Demographic And Clinical Characteristics Of Patients With Extrapulmonary Tuberculosis In Shandong Province

Purpose:Tuberculosis is caused by mycobacterium tuberculosis, which could involve almost all the organs and tissue, and is divided into pulmonary tuberculosis(PTB) and extra-pulmonary tuberculosis(EPTB). The extra-pulmonary tuberculosis includes pleura tuberculosis, urinary tuberculosis, lymphatic tuberculosis, osteoarticular tuberculosis, central nervous system tuberculosis, peritoneal tuberculosis, reproductive system tuberculosis and digestive tuberculosis. Recently, the ratio of extra pulmonary tuberculosis is increased in American, Germany, England etc. Due to the little attention and study on this field, the same trend is also appear in our country. Until now, the ratio of extra pulmonary tuberculosis in Shandong Provinceis still unclear. In this study, we investigate the extra-pulmonary tuberculosis patients in many tuberculosis prevention and control hospital, to (I) demonstrate the location of extra-pulmonary tuberculosis, demography and clinical features; (II) explicit the increase trend and probe the relevant factors; (III) summarize the relationship among therapeutic regimen, treatment, and prognosis; (IV) increase the knowledge and alertness of extra pulmonary tuberculosis, then increasing the diagnosis, prognosis, reducing the disability rate and fatality rate.Materials and methords:We collected the patients with positive mycobacterium tuberculosis culture in Shandong province tuberculosis prevention and control of hospitals from 2008.01-2013.06. The inclusion criteria as follows:(1) no age limitation; (2) no gender limitation; (3) no limitation of disease region, include pulmonary and extra pulmonary regions. When the extra pulmonary tuberculosis have more than one extra pulmonary lesion, the primary disease is in priority; (4) The composite group of mycobacterium tuberculosis culture is positive (including mycobacterium tuberculosis, mycobacterium bovis and African mycobacteria); (5) having intact admission and discharge record, lab and accessory examination, operative treatment patients should have intact surgery record. The exclusion criteria are:mycobacterium tuberculosis culture is positive, bud no strain identification or identification is non mycobacterium tuberculosis. This retrospective analysis can demonstrate the location, the demography and clinical featuresof EPTB. The multi-factor regression analysis was used to investigate the relationship between patient character and lesions location.Results:(1) We analyzed the 5624 TB data. The pure PTB is (n=4277) 76.0%, pure EPTB is (n=4277)76.0% and PTB combine EPTB is(n=4277)76.0%. Between 2008 and 2012, the ratio of EPTB (combining or not the pulmonary tuberculosis)increased year by year, from 12.57% in 2008 to 27.68% in 2012 (P<0.001). The most common region of 1347 EPTB are pleura, bonn/joint, lymph gland. We used the logistic regression analysis to filtrate the increase relate factors, the results showed, compared to pulmonary tuberculosis, EPTB was more in male, and had previous tuberculosis history. The pure EPTB patients are more tend to urban population. EPTB showed no significant relationship with HIV infection. (2) The results of analysis of 1347 EPTB data. Except the tuberculous peritonitis, the EPTB was tend to man, most obviously in tuberculous pleuritic (male/female= 2.93:1). The toxic symptom differs among different region, but mostly have no systemic tuberculosis poisoning symptoms. The drug resistance rate of EPTB mycobacterium tuberculosisstain is not high, and the clinical therapy is mainly isoniazide, rifampicin, ethambutol, pyrazinamide, however, antituberculosis drugs abuse still exist.The EPTB have long course oftreatment, the course oftreatment of buterculosispleuritisis almost 8 months, other region EPTB have more than 15 month treatment.Conclusion:1. The clinical constitution of tuberculosis in Shandong Province changed, the EPTB ration increased.2. Compared to pulmonary tuberculosis, the EPTB is tend to male, and previous tuberculosis history patient. The pure EPTB patients are more tend to urban population.3. The most common region of EPTB are pleura, bonn/joint, lymph gland.4. The toxic symptom differs among different region, but mostly having no systemic tuberculosis poisoning symptoms.5. The clinical therapy is mainly isoniazide, rifampicin, ethambutol, pyrazinamide. The rational drug use should be stressful.