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Article(id=1208106711857074203, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208106710208717234, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.04.0375, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1624204800000, receivedDateStr=2021-06-21, revisedDate=null, revisedDateStr=null, acceptedDate=1645718400000, acceptedDateStr=2022-02-25, onlineDate=1765964685644, onlineDateStr=2025-12-17, pubDate=1651075200000, pubDateStr=2022-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765964685644, onlineIssueDateStr=2025-12-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765964685644, creator=13701087609, updateTime=1765964685644, updator=13701087609, issue=Issue{id=1208106710208717234, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='4', pageStart='321', pageEnd='426', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1765964685250, creator=13701087609, updateTime=1765964685250, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=375, endPage=381, ext={EN=ArticleExt(id=1208106712104538149, articleId=1208106711857074203, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical characteristics and prognosis analysis of patients with end-stage renal disease in maintenance hemodialysis and complicated with pathogen-positive and -negative pulmonary tuberculosis, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the clinical characteristics and prognosis of patients with end-stage renal disease (ESRD)in maintenance hemodialysis (MHD) and complicated with pathogen-positive and -negative pulmonary tuberculosis. Methods A total of 98 ESRD patients complicated with pulmonary tuberculosis, admitted in the Tuberculosis Department and undergone MHD at the Blood Purification Center of the 8th Medical Center of PLA General Hospital from July 2012 to February 2022, were collected,and divided into pathogen-positive group (n=34) and pathogen-negative group (n=64) according to the results of sputum smear, sputum culture of Mycobacterium tuberculosis and molecular biological diagnosis. The clinical characteristics, therapeutic effect and prognosis of the two groups were compared and analyzed. Results Both the pathogen-positive and -negative pulmonary tuberculosis groups were mainly the males (85.3% and 76.6%, respectively) and middle-aged and elderly people [(56.4±15.6) years old and (55.8±15.0) years old, respectively]. The proportion of patients with non-primary glomerulonephritis as main underlying kidney disease, and with cough and sputum as the first manifested symptom, were both higher in pathogen-positive group than in pathogen-negative group (38.2% vs. 17.2% and 91.2% vs. 50.0%, respectively) (P<0.05). The laboratory results showed that the leukocyte, neutrophil, monocyte count,neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) and C-reactive protein level were higher, while the lymphocyte count was lower in pathogen-positive group than in pathogen-negative group (P<0.05). The chest CT found that the proportion of pleural thickened and cavity formation was higher (P<0.05), while of strip shadow was lower (P<0.05) in pathogen-positive group than in pathogen-negative group. The efficacy of anti-tuberculosis treatment was better in the both groups (94.1% vs. 95.3%). Multivariate logistic regression analysis found that cough and sputum (OR=12.572, 95%CI 2.609-60.581), MLR (OR=8.226, 95%CI 2.479-27.298),pleural thickening (OR=4.740, 95%CI 1.043-21.541) and cavitation (OR=8.462, 95%CI 2.423-29.555) were the risk factors for patients complicated with pathogen-positive pulmonary tuberculosis. Conclusions Significant differences of clinical characteristics existed between the pathogen-positive and -negative tuberculosis patients with ESRD on MHD. Cough and sputum as the first symptom, MLR,pleural thickening and cavitation are the risk factors for the pathogen-positive tuberculosis.

, correspAuthors=Wu-Xing Zhang, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后情况。方法 收集2012年7月－2022年2月在解放军总医院第八医学中心结核科就诊并在血液净化中心行维持性血液透析治疗的98例终末期肾病并发肺结核患者，根据痰涂片、痰结核分枝杆菌培养及分子生物学诊断结果分为病原学阳性组(n=34)与病原学阴性组(n=64)，对比分析两组的临床特点、治疗效果及预后情况。结果 肺结核病原学阳性与阴性组均以男性(分别为85.3%、76.6%)和中老年人[分别为(56.4±15.6)岁、(55.8±15.0)岁]为主。与病原学阴性组比较，病原学阳性组基础病非原发性肾小球肾炎的比例(38.2% vs. 17.2%)和首发症状为咳嗽咳痰的比例(91.2% vs. 50.0%)高(P<0.05)。实验室检查结果显示，病原学阳性组白细胞、中性粒细胞、单核细胞计数，中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)及C反应蛋白水平均高于病原学阴性组(P<0.05)，但淋巴细胞计数低于病原学阴性组(P<0.05)。胸部CT显示，与病原学阴性组比较，病原学阳性组胸膜增厚、空洞形成比例高(P<0.05)，条索影比例低(P<0.05)。两组抗结核治疗的疗效均较好(94.1% vs. 95.3%)。多因素logistic回归分析结果显示，咳嗽咳痰(OR=12.572，95%CI 2.609~60.581)、MLR(OR=8.226，95%CI 2.479~27.298)、合并胸膜增厚(OR=4.740，95%CI 1.043~21.541)及空洞形成(OR=8.462，95%CI 2.423~29.555)为肺结核患者病原学阳性的独立危险因素。结论 终末期肾病维持性血液透析并发病原学阳性及阴性肺结核患者的临床特点存在差异，以咳嗽咳痰为首发症状、MLR、合并胸膜增厚及空洞形成是肺结核病原学阳性的独立危险因素。

, correspAuthors=张五星, authorNote=null, correspAuthorsNote=
张五星，E-mail：
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王妙琴，硕士研究生，主要从事肾脏病及血液透析方面的临床与基础研究

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王妙琴，硕士研究生，主要从事肾脏病及血液透析方面的临床与基础研究

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王妙琴，硕士研究生，主要从事肾脏病及血液透析方面的临床与基础研究

