中华皮肤科杂志 ›› 2024, Vol. 57 ›› Issue (11): 1029-1036.doi: 10.35541/cjd.20230707

• 论著 • 上一篇    下一篇

118例皮肤结核患者皮肤损害部位与邻近器官结核的相关性分析

徐超1    徐鹏2    陈玲1    贺仁忠1   

  1. 1遵义医科大学附属医院结核病科，遵义  563000；2遵义医科大学基础医学院，遵义  563000
  • 收稿日期:2023-12-04 修回日期:2024-09-30 发布日期:2024-10-31
  • 通讯作者: 贺仁忠 E-mail:renzhonghe914@163.com
  • 基金资助:
    贵州省科技计划项目（黔科合支撑［2019］2804号）；贵州省卫生健康委科学技术基金（gzwkj2022-260）；国家自然科学基金（81760003）

Analysis of the relationship between skin lesion sites and adjacent organ tuberculosis in 118 patients with cutaneous tuberculosis

Xu Chao1, Xu Peng2, Chen Ling1, He Renzhong1   

  1. 1Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou, China; 2School of Basic Medicine, Zunyi Medical University, Zunyi 563000, Guizhou, China
  • Received:2023-12-04 Revised:2024-09-30 Published:2024-10-31
  • Contact: He Renzhong E-mail:renzhonghe914@163.com
  • Supported by:
    Guizhou Science and Technology Support Plan Project （Guizhou Science and Technology Cooperation Support ［2019］ 2804）; Science and Technical Fund of the Health Department of Guizhou Province （gzwki2022-260）; National Natural Science Foundation of China （81760003）

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摘要： 【摘要】 目的 探讨皮肤结核（CTB）的流行病学和临床特征，分析皮肤损害部位与邻近器官结核的相关性，为其有效防治提供理论依据。方法 回顾性收集2011年1月至2018年12月遵义医科大学附属医院结核病科收治的CTB患者的人口学资料、临床特征和辅助检查资料，分析不同年龄段和性别CTB患者的发病情况、皮肤损害部位与其他器官结核病灶之间的关系及病原学和组织病理学检查的阳性率。结果 共收集到CTB患者118例，占所有结核病患者的1.03%（118/11 460），其中确诊65例。65例确诊CTB患者中，14～25岁青少年占比最高（23.1%），男女比例为1.32∶1（37∶28），女性在26～35岁年龄段患者中占比最高（6/10）；皮肤损害主要发生部位为胸部（29/65，44.6%）、腹部（13/65，20.0%）及四肢（10/65，15.4%），主要表现为局部包块（41/65，63.1%）、皮肤破溃（16/65，24.6%）及皮肤瘙痒（2/65，3.1%）；临床诊断患者53例，确诊患者与临床诊断患者皮肤损害部位差异具有统计学意义（χ2 = 13.42，P = 0.026），性别和年龄分布、皮肤损害表现、合并其他结核情况等各指标差异均无统计学意义（P > 0.05）。118例CTB患者中，表现为单一皮肤损害患者占1.7%（2例），合并有肺结核和/或其他器官肺外结核的患者占98.3%（116例），合并其他结核患者中，肺结核、消化系统结核、浅表淋巴结结核、脊柱结核患者邻近部位CTB发生比例较高，分别为45.6%（52/114）、34.6%（9/26）、50.0%（8/16）、62.5%（10/16），且并发的CTB损害分别位于胸部、腹部、头面颈部和腰背部。肺部病原学检查阳性率32.2%（38/118），总体利福平耐药率7.1%（2/28）；皮肤病原学检查阳性率48.7%（19/39），皮肤组织病理学检查阳性率52.6%（10/19）；免疫学检查阳性率75.9%（41/54）。结论 CTB在所有结核病例中占比低，青少年男性患者多见，女性患者在26～35岁年龄段病例中占比最高；皮肤损害具有多态性，发生部位主要在胸部、腹部及四肢，且与邻近器官结核具有一定的相关性。

