国内白血病合并结核病临床病例分析
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摘要
目的研究我国白血病合并结核病的患病率、病死率、临床表现和治疗效果,为今后白血病合并结核病的早期诊断及有效治疗提供依据。方法以"白血病""结核""化疗"以及"leukemia""tuberculosis""chemotherapy"为检索词,在中国知网、重庆维普数据库、万方电子期刊数据库以及Pubmed数据库检索,时间截止到2018年7月。结果符合白血病合并结核病纳入标准的病例共229例,其中肺结核200例,肺外结核29例;急性淋巴细胞白血病64例,急性髓系白血病151例,慢性淋巴细胞白血病4例,慢性髓系白血病10例。男女比例为1.2∶1,平均年龄为43.9岁。临床特点:229例病例中204例(89.1%)以发热为首要临床表现,120例(52.4%)表现为持续高热,表现为低热、盗汗、消瘦的分别有13例(5.7%)、30例(13.1%)、36例(15.7%);184例(80.3%)结核病例通过影像学检查确诊,109例(47.6%)结核菌素(PPD)试验阳性,98例(42.8%)诊断性抗结核治疗有效,24例(10.5%)痰结核菌检查阳性,18例(7.9%)病理活检阳性,3例T细胞斑点(T-spot)试验阳性,2例支气管镜冲洗液涂片阳性,1例结核杆菌PCR测定阳性。135例行抗结核治疗,其中107例治疗有效,有效率79.3%。6例因结核病死亡,归因病死率为2.6%(6/229)。结论白血病患者合并结核病概率较普通人群高,早期临床表现和体征不典型,多方面寻找结核感染证据、早期诊断和规范治疗是降低其病死率的关键。
Objective To study the prevalence, mortality, clinical manifestations and treatment outcome of tuberculosis in leukemia patients in China, the results of which can inform early diagnosis and effective treatment. Methods CNKI, Wanfang,CQVIP and Pubmed databases were searched to identify all available articles(up to July 2018). Results A total of 229 cases were identified for analysis. The prevalence rate was 3.9%, including 200 cases of pulmonary tuberculosis and 29 cases of extrapulmonary tuberculosis. Overall, there were 64 cases of acute lymphoblastic leukemia, 151 cases of acute myeloid leukemia, 4 cases of chronic lymph leukemia, and 10 cases of chronic myeloid leukemia. The male to female ratio was 1.2:1 and the average age was 43.9 years old. Fever was the primary clinical manifestation in 89.1%(204/229) of the cases. More than half(52.4%, 120/229) of the patients showed persistent high fever. However, the patients with low fever, night sweats, and weight loss only accounted for 5.7%(13/229),13.1%(30/229), 15.7%(36/229), respectively. The diagnosis of tuberculosis was supported by imaging examination in184 cases(80.3%), positive PPD test in 109 cases(47.6%),effective diagnostic antituberculous therapy in 98 cases(42.8%),positive sputum tuberculosis test in 24 cases(10.5%), positive pathological biopsy in 18 cases(7.9%), positive T-spot test in3 cases, positive bronchoscopy smear in 2 cases, and positive PCR assay of Mycobacterium tuberculosis in 1 case. Overall,135 patients received anti-tuberculosis treatment, resulting in effective outcome in 107(79.3%) cases, death(due to tuberculosis) in 6 cases(2.6%, 6/229). Conclusions The incidence of tuberculosis in leukemia patients is higher than that in general population in China. The clinical manifestations and signs are atypical at early stage. Early signs suggestive of tuberculosis infection,early diagnosis and standard treatment are the key to reduce the mortality rate of tuberculosis in leukemia patients.
Objective To study the prevalence, mortality, clinical manifestations and treatment outcome of tuberculosis in leukemia patients in China, the results of which can inform early diagnosis and effective treatment. Methods CNKI, Wanfang,CQVIP and Pubmed databases were searched to identify all available articles(up to July 2018). Results A total of 229 cases were identified for analysis. The prevalence rate was 3.9%, including 200 cases of pulmonary tuberculosis and 29 cases of extrapulmonary tuberculosis. Overall, there were 64 cases of acute lymphoblastic leukemia, 151 cases of acute myeloid leukemia, 4 cases of chronic lymph leukemia, and 10 cases of chronic myeloid leukemia. The male to female ratio was 1.2:1 and the average age was 43.9 years old. Fever was the primary clinical manifestation in 89.1%(204/229) of the cases. More than half(52.4%, 120/229) of the patients showed persistent high fever. However, the patients with low fever, night sweats, and weight loss only accounted for 5.7%(13/229),13.1%(30/229), 15.7%(36/229), respectively. The diagnosis of tuberculosis was supported by imaging examination in184 cases(80.3%), positive PPD test in 109 cases(47.6%),effective diagnostic antituberculous therapy in 98 cases(42.8%),positive sputum tuberculosis test in 24 cases(10.5%), positive pathological biopsy in 18 cases(7.9%), positive T-spot test in3 cases, positive bronchoscopy smear in 2 cases, and positive PCR assay of Mycobacterium tuberculosis in 1 case. Overall,135 patients received anti-tuberculosis treatment, resulting in effective outcome in 107(79.3%) cases, death(due to tuberculosis) in 6 cases(2.6%, 6/229). Conclusions The incidence of tuberculosis in leukemia patients is higher than that in general population in China. The clinical manifestations and signs are atypical at early stage. Early signs suggestive of tuberculosis infection,early diagnosis and standard treatment are the key to reduce the mortality rate of tuberculosis in leukemia patients.
