贫血对肺结核患者转归的影响*

doi:10.3969/j.issn.1671-2587.2026.01.017

临床输血与检验 ›› 2026, Vol. 28 ›› Issue (1): 111-120.DOI: 10.3969/j.issn.1671-2587.2026.01.017

贫血对肺结核患者转归的影响^*

齐畅^1,2, 蒋波笛¹, 付晨珺¹, 亢晓薇¹, 崔丹¹, 黄明珠¹, 李瑞平¹, 孟祥红¹

¹解放军总医院第八医学中心输血医学科，北京 100091;
²佳木斯大学基础医学院，黑龙江佳木斯 154007

收稿日期:2025-05-09 发布日期:2026-02-13
通讯作者: 孟祥红，主要从事临床输血与免疫研究，（E-mail）xh5562@sina.com。
作者简介:齐畅，主要从事病原生物学研究，（E-mail）1817592916@qq.com。
基金资助:
*本项目受国家卫健委科技专项课题（No.2021KYSHX02302）资助

The Impact of Anemia on the Outcome of Patients with Pulmonary Tuberculosis

QI Chang^1,2, JIANG Bodi¹, FU Chenjun¹, KANG Xiaowei¹, CUI Dan¹, HUANG Mingzhu¹, LI Ruiping¹, MENG Xianghong¹

¹Department of Blood Transfusion Medicine, 8th Medical Center of PLA General Hospital, Beijing 100091;
²Medical College of Basic Medicine, Jiamusi University, Jiamusi, Heilongjiang 154007

Received:2025-05-09 Published:2026-02-13

摘要/Abstract

摘要： 目的比较贫血与非贫血对于肺结核患者病情恢复是否存在明显的转归差别。方法回顾分析了我院2023年1月1日—2023年12月31日因肺结核住院患者253例，按照是否存在贫血将患者分为两组，分别为贫血组（n=163）及非贫血组（n=90），通过分析患者的临床特征，并对患者治疗前后的血液检测指标、痰细菌载量、影像学资料进行比较，使用Logistic回归分析，明确贫血与痰细菌载量和肺部病理损伤之间的相关性，进一步研究贫血对于肺结核患者转归的影响。结果我院肺结核患者贫血率为60%以上，贫血类型以正细胞正色素性贫血为主，肺结核贫血患者治疗前中性粒细胞百分比（NEUT%）、淋巴细胞百分比（LY%）、中性粒细胞绝对值（NEUT#）、淋巴细胞绝对值（LY#）、红细胞体积分布宽度变异系数（RDW-CV）、天门冬氨酸氨基转移酶（AST）、总蛋白（TP）、白蛋白（ALB）、凝血酶原时间（PT）、凝血酶原活动度（PA）、凝血酶时间（TT）、D-二聚体（DD）、C-反应蛋白（CRP）、红细胞沉降率（ESR）等血液检测指标与非贫血组患者有统计学差异（P<0.05），肺结核贫血患者与非贫血患者标准化治疗完成后，LY#、LY%、MONO%、RDW-CV、TP、ALB、ESR血液检测指标有统计学差异（P<0.05）;治疗效果（P=0.026）、治疗周期（P=0.000 3）;肺部空洞率（P=0.021）、肺部胸腔积液率（P=0.004 19）、空洞闭合情况（P=0.015 3）、胸腔积液吸收（P=0.002 3）、肺部损伤区域（P=0.025 6）;Logistic回归分析明确了贫血是痰细菌载量增加和肺部病理损伤加重的相关因素。结论贫血对肺结核患者的治疗效果存在负面影响;贫血是肺结核患者肺损伤的危险因素;治疗前后的血液检测指标差异可能预测患者预后不良;肺结核贫血组患者治疗效果差、治疗周期长;肺结核贫血组患者肺部空洞率高、肺部胸腔积液率高、空洞闭合延迟、胸腔积液吸收缓慢、肺部损伤区域增多;Logistic回归分析明确了贫血是痰细菌载量增加和肺部病理损伤加重的相关因素。

