慢性阻塞性肺疾病合并肺结核的临床特征及危险因素分析

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺结核的临床特征，分析其危险因素。 方法选择陆军军医大学第二附属医院呼吸与危重症医学中心2016年1月至2018年12月所有COPD患者1 210例，选择同期单纯COPD患者22例，观察COPD合并肺结核的临床特征，同时应用多因素Logistic回归分析COPD合并肺结核的危险因素。 结果所有COPD患者中，COPD合并肺结核患者120例，其患病率为9.91%，而其病死率为1.67%。在COPD合并肺结核中，合并其他疾病主要为肺癌、肺部感染、肺源性心脏病、高血压、冠心病、呼吸衰竭、糖尿病，患病率分别为20%、18.33%、17.50%、15.83%、12.5%、12.5%、5.83%；在相关因素分析，结果显示COPD合并肺结核组在每年急性加重次数上显著多于对照组(P<0.05)，两组间在性别比例、年龄、病程、吸烟比例以及吸烟时间上无统计学差异(P>0.05)。在多因素Logistic回归分析中，病程(>10年)、急性加重次数(>2次/年)、低蛋白血症是COPD合并肺结核的危险因素，OR值分别为8.455、45.607、14.990。 结论COPD合并肺结核后易合并其他疾病，增大其诊断和治疗的难度，及早关注其危险因素对其治疗和预后有临床意义。

Clinical characteristics and risk factors of chronic obstructive pulmonary disease with tuberculosis

ObjectiveTo explore the clinical characteristics and analyze the risk factors in chronic obstructive pulmonary disease (COPD) with tuberculosis. Methods1 210 COPD cases were collected of department of respiratory and critical care medicine of Xinqiao Hospital all COPD cases in January 2016 to December 2018, and 22 COPD cases without other disease as control from January 2016 to December 2018. Meanwhile, the clinical characteristics and risk factors were analyzed by multi factor Logistic regression. Results120 COPD with tuberculosis cases were found, which the morbidity and prevalence rate were 9.91% and 1.67%. In the investigation of co-morbidities, the result showed that lung cancer, Pulmonary infection, pulmonary heart disease, hypertension, coronary heart disease, respiratory failure, diabetes were major diseases, the prevalence rate of them was 20%, 18.33%, 17.50%, 15.83%, 12.5%, 12.5%, 5.83%, respectively. In the study of related factors, the result indicated that number of acute exacerbation was remarkably higher in experimental group than control groups (P<0.05). Nevertheless, there was no significant difference in age, sex, course, smoking rate and smoking time between the two groups (P>0.05). In the logistic regression analysis, the results showed that COPD course over 10 years, number of acute exacerbation over 2 times per year and hypoproteinemia were the risk factors for COPD with tuberculosis. ConclusionIt is easy to be complicated with other diseases in COPD complicated with tuberculosis, which increases the difficulty of diagnosis and treatment to some extent. Therefore, it is necessary to pay attention to the risk factors for the treatment and prognosis.