关键词: 冠状病毒感染, 结核, 肺, 共病现象, 疾病特征, 对比研究

Abstract:

Objective: To analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) complicated by pulmonary tuberculosis (PTB), and to provide a scientific basis for clinical diagnosis and management. Methods: A retrospective study was performed. Forty-six inpatients with COVID-19 and PTB admitted to Hunan Provincial Chest Hospital between December 2022 and January 2023 were enrolled as the case group. Forty-six patients with PTB alone (negative COVID-19 nucleic acid) treated during the same period served as the control group. Admission symptoms, imaging findings, laboratory results, adverse drug reactions, and length of hospital stay were compared between the two groups. Results: Regarding admission signs, the proportions of fever, cough, expectoration and weight loss in the case group were significantly higher than those in the control group (69.6% (32/46) vs. 45.7% (21/46); 84.8% (39/46) vs. 65.2% (30/46); 78.3% (36/46) vs. 56.5% (26/46); 39.1% (18/46) vs. 19.6% (9/46)), with statistically significant differences (χ²=5.386, 4.696, 4.946, 4.246, all P<0.05). For imaging changes, the proportions of infiltrative lesions and combined cavities in the case group were markedly higher than those in the control group (93.5% (43/46) vs. 65.2% (30/46); 60.9% (28/46) vs. 28.3% (13/46)), with statistically significant differences (χ²=11.210, 9.900, both P<0.05). In laboratory auxiliary tests, the positive rates of sputum smear acid-fast bacillus staining, T-SPOT.TB, and purified protein derivative skin test in the case group were notably lower than those in the control group (28.3% (13/46) vs. 52.2% (24/46); 58.7% (27/46) vs. 82.6% (38/46); 47.8% (22/46) vs. 80.4% (37/46)), with statistically significant differences (χ²=5.470, 6.343, 10.632, all P<0.05). During treatment, the proportion of leukopenia in the case group (39.1%, 18/46) was significantly higher than that in the control group (17.4%, 8/46), and the proportion of patients with hospital stay ≥21 days (84.8%, 39/46) was also significantly higher than that in the control group (62.2%, 30/46), with statistically significant differences (χ²=5.361, 4.696, both P<0.05). Seven patients in the case group received short-course low-dose glucocorticoid therapy without tuberculosis lesion dissemination. Conclusion: COVID-19 infection aggravates clinical manifestations and imaging lesions in patients with PTB, and reduces the positive rates of tuberculosis laboratory tests. The increased incidence of leukopenia is mild and does not interfere with standard antituberculosis treatment. Clinical recognition, diagnosis, and differential diagnosis of patients with COVID-19 and PTB should be strengthened, and close safety monitoring during treatment is warranted.

Key words: Coronavirus infections, Tuberculosis, pulmonary, Comorbidity, Disease attributes, Comparative study