关键词: 结核, 皮肤, 流行病学, 年龄分布, 性别分布, 临床特征, 微生物敏感性试验, 诊断

Abstract: 【Abstract】 Objective To investigate the epidemiological and clinical characteristics of cutaneous tuberculosis （CTB）, to analyze the relationship between skin lesion sites and adjacent organ tuberculosis, and to provide a theoretical basis for the effective control of CTB. Methods Demographic data, clinical characteristics and accessory examination findings were retrospectively collected from CTB patients admitted to the Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University from January 2011 to December 2018. Analysis was carried out on the incidence of CTB among patients of different ages and genders, the relationship between skin lesion sites and other organ tuberculosis, and the positive rates of etiological and histopathological examinations. Results A total of 118 patients with CTB were included, accounting for 1.03%（118/11 460） of all tuberculosis patients, and 65 were confirmedly diagnosed with CTB. Among the 65 confirmed CTB patients, CTB mostly occurred in teenagers aged 14 - 25 years （15/65，23.1%）, the male-to-female ratio was 1.32∶1 （37∶28）, and the proportion of females was highest in the age group of 26 - 35 years （6/10）; skin lesions mainly occurred on the chest （29/65, 44.6%）, abdomen （13/65, 20.0%）, and limbs （10/65, 15.4%）, and mainly manifested as localized masses （41/65, 63.1%）, skin ulceration （16/65, 24.6%）, and skin itching （2/65, 3.1%）; 53 patients were clinically diagnosed with CTB, and there was a significant difference in the lesional sites between the patients diagnosed with confirmed CTB and those clinically diagnosed with CTB （χ2 = 13.42, P = 0.026）, while there were no significant differences in gender and age distribution, skin manifestations, or other tuberculosis comorbidities （all P > 0.05）. Among the 118 patients with CTB, 2 （1.7%） presented with a solitary skin lesion, while 116（98.3%） were accompanied by pulmonary tuberculosis and/or extrapulmonary tuberculosis in other organs; among patients with other tuberculosis, those with pulmonary tuberculosis, digestive tuberculosis, superficial lymph node tuberculosis and with spinal tuberculosis showed relatively high proportions of patients with adjacent CTB, which were 45.6% （52/114）, 34.6% （9/26）, 50.0% （8/16） and 62.5% （10/16） respectively, with the concurrent CTB lesions located on the chest, abdomen, head, face and neck, and waist and back respectively; the positive rate of pulmonary etiological examination was 32.2%（38/118）, and the overall rifampin-resistance rate was 7.1%（2/28）; the positive rates of skin etiological examination, skin histopathological examination and immunological examination were 48.7% （19/39）, 52.6%（10/19） and 75.9% （41/54）, respectively. Conclusion The proportion of CTB patients was relatively low among all tuberculosis cases; CTB was more common in male teenagers, and the proportion of females was highest in the age group of 26 - 35 years; CTB lesions were polymorphic and mainly occurred on the chest, abdomen and extremities; there was a certain correlation between CTB and adjacent organ tuberculosis.

Key words: Tuberculosis, cutaneous, Epidemiology, Age distribution, Sex distribution, Clinical characteristics, Microbial sensitivity tests, Diagnosis

引用本文

徐超 徐鹏 陈玲 贺仁忠. 118例皮肤结核患者皮肤损害部位与邻近器官结核的相关性分析[J]. 中华皮肤科杂志, 2024,57(11):1029-1036. doi:10.35541/cjd.20230707

Xu Chao, Xu Peng, Chen Ling, He Renzhong. Analysis of the relationship between skin lesion sites and adjacent organ tuberculosis in 118 patients with cutaneous tuberculosis[J]. Chinese Journal of Dermatology, 2024, 57(11): 1029-1036.doi:10.35541/cjd.20230707