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J Trop Med, 2020, 20(9): 1173-1177., articleTitle=The value of peripheral blood NLR and MLR in the prognosis evaluation of elderly patients with pulmonary tuberculosis, refAbstract=null), Reference(id=1208106719482319290, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=9, pageStart=1173, pageEnd=1177, url=null, language=null, rfNumber=[20], rfOrder=29, authorNames=胡小红, 王玉梅, 林小马, journalName=热带医学杂志, refType=null, unstructuredReference=[胡小红, 王玉梅, 林小马. 外周血NLR、MLR在老年肺结核患者预后评估中的价值[J]. 热带医学杂志, 2020, 20(9):1173-1177.], articleTitle=外周血NLR、MLR在老年肺结核患者预后评估中的价值, refAbstract=null), Reference(id=1208106719578788283, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, doi=null, pmid=null, pmcid=null, year=2017, volume=21, issue=9, pageStart=1013, pageEnd=1019, url=null, language=null, rfNumber=[21], rfOrder=30, authorNames=Yoon C, Chaisson LH, Patel SM, journalName=Int J Tuberc Lung Dis, refType=null, unstructuredReference=Yoon C, Chaisson LH, Patel SM, et al. Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis[J]. Int J Tuberc Lung Dis, 2017, 21(9): 1013-1019., articleTitle=Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis, refAbstract=null), Reference(id=1208106719683645891, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, doi=null, pmid=null, pmcid=null, year=2021, volume=32, issue=5, pageStart=534, pageEnd=536, url=null, language=null, rfNumber=[22], rfOrder=31, authorNames=Zhu J, Zhao NN, Hua YJ, journalName=Jiangsu J Prev Med, refType=null, unstructuredReference=Zhu J, Zhao NN, Hua YJ, et al. Evaluation of the diagnostic efficacy of hypersensitive C-reaction protein for tuberculosis activity by ROC curve[J]. 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Comparison of MSCT imaging of non-treatment sputum smear or culture-positive pulmonary tuberculosis and sputum smear and culture-negative pulmonary tuberculosis[J]. Mod Med Imagel, 2011, 20(3): 138-140., articleTitle=Comparison of MSCT imaging of non-treatment sputum smear or culture-positive pulmonary tuberculosis and sputum smear and culture-negative pulmonary tuberculosis, refAbstract=null), Reference(id=1208106719960469967, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, doi=null, pmid=null, pmcid=null, year=2011, volume=20, issue=3, pageStart=138, pageEnd=140, url=null, language=null, rfNumber=[23], rfOrder=34, authorNames=黎惠如, 刘文, journalName=现代医用影像学, refType=null, unstructuredReference=[黎惠如, 刘文. 初次治疗菌阳肺结核与菌阴肺结核的MSCT影像比较[J]. 现代医用影像学, 2011, 20(3): 138-140.], articleTitle=初次治疗菌阳肺结核与菌阴肺结核的MSCT影像比较, refAbstract=null), Reference(id=1208106720052744656, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, doi=null, pmid=null, pmcid=null, year=2019, volume=98, issue=34, pageStart=e16921, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=35, authorNames=Kim JH, Kim MJ, Ham SY, journalName=Medicine (Baltimore), refType=null, unstructuredReference=Kim JH, Kim MJ, Ham SY. Clinical characteristics and chest computed tomography findings of smear-positive and smear-negative pulmonary tuberculosis in hospitalized adult patients[J]. Medicine (Baltimore), 2019, 98(34): e16921., articleTitle=Clinical characteristics and chest computed tomography findings of smear-positive and smear-negative pulmonary tuberculosis in hospitalized adult patients, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1208106712721100858, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, xref=1, ext=[AuthorCompanyExt(id=1208106712733683772, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, companyId=1208106712721100858, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Graduate School of Hebei North University, Zhangjiakou, Hebei 075000, China), AuthorCompanyExt(id=1208106712742072381, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, companyId=1208106712721100858, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1河北北方学院研究生学院，河北张家口 075000)]), AuthorCompany(id=1208106712846929987, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, xref=2, ext=[AuthorCompanyExt(id=1208106712855318596, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, companyId=1208106712846929987, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Nephrology, the 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China), AuthorCompanyExt(id=1208106712876290118, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, companyId=1208106712846929987, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2解放军总医院第八医学中心肾脏病科，北京 100091)])], figs=[ArticleFig(id=1208106715371901153, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.1, caption=

Comparison of general data of patients with pathogen-positive and -negative pulmonary tuberculosis

, figureFileSmall=null, figureFileBig=null, tableContent=
指标病原学阳性组(n=34)病原学阴性组(n=64)P
性别[例(%)]  0.307
 男29(85.3)49(76.6)
 女5(14.7)15(23.4)
年龄(岁，$\bar{x}±s$)56.4±15.655.8±15.00.856
原发病[例(%)]  0.021
 原发性肾小球肾炎21(61.8)53(82.8)
 非原发性肾小球肾炎13(38.2)11(17.2)
合并疾病[例(%)]
 高血压27(79.4)48(75.0)0.624
 糖尿病17(50.0)30(46.9)0.768
 冠心病2(5.9)14(21.9)0.080
透析时间[例(%)]  0.271
 ≤1年9(26.5)24(37.5)
 >1年25(73.5)40(62.5)
结核检出时间[例(%)]  0.31
 透析后≤1年9(26.5)25(39.1)
 透析后>1年25(73.5)39(60.9) 
), ArticleFig(id=1208106715447398626, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表1, caption=

