恶性肿瘤继发结核病患者的临床特征及相关因素分析

目的 探讨恶性肿瘤继发结核病患者的临床特征及相关因素。方法 搜集西安市胸科医院2014年1月至2018年6月收治的确诊为恶性肿瘤继发结核病患者的临床资料,共计163例,作为观察组;搜集同期临床资料完整的100例单纯结核病患者和100例单纯恶性肿瘤患者作为对照。分析恶性肿瘤继发结核病患者的发病情况、临床特点、实验室检查结果、诊断情况,以及恶性肿瘤继发结核病的影响因素。结果 观察组患者的平均年龄为(62.50±9.02)岁,明显高于单纯结核病组患者[(53.67±7.64)岁],差异有统计学意义(t=2.65,P=0.014)。观察组患者的恶性肿瘤以肺癌最为常见[36.20%(59/163)],以并发肺结核最多见[47.85%(78/163)]。观察组患者结核首次诊断率为31.90%(52/163),明显低于单纯结核病组患者的62.00%(62/100),差异有统计学意义(χ ²=22.86,P=0.000)。观察组患者结核菌素纯蛋白衍生物(PPD)试验阳性率为41.72%(68/163),明显低于单纯结核病组患者[66.00% (66/100)];病原学和(或)病理检查阳性率[68.71%(112/163)]明显高于单纯结核病组患者[53.00%(53/100)],差异均有统计学意义(χ ²值分别为8.78和7.11,P值均<0.05)。观察组患者年龄≥60岁、既往有结核病病史、TNM分期Ⅲ~Ⅳ、未接受肿瘤治疗、接受化疗患者的比率分别为73.01%(119/163)、22.70%(37/163)、78.53%(128/163)、35.58%(58/163)、58.28%(95/163),明显高于单纯恶性肿瘤患者[分别为(61.00%(61/100)、12.00%(12/100)、67.00%(67/100)、22.00%(22/100)、49.00%(49/100)],差异均有统计学意义(χ ²值分别为4.14、4.27、4.30、5.40、4.23,P值均<0.05)。结论 恶性肿瘤继发结核病患者年龄较单纯结核病患者大,结核首次诊断率低,多依据病原学及病理检查确诊。年龄≥60岁、既往有结核病史、肿瘤分期差、未接受肿瘤治疗及接受化疗与恶性肿瘤患者继发结核病相关。

Clinical characteristics and related factors of patients with secondary tuberculosis after malignant tumors

Objective To investigate the clinical characteristics and related factors of tuberculosis secondary to malignant tumors. Methods The clinical data of 163 cases of tuberculosis secondary to malignant tumors (referred as the observation group) admitted to Xi’an Chest Hospital from January 2014 to June 2018 were collected. In addition, 100 cases of tuberculosis and 100 cases of malignant tumors with complete clinical data during the same period were selected as the control group. The incidence, clinical characteristics, laboratory results, diagnosis and risk factors of tuberculosis secondary to malignant tumors were analyzed. Results The average age of the patients in the observation group was (62.50±9.02) years, which was higher than that of the patients with tuberculosis alone ((53.67±7.64) years), and the difference was statistically significant (t=2.65, P=0.014). In the observation group, the most common malignant tumor was lung cancer (36.20% (59/163)), and lung tuberculosis (47.85% (78/163)) was the most common secondary tuberculosis. The first diagnosis rate of tuberculosis in the observation group was 31.90% (52/163), which was lower than that in the simple tuberculosis group (62.00% (62/100)), and the difference was statistically significant (χ ²=22.86, P=0.000). The positive rate of pure protein derivative test of tuberculin in observation group was 41.72% (68/163), which was lower than that in simple tuberculosis group (66.00% (66/100)); the positive rate of etiology and/or pathology examination (68.71% (112/163)) was higher than that in simple tuberculosis group (53.00% (53/100)); and the differences were statistically significant (χ ²=8.78 and 7.11, respectively; Ps<0.05). Patients who aged over 60 years, with a history of tuberculosis, with poor tumor staging (TNM Ⅲ or Ⅳ), had not received cancer treatment, and had received chemotherapy before in the observation group were 73.01% (119/163), 22.70% (37/163), 78.53% (128/163), 35.58% (58/163) and 58.28% (95/163), respectively, which were higher than those in the simple malignant tumors (61.00% (61/100), 12.00% (12/100), 67.00% (67/10), 22.00% (22/100), and 49.00% (49/100)); the differences were statistically significant (χ ² values were 4.14, 4.27, 4.30, 5.40, and 4.23 respectively, all Ps<0.05). Conclusion Compared with simple tuberculosis patients, tuberculosis patients secondary to malignant tumors are older, and have lower first diagnostic rate of tuberculosis. They are diagnosed mostly according to etiology and pathology. Age ≥60 years old, previous history of tuberculosis, poor staging of tumors, no previous anti-tumor therapies and previous chemotherapy are associated with secondary tuberculosis in patients with malignant tumors.