■睫状结核(TB)仍然是威胁人类健康的重要传染病。本文总结了粟粒性TB的临床特点和预后因素。
■回顾性分析了2010年至2022年的粟粒性结核病患者的临床信息。对患有恶性结核的患者进行了表征,并与不良结局病例进行了比较。通过多因素logistic回归分析确定与不良结局独立相关的因素。
■共分析了288例患者,包括181例不良后果。临床表现不典型。88.54%的患者出现全身症状,而69.79%出现呼吸道症状。40.97%有神经系统症状,35.07%报告胃肠道症状。主要合并症为药理学免疫抑制(21.53%),尘肺(15.28%),糖尿病(10.76%),和怀孕或产后(7.29%)。关于微生物学,大多数患者通过痰或支气管肺泡灌洗液(BALF)诊断,胸腔积液,腹水,脑脊液,尿液TB-DNA,结核病文化。同时,2.43%的患者通过脑脊液NGS确诊。预测不良结局的独立危险因素是当前吸烟,白细胞增多,丙氨酸转氨酶(ALT)水平升高,以及淋巴细胞减少症与骨髓结核或结核性淋巴结炎的组合。通过ROC曲线下面积0.753(95%IC0.697-0.810)验证模型的准确性。
■粟粒性结核的临床表现不典型,早期诊断具有挑战性。粟粒性结核病患者的主要合并症是药理学免疫抑制,尘肺,糖尿病,怀孕,和产后。关于病因检测,应收集多部位、多类型标本进行及时诊断。在某些情况下,脑脊液mNGS测试可能是可行的选择。最后,目前吸烟,白细胞增多,ALT水平升高,淋巴细胞减少症合并骨髓结核或结核性淋巴结炎被确定为不良结局的独立危险因素.
粟粒性结核病的临床表现不典型,早期诊断具有挑战性。粟粒性结核病患者的主要合并症是药理学免疫抑制,尘肺,糖尿病,怀孕,和产后。目前吸烟,白细胞增多,ALT水平升高,淋巴细胞减少症合并骨髓结核或结核性淋巴结炎被确定为不良结局的独立危险因素.
UNASSIGNED: Miliary Tuberculosis (TB) remains an important infectious disease that threatens human health. The clinical characteristics and prognostic factors of miliary TB are summarized in this study.
UNASSIGNED: The clinical information of miliary TB patients between 2010 and 2022 was retrospectively analyzed. Patients with miliary TB were characterized and compared to adverse outcomes cases. Factors independently associated with adverse outcomes were determined via multivariate logistic regression analysis.
UNASSIGNED: A total of 288 patients were analyzed, including 181 with adverse outcomes. The clinical manifestations are atypical. 88.54% Of them experienced systemic symptoms, whilst 69.79% manifested respiratory symptoms. 40.97% Presented with neurologic symptoms, while 35.07% reported gastrointestinal symptoms. The major comorbidities were pharmacological immunosuppression (21.53%), pneumoconiosis (15.28%), diabetes (10.76%), and pregnancy or postpartum (7.29%). Regarding microbiology, most patients were diagnosed via sputum or Bronchoalveolar Lavage Fluid (BALF), pleural effusion, ascites, cerebrospinal fluid, urine TB-DNA, and tuberculosis culture. Meanwhile, 2.43% of patients were diagnosed via cerebrospinal fluid NGS. Independent risk factors predictive of adverse outcomes were current smoking, leukocytosis, elevated alanine aminotransferase (ALT) levels, and the combination of lymphopenia with bone marrow tuberculosis or tuberculous lymphadenitis. The accuracy of the model was validated by an area under the ROC curve of 0.753 (95% IC 0.697-0.810).
UNASSIGNED: The clinical manifestations of miliary TB are atypical, and early diagnosis is challenging. The major comorbidities in miliary TB patients were pharmacological immunosuppression, pneumoconiosis, diabetes, pregnancy, and postpartum. Regarding etiological detection, multi-site and multi-type specimens should be collected for a timely diagnosis. Cerebrospinal fluid mNGS test may be a viable choice in some cases. Finally, current smoking, leukocytosis, elevated ALT levels, and the combination of lymphopenia with bone marrow tuberculosis or tuberculous lymphadenitis were identified as independent risk factors for adverse outcomes.
The clinical manifestations of miliary TB are atypical, and early diagnosis is challenging. The major comorbidities in miliary TB patients were pharmacological immunosuppression, pneumoconiosis, diabetes, pregnancy, and postpartum. Current smoking, leukocytosis, elevated ALT levels, and the combination of lymphopenia with bone marrow tuberculosis or tuberculous lymphadenitis were identified as independent risk factors for adverse outcomes.