Abstract: Background　Chronic kidney disease（CKD） patients are a major population prone to pulmonary tuberculosis due to decreased cellular and humoral immunity caused by pre-uremia immunosuppressive treatment and multiple factors in uremia.Hainan Province is a high incidence area of pulmonary tuberculosis in China，but there is lack of long-term pulmonary tuberculosis prevalence data among hemodialysis patients in this region.Objective　To investigate the epidemiological status and influencing factors of pulmonary tuberculosis in maintenance hemodialysis （MHD） patients in Hainan Province in 2017，to find a breakthrough in further tuberculosis prevention and control.Methods　Participants were 2 385 patients undergoing MHD in the blood purification center / room of 33 secondary and tertiary hospitals in Hainan during January 1 to December 30，2017.They were invited to attend a survey conducted by well-trained medical quality controllers from the blood purification center / room of the above-mentioned hospitals using a self-administered questionnaire developed by Hainan Provincial Blood Purification Quality Control Center for investigating their demographic and clinical as well as imaging data.The survey results were registered by the controllers.Results　A total of 1 917 responsive questionnaires were collected，obtaining a return rate of 80.37%.Of the 1 917 respondents，by chest CT scan，457 （23.84%） were detected with negative findings，336（17.53%） with inactive tuberculosis，1 045（54.51%） with suspected pulmonary tuberculosis，and 79（4.12%） with pulmonary tuberculosis.The results of chest CT scan varied significantly by sex，age，type of medical insurance，primary renal disease and geographical distribution （P<0.05）.The results of chest CT scan in age group of ≤44 years were significantly different from those of age groups of 45-59，60-74，and 75-89（P<0.05）.The results of chest CT scan showed a significant difference between age groups of 45-59 and 75-89（P<0.05）.The results of chest CT scan also demonstrated a significant difference between those with urban resident basic medical insurance and those with basic medical insurance for employees（P<0.05）.Those with primary glomerulonephritis-induced uremia showed significantly different results of chest CT scan compared with those with diabetic nephropathy-induced uremia（P<0.05）.Significantly different results of chest CT scan were found between patients from northern Hainan and those from eastern，southern and central Hainan（P<0.05），and between patients from eastern Hainan and those from southern and western Hainan（P<0.05），and between patients from southern Hainan and those from central Hainan（P<0.05），as well as between patients from western Hainan and central Hainan（P<0.05）.Age 〔OR=1.492，95%CI （1.303，1.709） 〕，geographical distribution 〔northern Hainan：OR=5.299，95%CI （3.493，8.038）；southern Hainan：OR=2.320，95%CI （1.469，3.663）；western Hainan：OR=3.817，95%CI （2.454，5.937）〕were factors associated with suspected pulmonary tuberculosis（P<0.05）.Age〔OR=1.373，95%CI （1.160，1.625）〕，geographical distribution 〔northern Hainan：OR=3.739，95%CI （2.219，3.299）；southern Hainan：OR=1.929，95%CI （1.079，3.448）；western Hainan：OR=2.332，95%CI （1.327，4.100）〕 were factors associated with inactive pulmonary tuberculosis （P<0.05）.Gender〔OR=2.073，95%CI （1.172，3.665）〕，age〔OR=1.944，95%CI （1.466，2.578）〕，geographical distribution〔northern Hainan：OR=5.103，95%CI （1.710，15.224）〕；southern Hainan：OR=4.650，95%CI（1.458，14.828）；western Hainan：OR=3.260，95%CI （1.004，10.579）〕were factors associated with pulmonary tuberculosis （P<0.05）.Conclusion　Chest CT scan showed that in Hainan in 2017，the prevalence of pulmonary tuberculosis was 4.12% in MHD patients.And MHD patients with suspected and confirmed pulmonary tuberculosis accounted for 56.83% of the total tuberculosis cases in the province.Oder age，male，and having medial insurance were associated with higher prevalence of pulmonary tuberculosis.Nephropathy-induced uremia increased the risk of having pulmonary tuberculosis compared with primary glomerulonephritis-induced uremia.Central Hainan was associated with lower risk of having pulmonary tuberculosis and suspected pulmonary tuberculosis.Age and geographical distribution were associated with suspected，and inactive as well as confirmed pulmonary tuberculosis.Moreover，sex was also associated with pulmonary tuberculosis，which also should be paid attention to.