关键词: 肺结核, 贫血, 转归, 痰细菌载量

Abstract: Objective To compare whether there is a significant difference in disease outcomes between anemic and non-anemic patients with pulmonary tuberculosis. Methods A retrospective analysis was conducted on 253 inpatients diagnosed with pulmonary tuberculosis at our hospital from January 1 st, 2023 to December 31 st, 2023. Patients were divided into two groups based on anemia status: anemic group (n=163) and non-anemic group (n=90). Clinical characteristics were analyzed hematological indices、sputum bacterial load and imaging data were compared before and after treatment. Logistic regression analysis was used to clarify the correlation between anemia and sputum bacterial load and pulmonary pathological damage, to further explore the impact of anemia on pulmonary tuberculosis outcomes. Results The anemia rate among pulmonary tuberculosis patients in our hospital exceeds 60%, the main type of anemia is normocytic normochromic anemia. Before treatment, anemic patients with pulmonary tuberculosis showed differences in hematological indices compared to non-anemic patients, including neutrophil percentage (NEUT%)、lymphocyte percentage (LY%)、absolute neutrophil count (NEUT#)、absolute lymphocyte count (LY#)、red blood cell distribution width coefficient of variation (RDW-CV)、aspartate aminotransferase (AST)、total protein (TP)、albumin (ALB), prothrombin time (PT)、prothrombin activity (PA)、thrombin time (TT)、D-dimer (DD), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). After treatment, anemic patients still exhibited differences in LY#、LY%、monocyte percentage (MONO%)、RDW-CV、TP、ALB and ESR, indicating anemia's impact on the hematopoietic system and immune cell function. Anemic patients had poorer treatment efficacy, longer treatment duration, higher rates of pulmonary cavitation and pleural effusion, delayed cavitary closure, slow pleural effusion absorption, and increased pulmonary injury areas. Logistic regression analysis confirmed that anemia was a correlated factor for increased sputum bacterial load and aggravated pulmonary pathological damage. Conclusion Anemia negatively affects treatment outcomes in pulmonary tuberculosis patients, anemia is a risk factor for pulmonary injury. Differences in blood test indicators before and after treatment suggest poor prognosis.

Key words: Pulmonary tuberculosis, Anemia, Outcome, Sputum bacterial load

中图分类号:

R521

齐畅, 蒋波笛, 付晨珺, 亢晓薇, 崔丹, 黄明珠, 李瑞平, 孟祥红. 贫血对肺结核患者转归的影响^*[J]. 临床输血与检验, 2026, 28(1): 111-120.

QI Chang, JIANG Bodi, FU Chenjun, KANG Xiaowei, CUI Dan, HUANG Mingzhu, LI Ruiping, MENG Xianghong. The Impact of Anemia on the Outcome of Patients with Pulmonary Tuberculosis[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2026, 28(1): 111-120.