病原学阳性与阴性组肺结核患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标病原学阳性组(n=34)病原学阴性组(n=64)P
性别[例(%)]  0.307
 男29(85.3)49(76.6)
 女5(14.7)15(23.4)
年龄(岁，$\bar{x}±s$)56.4±15.655.8±15.00.856
原发病[例(%)]  0.021
 原发性肾小球肾炎21(61.8)53(82.8)
 非原发性肾小球肾炎13(38.2)11(17.2)
合并疾病[例(%)]
 高血压27(79.4)48(75.0)0.624
 糖尿病17(50.0)30(46.9)0.768
 冠心病2(5.9)14(21.9)0.080
透析时间[例(%)]  0.271
 ≤1年9(26.5)24(37.5)
 >1年25(73.5)40(62.5)
结核检出时间[例(%)]  0.31
 透析后≤1年9(26.5)25(39.1)
 透析后>1年25(73.5)39(60.9) 
), ArticleFig(id=1208106715539673317, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.2, caption=

Comparison of the first symptoms of patients with pathogen-positive and -negative pulmonary tuberculosis[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
首发症状病原学阳性组(n=34)病原学阴性组(n=64)P
发热18(52.9)30(46.9)0.567
咳嗽咳痰31(91.2)32(50.0)0.000
胸闷6(17.6)17(26.6)0.322
疼痛2(5.9)8(12.5)0.303
乏力、纳差1(2.9)7(10.9)0.323
), ArticleFig(id=1208106715640336617, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表2, caption=

病原学阳性与阴性组肺结核患者首发症状比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
首发症状病原学阳性组(n=34)病原学阴性组(n=64)P
发热18(52.9)30(46.9)0.567
咳嗽咳痰31(91.2)32(50.0)0.000
胸闷6(17.6)17(26.6)0.322
疼痛2(5.9)8(12.5)0.303
乏力、纳差1(2.9)7(10.9)0.323
), ArticleFig(id=1208106715724222702, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.3, caption=

Comparison of laboratory examination of patients with pathogen-positive and -negative pulmonary tuberculosis

, figureFileSmall=null, figureFileBig=null, tableContent=
项目病原学阳性组(n=34)病原学阴性组(n=64)P
γ干扰素释放试验[例(%)]a  0.715
 阳性17(60.7)35(64.8)
 阴性11(39.3)19(35.2)
白细胞[×109/L, M(Q1, Q3)]8.11(5.83, 10.03)6.05(4.20, 8.34)0.006
中性粒细胞[×109/L, M(Q1, Q3)]6.53(4.50, 8.00)4.27(2.81, 6.18)0.002
淋巴细胞[×109/L, M(Q1, Q3)]0.65(0.45, 0.91)0.86(0.59, 1.11)0.017
NLR[M(Q1, Q3)]8.35(5.49, 15.95)4.93(3.36, 8.23)0.000
单核细胞(×109/L, $\bar{x}±s$)0.63±0.280.44±0.230.001
MLR[M(Q1, Q3)]0.84(0.54, 1.40)0.47(0.30, 0.81)0.000
血小板(×109/L, $\bar{x}±s$)207.56±119.70211.50±103.980.862
PLR[M(Q1, Q3)]306.13(195.57, 470.61)235.76(137.91, 386.89)0.083
血红蛋白(g/L, $\bar{x}±s$)93.91±23.0495.91±23.080.685
白蛋白(g/L, $\bar{x}±s$)30.74±6.3732.58±5.090.124
红细胞沉降率(mm/h, $\bar{x}±s$)71.52±34.8164.86±42.250.432
腺苷脱氨酶[U/L, M(Q1, Q3)]25.80(14.55, 35.35)17.05(10.18, 31.23)0.969
C反应蛋白[mg/L, M(Q1, Q3)]76.57(43.15, 130.55)39.42(8.66, 90.40)0.018
钙[mmol/L, M(Q1, Q3)]2.30(2.13, 2.46)2.23(2.06, 2.41)0.582
磷[mmol/L, M(Q1, Q3)]1.70(1.20, 2.19)1.49(1.16, 1.84)0.340
), ArticleFig(id=1208106715803914479, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表3, caption=

病原学阳性与阴性组肺结核患者实验室检查结果的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目病原学阳性组(n=34)病原学阴性组(n=64)P
γ干扰素释放试验[例(%)]a  0.715
 阳性17(60.7)35(64.8)
 阴性11(39.3)19(35.2)
白细胞[×109/L, M(Q1, Q3)]8.11(5.83, 10.03)6.05(4.20, 8.34)0.006
中性粒细胞[×109/L, M(Q1, Q3)]6.53(4.50, 8.00)4.27(2.81, 6.18)0.002
淋巴细胞[×109/L, M(Q1, Q3)]0.65(0.45, 0.91)0.86(0.59, 1.11)0.017
NLR[M(Q1, Q3)]8.35(5.49, 15.95)4.93(3.36, 8.23)0.000
单核细胞(×109/L, $\bar{x}±s$)0.63±0.280.44±0.230.001
MLR[M(Q1, Q3)]0.84(0.54, 1.40)0.47(0.30, 0.81)0.000
血小板(×109/L, $\bar{x}±s$)207.56±119.70211.50±103.980.862
PLR[M(Q1, Q3)]306.13(195.57, 470.61)235.76(137.91, 386.89)0.083
血红蛋白(g/L, $\bar{x}±s$)93.91±23.0495.91±23.080.685
白蛋白(g/L, $\bar{x}±s$)30.74±6.3732.58±5.090.124
红细胞沉降率(mm/h, $\bar{x}±s$)71.52±34.8164.86±42.250.432
腺苷脱氨酶[U/L, M(Q1, Q3)]25.80(14.55, 35.35)17.05(10.18, 31.23)0.969
C反应蛋白[mg/L, M(Q1, Q3)]76.57(43.15, 130.55)39.42(8.66, 90.40)0.018
钙[mmol/L, M(Q1, Q3)]2.30(2.13, 2.46)2.23(2.06, 2.41)0.582
磷[mmol/L, M(Q1, Q3)]1.70(1.20, 2.19)1.49(1.16, 1.84)0.340
), ArticleFig(id=1208106715891994867, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.4, caption=

