摘要
[背景]尘肺合并肺结核患者的痰菌阳性率低于单纯肺结核患者,病情评估困难。[目的]比较尘肺合并菌阴及菌阳肺结核患者的血液检测指标差异,为尘肺合并肺结核患者的病变评估提供依据。[方法]回顾性收集四川大学华西第四医院职业病科2010—2020年确诊的329例尘肺合并肺结核患者的相关信息,其中尘肺合并菌阴肺结核患者260例,尘肺合并菌阳肺结核患者69例。分析比较两组患者的人口学特征及血液检查指标,采用多因素logistic分析尘肺合并肺结核患者痰菌阳性的相关因素。[结果]两组研究对象体重指数(BMI)分布差异有统计学意义(P<0.05),菌阳组BMI≤18.5 kg·m^(−2)所占比例更高。尘肺合并菌阳肺结核患者的血小板计数、纤维蛋白原、白细胞计数、中性粒细胞计数、单核细胞计数、C反应蛋白、血细胞沉降率和D-二聚体水平高于尘肺合并菌阴肺结核患者(P<0.05);尘肺合并菌阳肺结核患者的平均血小板体积、血红蛋白、白球比、高密度脂蛋白水平低于尘肺合并菌阴肺结核患者(P<0.05)。除平均血小板体积、纤维蛋白原和高密度脂蛋白外,其余存在差异的指标在菌阳组的异常比例均高于菌阴组(P<0.05)。多因素logistic回归显示C反应蛋白(OR=1.006,95%CI:1.001~1.010)、血小板计数(OR=1.004,95%CI:1.002~1.007)、单核细胞计数(OR=3.461,95%CI:1.370~8.745)是尘肺合并肺结核患者痰涂片阳性的相关因素(P<0.05)。[结论]部分血液检测指标在尘肺合并菌阳与菌阴肺结核患者中存在一定的差异,C反应蛋白、血小板计数、单核细胞计数是尘肺合并肺结核患者痰菌阳性的相关因素。监测血液检测的部分指标对尘肺合并肺结核患者病变评估有一定参考意义。
[Background]The positive rate of sputum bacteria in patients with pneumoconiosis complicated with pulmonary tuberculosis is lower than that in patients with simple tuberculosis,which makes the disease assessment more difficult.[Objective]To compare the differences of blood test indexes between patients with pneumoconiosis complicated with bacteriologically negative and bacteriologically positive pulmonary tuberculosis,so as to provide a basis for the assessment of lesions in patients with pneumoconiosis complicated with pulmonary tuberculosis.[Methods]The relevant information of 329 patients with pneumoconiosis complicated with tuberculosis diagnosed from 2010 to 2020 was retrospectively collected,including 260 cases of pneumoconiosis complicated with bacteriologically negative tuberculosis(B-TB)and 69 cases of pneumoconiosis complicated with bacteriologically positive tuberculosis(B+TB).The demographic characteristics and blood test indexes of the two groups of patients were analyzed and compared,and logistic regression analysis was conducted to identify factors associated with pneumoconiosis complicated with bacteriologically positive tuberculosis.[Results]Body mass index(BMI)was significantly different between the two groups(P<0.05),and the proportion of BMI≤18.5 kg·m^(−2) in the pneumoconiosis cases with B+TB was higher than those with B-TB.The levels of platelet count,fibrinogen,white blood cell count,neutrophil count,monocyte count,C-reactive protein,erythrocyte sedimentation rate,and D-dimer in the pneumoconiosis cases with B+TB were higher than those in the pneumoconiosis cases with B-TB(P<0.05);the levels of mean platelet volume,hemoglobin,albumin to globulin ratio,and high-density lipoprotein in the pneumoconiosis with B+TB group were lower than that in the pneumoconiosis with B-TB group(P<0.05).The abnormal rates of other indicators except mean platelet volume,fibrinogen,and high-density lipoprotein were higher in the pneumoconiosis with B+TB group than in the pneumoconiosis with B-TB group(P<0.05).The results of multiple logistic regression showed that C-reactive protein(OR=1.006,95%CI:1.001-1.010),platelet count(OR=1.004,95%CI:1.002-1.007),and monocyte count(OR=3.461,95%CI:1.370-8.745)were associated with positive sputum smear in patients with pneumoconiosis complicated with pulmonary tuberculosis(P<0.05).[Conclusion]Some blood test indexes show differences between pneumoconiosis complicated with bacteriologically positive patients and pneumoconiosis complicated with bacteriologically-negative tuberculosis patients.C-reactive protein,platelet count,and monocyte count are factors associated with sputum positivity in pneumoconiosis complicated with tuberculosis patients.Monitoring selected indicators of blood test have a certain reference value for the assessment of lesions in patients with pneumoconiosis complicated with tuberculosis.
作者
曹娜
杜文
兰亚佳
彭莉君
CAO Na;DU Wen;LAN Yajia;PENG Lijun(Research Center for Preventive and Therapy of Occupational Diseases,West China-PUMC C.C.Chen Institute of Health/West China Occupational Pneumoconiosis Cohort Study Work Group,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
出处
《环境与职业医学》
CAS
CSCD
北大核心
2022年第9期1026-1030,共5页
Journal of Environmental and Occupational Medicine
关键词
尘肺合并肺结核
C反应蛋白
血小板计数
单核细胞计数
pneumoconiosis complicated with tuberculosis
C-reactive protein
platelet count
monocyte count