参考文献

[1] KWON Y S,KIM Y H,SONG J U,et al.Risk factors for death during pulmonary tuberculosis treatment in Korea: a multicenter retrospective cohort study[J]. J Korean Med Sci,2014,29(9):1226-1231.
[2] 王歆尧,姜美丽,庞元捷,等. 中国结核病疾病负担现状[J]. 中华流行病学杂志,2024,45(6):857-864.
[3] DASARADHAN T,KONETI J,KALLURU R,et al.Tuberculosis-associated Anemia: a narrative review[J]. Cureus,2022,14(8):e27746.
[4] WAITT C J,SQUIRE S B.A systematic review of risk factors for death in adults during and after tuberculosis treatment[J]. Int J Tuberc Lung Dis,2011,15(7):871-885.
[5] PASRICHA S R,ROGERS L,BRANCA F,et al.Measuring haemoglobin concentration to define anaemia: WHO guidelines[J]. Lancet,2024,403(10440):1963-1966.
[6] 中国疾病预防控制中心. 中国结核病防治工作技术指南(2021年版)[EB/OL].[2025-12-18].https://www.chinacdc.cn/jkyj/crb2/yl/fjh/jswj_fjh/202410/P020241010432930570191.pdf.
[7] World Health Organization.WHO consolidated guidelines on tuberculosis: Module 4: treatment—drug-resistant tuberculosis treatment[EB/OL]. [2025-04-27].https://www.who.int/publications/i/item/9789240063129.
[8] D'SOUZA K A,ZAIDI S M A,JASWAL M,et al. Factors associated with month 2 smear non-conversion among Category 1 tuberculosis patients in Karachi,Pakistan[J]. J Infect Public Health,2018,11(2):283-285.
[9] TESFAHUNEYGN G,MEDHIN G,LEGESSE M.Adherence to Anti-tuberculosis treatment and treatment outcomes among tuberculosis patients in Alamata District,northeast Ethiopia[J]. BMC Res Notes,2015,8: 503.
[10] CARROLL C P,CICHOWITZ C,YU T,et al.Predictors of acute care utilization and acute pain treatment outcomes in adults with sickle cell disease: The role of non-hematologic characteristics and baseline chronic opioid dose[J]. Am J Hematol,2018,93(9):1127-1135.
[11] RAMÍREZ-LAPAUSA M,PASCUAL PAREJA J F,CARRILLO GÓMEZ R,et al. Retrospective study of tolerability and efficacy of linezolid in patients with multidrug-resistant tuberculosis (1998—2014)[J]. Enferm Infecc Microbiol Clin,2016,34(2):85-90.
[12] DE MENDONÇA E B,SCHMALTZ C A,SANT'ANNA F M,et al. Correction: Anemia in tuberculosis cases: A biomarker of severity?[J]. PLoS One,2021,16(3):e0249545.
[13] ARAÚJO-PEREIRA M,BARRETO-DUARTE B,ARRIAGA M B,et al. Relationship between Anemia and systemic inflammation in people living with HIV and tuberculosis: a sub-analysis of the CADIRIS clinical trial[J]. Front Immunol,2022,13:916216.
[14] ZHANG S Y,FU J Y,GUO X Y,et al.Improvement cues of lesion absorption using the adjuvant therapy of traditional Chinese medicine Qinbudan tablet for retreatment pulmonary tuberculosis with standard anti-tuberculosis regimen[J]. Infect Dis Poverty,2020,9(1): 50.
[15] BALUKU J B,MAYINJA E,MUGABE P,et al.Prevalence of anaemia and associated factors among people with pulmonary tuberculosis in Uganda[J]. Epidemiol Infect, 2022,150:e29.
[16] SABIITI W,AZAM K,FARMER E C W,et al. Tuberculosis bacillary load,an early marker of disease severity: the utility of tuberculosis Molecular Bacterial Load Assay[J]. Thorax,2020,75(7):606-608.
[17] SHEN T,CAO X J,SHI J W,et al.The morphological changes of monocytes in peripheral blood as a potential indicator for predicting active pulmonary tuberculosis[J]. Clin Chim Acta,2018,481:189-192.
[18] YANG X,FENG H.Changes of lymphocyte subsets in smear-negative pulmonary tuberculosis[J]. Indian J Pathol Microbiol,2023,66(2):321-326.
[19] HE X S,HOU H B,JIANG Y T,et al.Association between indices of peripheral blood inflammation and cavitary pulmonary tuberculosis[J]. Int J Gen Med,2024,17: 5133-5142.
[20] DONG Z W,SHI J Y,DORHOI A,et al.Hemostasis and lipoprotein indices signify exacerbated lung injury in TB with diabetes comorbidity[J]. Chest,2018,153(5): 1187-1200.
[21] MUGUSI F M,MEHTA S,VILLAMOR E,et al.Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis[J]. BMC Public Health,2009,9:409.
[22] KOURBATOVA E V,BORODULIN B E,BORODULINA E A,et al.Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia[J]. Int J Tuberc Lung Dis,2006,10(11):1224-1230.
[23] JO K W,YOO J W,HONG Y,et al.Risk factors for 1-year relapse of pulmonary tuberculosis treated with a 6-month daily regimen[J]. Respir Med,2014,108(4):654-659.
[24] MADUSKAR P,HOGEWEG L,DE JONG P A,et al. Cavity contour segmentation in chest radiographs using supervised learning and dynamic programming[J]. Med Phys,2014,41(7):071912.
[25] LUO M X,LIU M,WU X C,et al.Impact of Anemia on prognosis in tuberculosis patients[J]. Ann Transl Med, 2022,10(6):329.
[26] 齐畅,蒋波笛,孟祥红. 肺结核合并贫血研究新进展[J]. 临床输血与检验,2025,27(6):876-881.

贫血对肺结核患者转归的影响^*

The Impact of Anemia on the Outcome of Patients with Pulmonary Tuberculosis

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