Comparison of chest CT findings of patients with pathogen-positive and -negative pulmonary tuberculosis[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目病原学阳性组(n=34)病原学阴性组(n=64)P
侵犯部位  0.939
 双肺26(76.5)47(73.4)
 左肺4(11.8)8(12.5)
 右肺4(11.8)9(14.1)
胸部CT表现
 斑片影25(73.5)35(54.7)0.068
 胸膜增厚11(32.4)8(12.5)0.018
 胸腔积液21(61.8)27(42.2)0.065
 结节15(44.1)28(43.8)0.972
 空洞17(50.0)9(14.1)0.000
 条索影6(17.6)27(42.2)0.014
 钙化影7(20.6)10(15.6)0.537
 支气管扩张2(5.9)2(3.1)0.904
 磨玻璃影1(2.9)1(1.6)1.000
 淋巴结增大10(29.4)13(20.3)0.312
增大的淋巴结分布部位
 纵隔10(29.4)12(18.8)0.229
 腋窝01(1.6)0.466
 肺门6(17.6)5(7.8)0.142
), ArticleFig(id=1208106716005241078, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表4, caption=

病原学阳性与阴性组肺结核患者胸部CT表现比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目病原学阳性组(n=34)病原学阴性组(n=64)P
侵犯部位  0.939
 双肺26(76.5)47(73.4)
 左肺4(11.8)8(12.5)
 右肺4(11.8)9(14.1)
胸部CT表现
 斑片影25(73.5)35(54.7)0.068
 胸膜增厚11(32.4)8(12.5)0.018
 胸腔积液21(61.8)27(42.2)0.065
 结节15(44.1)28(43.8)0.972
 空洞17(50.0)9(14.1)0.000
 条索影6(17.6)27(42.2)0.014
 钙化影7(20.6)10(15.6)0.537
 支气管扩张2(5.9)2(3.1)0.904
 磨玻璃影1(2.9)1(1.6)1.000
 淋巴结增大10(29.4)13(20.3)0.312
增大的淋巴结分布部位
 纵隔10(29.4)12(18.8)0.229
 腋窝01(1.6)0.466
 肺门6(17.6)5(7.8)0.142
), ArticleFig(id=1208106716089127164, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.5, caption=

Comparison of treatment and outcome of patients with pathogen-positive and -negative pulmonary tuberculosis [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目病原学阳性组(n=34)病原学阴性组(n=64)P
治疗效果  0.954
 发生不良反应6(17.6)11(17.2)
 未发生不良反应28(82.4)53(82.8)
转归  0.899
 好转32(94.1)61(95.3)
 加重1(2.9)2(3.1)
 死亡1(2.9)1(1.6) 
), ArticleFig(id=1208106716168818945, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表5, caption=

病原学阳性与阴性组肺结核患者治疗及转归比较[例(%)]

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项目病原学阳性组(n=34)病原学阴性组(n=64)P
治疗效果  0.954
 发生不良反应6(17.6)11(17.2)
 未发生不良反应28(82.4)53(82.8)
转归  0.899
 好转32(94.1)61(95.3)
 加重1(2.9)2(3.1)
 死亡1(2.9)1(1.6) 
), ArticleFig(id=1208106716282065158, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.6, caption=

Comparison of adverse reactions in patients with pathogen-positive and -negative pulmonary tuberculosis [n(%)]

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不良反应病原学阳性组(n=34)病原学阴性组(n=64)P
双下肢麻木02(3.1)0.300
视物模糊05(7.8)0.096
消化道反应3(8.8)1(1.6)0.085
肝功能异常1(2.9)3(4.7)1.000
白细胞减少02(3.1)0.300
血小板减少2(5.9)00.051
皮疹01(1.6)0.466
), ArticleFig(id=1208106716361756937, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表6, caption=

病原学阳性与阴性组肺结核患者抗结核治疗不良反应比较[例(%)]

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不良反应病原学阳性组(n=34)病原学阴性组(n=64)P
双下肢麻木02(3.1)0.300
视物模糊05(7.8)0.096
消化道反应3(8.8)1(1.6)0.085
肝功能异常1(2.9)3(4.7)1.000
白细胞减少02(3.1)0.300
血小板减少2(5.9)00.051
皮疹01(1.6)0.466
), ArticleFig(id=1208106716445643022, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.7, caption=

Univariate logistic regression analysis of the related factors of ESRD patients in MHD complicated with pathogen-positive pulmonary tuberculosis

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因素βSEWald χ2POR95%CI
非原发性肾小球肾炎1.0930.4845.0970.0242.9831.155~7.703
咳嗽咳痰2.3350.65412.7400.00010.3332.866~37.254
白细胞0.1730.0745.5350.0191.1891.029~1.374
中性粒细胞0.2030.0816.2180.0131.2251.044~1.436
淋巴细胞–1.1710.5943.8840.0490.3100.097~0.994
NLR0.1260.0429.2030.0021.1341.046~1.230
单核细胞3.0120.94010.2800.00120.3353.225~128.229
MLR2.0180.56612.6990.0007.5062.477~22.745
C反应蛋白0.0060.0032.7850.0951.0060.999~1.013
胸膜增厚1.2080.5275.2660.0223.3481.193~9.396
空洞形成1.8100.49713.2680.0006.1112.307~16.185
条索影–1.2250.5165.6350.0180.2940.107~0.808
), ArticleFig(id=1208106716537917714, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表7, caption=

