皮质类固醇在患有COVID-19的患者中发展活性肺结核的作用
Thanas Praphakornmano1, Pattama Torvorapanit1,2,3,4, Noppachai Siranart1
1Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand.
PloS one
|October 16, 2024
概括
接受高剂量皮质类固醇治疗的严重COVID-19肺炎患者面临结核病 (TB) 的风险增加. 这项研究发现结核病发病率显著上升,强调了在这个脆弱人群中进行潜在结核病查的必要性.
科学领域:
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 皮质类固醇对于治疗严重的COVID-19肺炎至关重要,减少死亡率.
- 使用高剂量的皮质类固醇会增加机会性感染的风险,包括结核病 (TB).
- 在接受高剂量皮质类固醇治疗的COVID-19患者中,随后结核病感染的具体风险尚不清楚.
研究的目的:
- 在接受高剂量皮质类固醇的COVID-19患者中调查结核病 (TB) 的发生率.
- 在这个患者队列中确定与结核病发展相关的风险因素.
- 将结核病发病率与普通人口进行比较,并评估结核病对死亡率的影响.
主要方法:
- 在楚拉龙康国王纪念医院进行的一项回顾性,横截面研究.
- 招募了243名被诊断为COVID-19的参与者,并接受高剂量的皮质类固醇治疗.
- 收集了结核病发展的基线特征和风险因素,分析了COVID-19诊断后的结核病流行率和发病率.
主要成果:
- 在COVID-19后确诊结核病的发病率为1.6% (每10万人/年646人),是普通人口的11倍.
- 在患有慢性病 (CKD) 2-4期和慢性肺病的患者中,结核病的患病率有显著差异.
- 与非结核病组 (0.4%) 相比,结核病组的死亡率明显高 (50%).
- 还观察到与细菌 (37.1%),真菌 (5.3%) 和Pneumocystis jirovecii (PJP) (1.2%) 的同时感染.
结论:
- 服用高剂量的皮质类固醇的COVID-19患者表现出肺结核发病率显著增加.
- 建议对这些患者进行潜在结核病的查,以便早期诊断和预防活跃结核病.
- 在这一群体中,与结核病相关的高死亡率强调了积极查和管理的重要性.
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