引文
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[11]张新华,王军,熊金元.急性白血病并发结核的临床特点(附18例分析)[J].临床血液学杂志,2007,20(3):171-172.
[12]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[13]CAVER T E,SLOBOD K S,FLYNN P M,et al.Profound abnormality of the B/T lymphocyte ratio during chemotherapy for pediatric acute lymphoblastic leukemia[J].Leukemia,1998,12(4):619-622.
[14]MARTINEAU A R,NEWTON S M,WILKINSON KA,et al.Neutrophil-mediated innate immune resistance to mycobacteria[J].J Clin Invest,2007,117(7):1988-1994.
[15]毛文英,刘惠莲.白血病患儿并发活动性结核疾病的诊治状况及危险因素分析[J].实用癌症杂志,2014,29(8):1024-1026.
[16]CHEN C Y,SHENG W H,CHENG A,et al.Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies[J].BMC Infect Dis,2011,11:324.
[17]AL-ANAZI K A,AL-JASSER A M,EVANS D A.Infections caused by Mycobacterium tuberculosis in patients with hematological disorders and in recipients of hematopoietic stem cell transplant,a twelve year retrospective study[J].Ann Clin Microbiol Antimicrob,2007,6:16.
[2]中华人民共和国卫生部.肺结核诊断标准WS288-2008[S].北京:人民卫生出版社,2008.
[3]PRINS J,BLANKER M H,BOHNEN A M,et al.Prevalence of erectile dysfunction:a systematic review of population-based studies[J].Int J Impot Res,2002,14(6):422-432.
[4]封蔚莹,童茵,金洁.白血病合并结核病24例临床分析[J].浙江预防医学,2007,19(4):90,93.
[5]李春迎,徐正慧,顾伟仪,等.急性白血病合并肺结核8例临床分析[J].白血病,2000,9(6):358-359.
[6]李军,蒋孟,羊裔明,等.白血病合并活动性结核病44例临床研究--单中心报告[J].中华血液学杂志,2013,34(7):572-577.
[7]谭鹤长.急性白血病合并结核病27例诊治体会[J].广东医学,2008,29(6):1070.
[8]翁春岚.急性白血病合并结核感染27例误诊分析[J].临床误诊误治,2009,22(11):54-55.
[9]肖喜春,司金春,陈淑霞,等.急性白血病合并结核感染的临床特征及诊断治疗方法分析[J].中华临床医师杂志(电子版),2014,8(17):3202-3204.
[10]严云,陈晓,卞锦国,等.急性白血病合并结核病的临床特点[J].中华血液学杂志,2001,22(8):445.
[11]张新华,王军,熊金元.急性白血病并发结核的临床特点(附18例分析)[J].临床血液学杂志,2007,20(3):171-172.
[12]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[13]CAVER T E,SLOBOD K S,FLYNN P M,et al.Profound abnormality of the B/T lymphocyte ratio during chemotherapy for pediatric acute lymphoblastic leukemia[J].Leukemia,1998,12(4):619-622.
[14]MARTINEAU A R,NEWTON S M,WILKINSON KA,et al.Neutrophil-mediated innate immune resistance to mycobacteria[J].J Clin Invest,2007,117(7):1988-1994.
[15]毛文英,刘惠莲.白血病患儿并发活动性结核疾病的诊治状况及危险因素分析[J].实用癌症杂志,2014,29(8):1024-1026.
[16]CHEN C Y,SHENG W H,CHENG A,et al.Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies[J].BMC Infect Dis,2011,11:324.
[17]AL-ANAZI K A,AL-JASSER A M,EVANS D A.Infections caused by Mycobacterium tuberculosis in patients with hematological disorders and in recipients of hematopoietic stem cell transplant,a twelve year retrospective study[J].Ann Clin Microbiol Antimicrob,2007,6:16.