行MHD的ESRD患者并发病原学阳性肺结核相关因素的单因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素βSEWald χ2POR95%CI
非原发性肾小球肾炎1.0930.4845.0970.0242.9831.155~7.703
咳嗽咳痰2.3350.65412.7400.00010.3332.866~37.254
白细胞0.1730.0745.5350.0191.1891.029~1.374
中性粒细胞0.2030.0816.2180.0131.2251.044~1.436
淋巴细胞–1.1710.5943.8840.0490.3100.097~0.994
NLR0.1260.0429.2030.0021.1341.046~1.230
单核细胞3.0120.94010.2800.00120.3353.225~128.229
MLR2.0180.56612.6990.0007.5062.477~22.745
C反应蛋白0.0060.0032.7850.0951.0060.999~1.013
胸膜增厚1.2080.5275.2660.0223.3481.193~9.396
空洞形成1.8100.49713.2680.0006.1112.307~16.185
条索影–1.2250.5165.6350.0180.2940.107~0.808
), ArticleFig(id=1208106716613415190, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=EN, label=Tab.8, caption=

Multivariate logistic regression analysis of the risk factors of pathogen-positive pulmonary tuberculosis for ESRD patients in MHD

, figureFileSmall=null, figureFileBig=null, tableContent=
因素βSEWald χ2POR95%CI
咳嗽咳痰2.5310.8029.9550.00212.5722.609~60.581
MLR2.1070.61211.8540.0018.2262.479~27.298
胸膜增厚1.5560.7724.0580.0444.7401.043~21.541
空洞形成2.1360.63811.2010.0018.4622.423~29.555
常数–5.1571.06623.3980.0000.006  
), ArticleFig(id=1208106716701495577, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106711857074203, language=CN, label=表8, caption=

行MHD的ESRD患者并发病原学阳性肺结核危险因素的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素βSEWald χ2POR95%CI
咳嗽咳痰2.5310.8029.9550.00212.5722.609~60.581
MLR2.1070.61211.8540.0018.2262.479~27.298
胸膜增厚1.5560.7724.0580.0444.7401.043~21.541
空洞形成2.1360.63811.2010.0018.4622.423~29.555
常数–5.1571.06623.3980.0000.006  
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终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后分析
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王妙琴 1 , 任瑞霖 2 , 张五星 2, * , 周伟 2 , 汪杨 2 , 黄巍 2
解放军医学杂志 | 临床研究 2022,47(4): 375-381
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解放军医学杂志 | 临床研究 2022, 47(4): 375-381
终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后分析
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王妙琴1, 任瑞霖2, 张五星2, * , 周伟2, 汪杨2, 黄巍2
作者信息
  • 1河北北方学院研究生学院，河北张家口 075000
  • 2解放军总医院第八医学中心肾脏病科，北京 100091

    • 王妙琴，硕士研究生，主要从事肾脏病及血液透析方面的临床与基础研究

通讯作者:

张五星，E-mail：
Clinical characteristics and prognosis analysis of patients with end-stage renal disease in maintenance hemodialysis and complicated with pathogen-positive and -negative pulmonary tuberculosis
Miao-Qin Wang1, Rui-Lin Ren2, Wu-Xing Zhang2, * , Wei Zhou2, Yang Wang2, Wei Huang2
Affiliations
  • 1Graduate School of Hebei North University, Zhangjiakou, Hebei 075000, China
  • 2Department of Nephrology, the 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
出版时间: 2022-04-28 doi: 10.11855/j.issn.0577-7402.2022.04.0375
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摘要
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目的 探讨终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后情况。方法 收集2012年7月－2022年2月在解放军总医院第八医学中心结核科就诊并在血液净化中心行维持性血液透析治疗的98例终末期肾病并发肺结核患者，根据痰涂片、痰结核分枝杆菌培养及分子生物学诊断结果分为病原学阳性组(n=34)与病原学阴性组(n=64)，对比分析两组的临床特点、治疗效果及预后情况。结果 肺结核病原学阳性与阴性组均以男性(分别为85.3%、76.6%)和中老年人[分别为(56.4±15.6)岁、(55.8±15.0)岁]为主。与病原学阴性组比较，病原学阳性组基础病非原发性肾小球肾炎的比例(38.2% vs. 17.2%)和首发症状为咳嗽咳痰的比例(91.2% vs. 50.0%)高(P<0.05)。实验室检查结果显示，病原学阳性组白细胞、中性粒细胞、单核细胞计数，中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)及C反应蛋白水平均高于病原学阴性组(P<0.05)，但淋巴细胞计数低于病原学阴性组(P<0.05)。胸部CT显示，与病原学阴性组比较，病原学阳性组胸膜增厚、空洞形成比例高(P<0.05)，条索影比例低(P<0.05)。两组抗结核治疗的疗效均较好(94.1% vs. 95.3%)。多因素logistic回归分析结果显示，咳嗽咳痰(OR=12.572，95%CI 2.609~60.581)、MLR(OR=8.226，95%CI 2.479~27.298)、合并胸膜增厚(OR=4.740，95%CI 1.043~21.541)及空洞形成(OR=8.462，95%CI 2.423~29.555)为肺结核患者病原学阳性的独立危险因素。结论 终末期肾病维持性血液透析并发病原学阳性及阴性肺结核患者的临床特点存在差异，以咳嗽咳痰为首发症状、MLR、合并胸膜增厚及空洞形成是肺结核病原学阳性的独立危险因素。