Key words: Renal dialysis；Nephrosis；Tuberculosis, pulmonary；Tomography, spiral computed；Cross-sectional studies；Root cause analysis；Hainan

摘要： 背景　慢性肾脏病（CKD）患者进入尿毒症期前常因肾脏原发病接受免疫抑制剂治疗，而进入尿毒症期后多种原因可致其细胞免疫和体液免疫低下，是肺结核侵犯的主要人群。海南省属于中国肺结核高发地区，血液透析患者肺结核患病率数据长期缺如。目的　调查2017年海南省维持性血液透析（MHD）患者肺结核流行病学现状，并分析其影响因素，以寻找下一步结核病防控突破点。方法　选取2017-01-01至2017-12-30在海南省33家二级以上医院血液净化中心/室行MHD的患者2 385例为调查对象。由海南省血液净化质量控制中心统一制定调查表后发放给各医院血液净化中心/室的医疗质控员进行调查与数据资料登记。调查表包含患者一般资料、临床资料、影像学检查结果。按照患者胸部CT检查结果将其分为胸部CT正常患者、非活动性肺结核患者、疑似肺结核患者、肺结核患者。采用多因素Logistic回归分析探究MHD患者出现非活动性肺结核、疑似肺结核、肺结核的影响因素。结果　共发放问卷2 385份，回收有效问卷1 917份，有效回收率为80.37%。1 917例MHD患者中，胸部CT正常457例（23.84%），非活动性肺结核336例（17.53%），疑似肺结核1 045例（54.51%），肺结核79例（4.12%）。不同性别、年龄、医保类型、肾脏原发病、区域分布的MHD患者胸部CT检查结果比较，差异有统计学意义（P<0.05）。其中≤44岁MHD患者胸部CT检查结果与45~59、60~74、75~89岁患者比较，差异有统计学意义（P<0.05）；45~59岁MHD患者胸部CT检查结果与75~89岁患者比较，差异有统计学意义（P<0.05）。海南省城镇居民医疗保险MHD患者胸部CT检查结果与海南省从业人员医疗保险患者比较，差异有统计学意义（P<0.05）。以原发性肾小球疾病（PGN）为原发病的MHD患者胸部CT检查结果与以糖尿病肾病（DN）为原发病患者比较，差异有统计学意义（P<0.05）。北部区域MHD患者胸部CT检查结果与东部、南部、中部区域患者比较，差异有统计学意义（P<0.05）。东部区域MHD患者胸部CT检查结果与南部、西部区域患者比较，差异有统计学意义（P<0.05）。南部区域MHD患者胸部CT检查结果与中部区域患者比较，差异有统计学意义（P<0.05）。西部区域MHD患者胸部CT检查结果与中部区域患者比较，差异有统计学意义（P<0.05）。年龄〔OR=1.492，95%CI（1.303，1.709）〕、区域分布〔北部：OR=5.299，95%CI（3.493，8.038）；南部：OR=2.320，95%CI（1.469，3.663）；西部：OR=3.817，95%CI（2.454，5.937）〕是MHD患者出现疑似肺结核的影响因素（P<0.05）。年龄〔OR=1.373，95%CI（1.160，1.625）〕、区域分布〔北部：OR=3.739，95%CI（2.219，3.299）；南部：OR=1.929，95%CI（1.079，3.448）；西部：OR=2.332，95%CI（1.327，4.100）〕是MHD患者出现非活动性肺结核的影响因素（P<0.05）。性别〔OR=2.073，95%CI（1.172，3.665）〕、年龄〔OR=1.944，95%CI（1.466，2.578）〕、区域分布〔北部：OR=5.103，95%CI（1.710，15.224）；南部：OR=4.650，95%CI（1.458，14.828）；西部：OR=3.260，95%CI（1.004，10.579）〕是MHD患者出现肺结核的影响因素（P<0.05）。结论　2017年海南省MHD患者CT检查结果示肺结核患病率为4.12%，将CT检查结果中疑似肺结核和肺结核进行汇总，总的临床肺结核患病率为56.83%；且肺结核患病率在老年、男性、有居民医疗保险的MHD患者中较高，同时在不同原发病患者中，DN患者结核患病率显著高于PGN；海南省中部区域MHD患者肺结核、疑似肺结核患病率均为全省最低。年龄、区域分布是MHD患者出现疑似肺结核、非活动性肺结核、肺结核的影响因素，性别是MHD患者出现肺结核的影响因素，需引起重视。

关键词: 肾透析；肾病；结核, 肺；体层摄影术, 螺旋计算机；横断面研究；影响因素分析；海南