终末期肾病  /  维持性血液透析  /  肺结核  /  病原学阴性  /  病原学阳性

Objective To explore the clinical characteristics and prognosis of patients with end-stage renal disease (ESRD)in maintenance hemodialysis (MHD) and complicated with pathogen-positive and -negative pulmonary tuberculosis. Methods A total of 98 ESRD patients complicated with pulmonary tuberculosis, admitted in the Tuberculosis Department and undergone MHD at the Blood Purification Center of the 8th Medical Center of PLA General Hospital from July 2012 to February 2022, were collected,and divided into pathogen-positive group (n=34) and pathogen-negative group (n=64) according to the results of sputum smear, sputum culture of Mycobacterium tuberculosis and molecular biological diagnosis. The clinical characteristics, therapeutic effect and prognosis of the two groups were compared and analyzed. Results Both the pathogen-positive and -negative pulmonary tuberculosis groups were mainly the males (85.3% and 76.6%, respectively) and middle-aged and elderly people [(56.4±15.6) years old and (55.8±15.0) years old, respectively]. The proportion of patients with non-primary glomerulonephritis as main underlying kidney disease, and with cough and sputum as the first manifested symptom, were both higher in pathogen-positive group than in pathogen-negative group (38.2% vs. 17.2% and 91.2% vs. 50.0%, respectively) (P<0.05). The laboratory results showed that the leukocyte, neutrophil, monocyte count,neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) and C-reactive protein level were higher, while the lymphocyte count was lower in pathogen-positive group than in pathogen-negative group (P<0.05). The chest CT found that the proportion of pleural thickened and cavity formation was higher (P<0.05), while of strip shadow was lower (P<0.05) in pathogen-positive group than in pathogen-negative group. The efficacy of anti-tuberculosis treatment was better in the both groups (94.1% vs. 95.3%). Multivariate logistic regression analysis found that cough and sputum (OR=12.572, 95%CI 2.609-60.581), MLR (OR=8.226, 95%CI 2.479-27.298),pleural thickening (OR=4.740, 95%CI 1.043-21.541) and cavitation (OR=8.462, 95%CI 2.423-29.555) were the risk factors for patients complicated with pathogen-positive pulmonary tuberculosis. Conclusions Significant differences of clinical characteristics existed between the pathogen-positive and -negative tuberculosis patients with ESRD on MHD. Cough and sputum as the first symptom, MLR,pleural thickening and cavitation are the risk factors for the pathogen-positive tuberculosis.

end-stage renal disease  /  maintenance hemodialysis  /  pulmonary tuberculosis  /  pathogen-negative pulmonary tuberculosis  /  pathogen-positive pulmonary tuberculosis
王妙琴, 任瑞霖, 张五星, 周伟, 汪杨, 黄巍. 终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后分析. 解放军医学杂志, 2022 , 47 (4) : 375 -381 . DOI: 10.11855/j.issn.0577-7402.2022.04.0375
Miao-Qin Wang, Rui-Lin Ren, Wu-Xing Zhang, Wei Zhou, Yang Wang, Wei Huang. Clinical characteristics and prognosis analysis of patients with end-stage renal disease in maintenance hemodialysis and complicated with pathogen-positive and -negative pulmonary tuberculosis[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (4) : 375 -381 . DOI: 10.11855/j.issn.0577-7402.2022.04.0375
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终末期肾病(end stage renal disease，ESRD)患者由于长期维持性血液透析(maintenance hemodialysis，MHD)、使用免疫抑制剂、免疫功能受损、高龄、糖尿病、低体重指数(BMI)及频繁来往医院等原因，较普通人群更易感染结核分枝杆菌(Mycobacterium tuberculosis，MTB)，从而引起结核病[1-3]。肺部是MTB最常累及的部位，根据痰涂片、痰培养及分子生物学诊断结果的不同，肺结核可分为病原学阳性与阴性两种[4]。普通人群的病原学阳性和阴性肺结核在血液检查指标和影像学方面均存在明显差异[5]，而在行MHD的ESRD人群中是否存在同样的差异，以及有无特异性差异，目前尚不清楚。本研究收集行MHD的ESRD并发肺结核患者的临床资料，按病原学阳性与阴性进行临床特点和预后分析，旨在进一步提高对行MHD的ESRD患者并发病原学阳性与阴性肺结核的认识。
1 资料与方法
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1.1 研究对象
收集2012年7月－2022年2月在解放军总医院第八医学中心血液净化中心行MHD治疗的4370例ESRD患者，从中筛选出MHD治疗后并发肺结核的患者98例进行回顾性分析。按痰涂片、痰培养、分子生物学检测的任一结果是否为阳性进行分组，分为病原学阳性组(n=34)和病原学阴性组(n=64)。结核病的诊断参考《中华人民共和国卫生行业标准WS 288-2017》及中国医院协会血液净化中心管理分会专家组《中国成人慢性肾脏病合并结核病管理专家共识》[6]，除有结核相应的临床表现外，必须具备下列表现1项以上：(1)病原学检出病原菌；(2)病理学证实为结核；(3)不明原因发热1个月以上，正规抗生素治疗无效，抗结核药物治疗数天后症状明显好转[7]。肺结核的诊断参考《WS 288-2017肺结核诊断标准》[8]。纳入标准：(1)行MHD的ESRD患者；(2)透析时间在3个月以上；(3)透析前无结核病史及活动性结核表现；(4)符合结核病诊断标准，且为肺结核。排除标准：(1)血行播散型肺结核；(2)病例资料不全。病原学阳性肺结核：分枝杆菌涂片、痰培养或分子生物学检测任一阳性的肺结核。病原学阴性肺结核：痰涂片、痰培养、痰涂片核酸检测均为阴性的肺结核。本研究获解放军总医院第八医学中心伦理委员会批准(309202106081038)。
1.2 观察指标
记录行MHD的ESRD患者并发病原学阳性和阴性肺结核患者的性别、年龄、原发病、合并疾病、透析时间、透析后结核检出时间、首发症状、胸部CT表现，白细胞、中性粒细胞、淋巴细胞、血小板计数，中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、血小板/淋巴细胞比值(PLR)，γ干扰素释放试验结果，红细胞沉降率，血红蛋白、血浆白蛋白(albumin，ALB)、C反应蛋白(C-reactive protein，CRP)、腺苷脱氨酶(adenosine deaminase，ADA)、钙、磷水平，治疗方案，药物不良反应及预后情况等。
1.3 指标分析
对病原学阳性组与阴性组患者的一般资料、首发症状、实验室检查、影像学检查、抗结核不良反应及转归情况进行组间比较，并采用单因素和多因素logistic回归分析行MHD的ESRD患者出现病原学阳性肺结核的危险因素。
1.4 统计学处理
采用SPSS 25.0软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，两组间比较采用t检验；不符合正态分布的计量资料以[M(Q1，Q3)]表示，两组间比较采用Mann-Whitney U检验；计数资料以例(%)表示，两组间比较采用χ2检验或Fisher确切概率法。为分析行MHD的ESRD患者出现病原学阳性肺结核的危险因素，将有统计学意义的指标纳入单因素logistic回归分析，继而对单因素分析有统计学意义的因素进行logistic逐步回归向后法分析。P<0.05为差异有统计学意义。
2 结果
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2.1 一般资料
病原学阳性与阴性组均以男性(分别为85.3%、76.6%)和中老年人[分别为(56.4±15.6)岁、(55.8±15.0)岁]为主，两组间比较差异无统计学意义(P>0.05)。两组患者的肾脏原发病均以原发性肾小球肾炎为主，但病原学阳性组的非原发性肾小球肾炎比例高(38.2% vs. 17.2%，P<0.05)。病原学阳性与阴性组合并疾病均以高血压最常见(分别为79.4%、75.0%)，其次为糖尿病(分别为50.0%、46.9%)，两组间差异无统计学意义(P>0.05)。此外，病原学阳性与阴性组患者的透析时间和透析后结核检出时间均集中在1年以上(表1)。
2.2 临床表现
在首发症状方面，病原学阳性组患者首发症状咳嗽咳痰较病原学阴性组患者更常见，差异有统计学意义(91.2% vs. 50.0%，P<0.05)。两组的其余首发症状如发热、胸闷、乏力、纳差等相似，差异无统计学意义(P>0.05)(表2)。
2.3 实验室及影像学检查结果
两组患者中82例行γ干扰素释放试验，结果显示，病原学阳性与阴性组的γ干扰素阳性率相近(60.7% vs. 64.8%)，差异无统计学意义(P>0.05)。其余实验室检查结果显示，病原学阳性组的白细胞、中性粒细胞、单核细胞计数，NLR、MLR和C反应蛋白水平高于病原学阴性组(P<0.05)，淋巴细胞计数低于病原学阴性组(P<0.05)(表3)。
胸部CT检查发现，两组患者均以双肺受累为主(76.5% vs. 73.4%)。与病原学阴性组比较，病原学阳性组胸膜增厚、空洞形成的比例增高，条索影比例降低(P<0.05)，其余胸部CT表现差异无统计学意义(P>0.05)(表4)。
2.4 治疗及转归
病原学阳性与阴性组患者治疗好转率差异无统计学意义(P>0.05)。病原学阳性组1例死亡，死因为脑出血；病原学阴性组1例死亡，死因为呼吸衰竭。在抗结核治疗过程中，共17例患者出现20例次药物不良反应，包括双下肢麻木、视物模糊、消化道反应、肝功能异常等，两组差异无统计学意义(P>0.05)(表5、6)。
2.5 行MHD的ESRD患者并发病原学阳性肺结核的危险因素分析
2.5.1 单因素logistic回归分析结果
将上述病原学阳性组与阴性组存在差异的指标(P<0.05)纳入单因素logistic回归分析，筛选出行MHD的ESRD患者出现病原学阳性肺结核的相关因素，结果显示，非原发性肾小球肾炎(OR=2.983，95%CI 1.155~7.703)、首发症状为咳嗽咳痰(OR=10.333，95%CI 2.866~37.254)、白细胞(OR=1.189，95%CI 1.029~1.374)、中性粒细胞(OR=1.225，95%CI 1.044~1.436)、淋巴细胞(OR=0.310，95%CI 0.097~0.994)、单核细胞(OR=20.335，95%CI 3.225~128.229)、NLR(OR=1.134，95%CI 1.046~1.230)、MLR(OR=7.506，95%CI 2.477~22.745)、胸膜增厚(OR=3.348，95%CI 1.193~9.396)、空洞形成(OR=6.111，95%CI 2.307~16.185)和条索影(OR=0.294，95%CI 0.107~0.808)是行MHD的ESRD患者出现病原学阳性肺结核的相关因素(P<0.05，表7)。
2.5.2 多因素logistic回归分析
将单因素logistic回归分析显示有统计学意义(P<0.05)的指标纳入多因素logistic回归向后法分析，结果发现，咳嗽咳痰(OR=12.572，95%CI 2.609~60.581)、MLR(OR=8.226，95%CI 2.479~27.298)、胸膜增厚(OR=4.740，95%CI 1.043~21.541)和空洞形成(OR=11.201，95%CI 2.423~29.555)是行MHD的ESRD患者出现病原学阳性肺结核的危险因素(P<0.05)(表8)。
3 讨论
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有研究发现，透析患者的结核病发病率是所在地区普通人群的4.1倍，是所在国家普通人群的5倍以上，提示透析患者结核病发病率较高，需要给予更大的关注[9]。本研究比较分析了行MHD的ESRD并发病原学阳性与阴性肺结核患者的人口学指标、临床特征、治疗及转归情况，结果显示，与病原学阴性组相比，病原学阳性组基础病为非原发性肾小球肾炎的比例及首发症状为咳嗽咳痰的比例高；白细胞、中性粒细胞、单核细胞计数，以及NLR、MLR、C反应蛋白水平均高，而淋巴细胞计数则低；胸部CT表现中胸膜增厚和空洞形成的比例高，条索影比例低；但在抗结核疗效和不良反应方面两组间差异无统计学意义。咳嗽咳痰、MLR、胸膜增厚和空洞形成是行MHD的ESRD患者出现病原学阳性肺结核的危险因素。
西方国家常见的ESRD病因为糖尿病肾病，而在我国及其他一些国家，ESRD的病因主要为原发性肾小球肾炎[10]。本研究中，ESRD的主要原发病为慢性肾小球肾炎，但在非此原发病的患者中，病原学阳性肺结核的比例偏高。因此，对由其他继发性肾病如糖尿病肾病、高血压肾损害等引起的ESRD患者，应更加关注其是否有发生病原学阳性肺结核的可能。
老年肺结核患者的临床症状以咳嗽咳痰为主[11]，且有研究发现，肺结核患者主要临床症状为咳嗽咳痰的比例高达87.4%[12]。本研究中老年人居多，同样以咳嗽咳痰为主要临床表现，尤其是在病原学阳性肺结核患者中该比例更高。研究发现，咳嗽是结核病传播的主要方式，痰液MTB含量较高的患者咳嗽频率较高，而治疗两周则可明显降低咳嗽频率，减少空气传播结核的可能性[13]。由于行MHD的ESRD并发肺结核患者需定期来往于医院，且透析场所人员密集，MTB通过咳嗽暴露在空气中，增加了院内传播的危险。因此，对于此类患者，尤其是病原学阳性患者，应及时治疗，降低咳嗽咳痰频率，以减少空气及医院内传播的可能性。
中性粒细胞、单核细胞、淋巴细胞计数及其比值(NLR、MLR)作为新的炎症指标已被证实与多种疾病的预后相关[14-17]。研究发现，在普通人群中，NLR、MLR及单核细胞计数与活动性肺结核相关，具有一定预测价值[18-19]。在老年肺结核人群中，病原学阳性组中性粒细胞计数、单核细胞计数及NLR、MLR水平均明显高于病原学阴性组，淋巴细胞计数明显低于病原学阴性组[20]。一项Meta分析结果显示，在HIV感染的成年人中，与症状筛查相比，CRP对结核病的筛选敏感度相似，而特异度更高[21]。在肺结核人群中，活动性肺结核患者的CRP高于非活动性肺结核患者[22]。本研究在行MHD的ESRD并发肺结核人群中发现，与病原学阴性患者相比，病原学阳性患者的中性粒细胞计数、单核细胞计数、NLR、MLR和CRP明显升高，淋巴细胞计数明显降低，与上述文献结果一致。因此，在透析人群中，这些指标可作为活动性肺结核及其是否具有传染性的预测指标。
本研究还发现，在胸部CT影像中，病原学阳性肺结核患者表现为胸膜增厚及空洞明显增多，病原学阴性肺结核患者则表现为条索影更多，与在普通肺结核人群中的研究一致[23-24]。有研究发现，成人病原学阳性肺结核还表现为实变、支气管扩张、上叶及多叶受累、淋巴结增大，这些表现可能与病原学阳性肺结核的传染性有关，可通过这些CT表现预测肺结核的传染性，并尽早进行空气隔离[24]。
行MHD的ESRD并发肺结核的抗结核治疗应遵循“早期、联合、适量、规律、全程”的原则。本研究中，首选的一线药物为异烟肼、利福平、乙胺丁醇、吡嗪酰胺、左氧氟沙星，多数患者预后良好。本研究未发现病原学阳性与阴性肺结核在治疗转归和不良反应方面存在统计学差异，即经抗结核和个体化治疗后，两组患者均可获得较好的疗效。但本研究是一项单中心回顾性研究，且由于病例相对少见，样本量较小，因此该结果仍需通过大样本量、多中心、前瞻性研究来进一步验证。
综上所述，本研究发现，在行MHD的ESRD并发肺结核患者中，咳嗽咳痰、MLR、胸膜增厚和空洞形成是发生病原学阳性肺结核的危险因素，这有助于对透析患者进行结核筛查，早期判断和预测病原学阴性或阳性，以便早期诊断和个体化治疗，降低结核在医院内传播的可能性。鉴于ESRD和结核病对全球公共健康的影响，将来有必要开发更加方便准确的病原学阳性标志物，并进一步制定和完善有针对性的指南来指导行MHD的ESRD并发肺结核患者的筛查和治疗。
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2022年第47卷第4期
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doi: 10.11855/j.issn.0577-7402.2022.04.0375
  • 接收时间：2021-06-21
  • 首发时间：2025-12-17
  • 出版时间：2022-04-28
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  • 收稿日期：2021-06-21
  • 录用日期：2022-02-25
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    1河北北方学院研究生学院，河北张家口 075000
    2解放军总医院第八医学中心肾脏病科，北京 100091

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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