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Pulmonary Function and Imaging Characteristics of Tuberculosis Associated Obstructive Pulmonary Disease Using
Propensity Score-matched Analysis WANG Yide，TIAN Zongxiang，LI Zheng，LI Fengsen *
The Fourth Clinical Medical College，Xinjiang Medical University，Urumqi 830000，China
*
Corresponding author：LI Fengsen，Professor，Chief physician；E-mail：fengsen602@163.com
【Abstract】 Background Studies on tuberculosis associated obstructive pulmonary disease（TOPD） are still scarce
in China，a country with a high burden of tuberculosis and chronic obstructive pulmonary disease（COPD）. Objective To
compare clinical features and pulmonary functions between TOPD and COPD，and to explore the relationship between imaging
features and pulmonary function in TOPD，aiming at providing information for improving clinicians' understanding of TOPD.
Methods A retrospective design was adopted. TOPD（n=387） and COPD（n=364） patients were recruited from the Fourth
Clinical Medical College of Xinjiang Medical University from January 2018 to November 2020. The TOPD patients were matched
with COPD patients at a ratio of 1 ∶ 2 using propensity score matching based on age，gender，ethnic group and other baseline
data. Clinical data and lung function indices （FEV 1 /FVC，FEV 1 %pre，and FVC%pre） were compared between the groups
before and after matching. Imaging manifestations of TOPD patients were further described. Spearman rank correlation analysis
was used to analyze the correlation of imaging features with lung function. Results The two matched groups had no significant
differences in sex ratio，mean age，and ethnic group distribution（P>0.05）. Compared to COPD patients，TOPD patients had
mean younger age of onset，longer mean length of hospital stay，and lower mean levels of FEV 1 /FVC，and FEV 1 %pre（P<0.05）.
Imaging examination showed that the sites of tuberculosis scar in TOPD patients were mostly in upper and lower lobes of the right
lung，and some patients had signs of emphysema and bronchiectasis to a certain extent. Spearman correlation analysis showed
that the number of lung lobes affected by tuberculosis was negatively correlated with FEV 1 /FVC，FEV 1 %pre，and FVC%pre
（r s =-0.202，P=0.011；r s =-0.456，P<0.001；r s =-0.442，P<0.001）. Conclusion Compared with COPD patients，TOPD
patients were characterized by younger age，longer hospital stay，and severer obstructive ventilatory disorder. In addition，lung
function decreased with the increase in the number of lobes affected by tuberculosis.
【Key words】 Tuberculosis associated obstructive pulmonary disease；Lung diseases，obstructive；Pulmonary
disease，chronic obstructive；Lung function；Respiratory function tests；Imaging；Propensity score

慢性阻塞性肺疾病（COPD）是一种常见的以持
本研究创新点：
续性呼吸道症状和气流受限为特征的慢性呼吸系统疾 （1）中国作为肺结核和慢性阻塞性肺疾病的高
病 ［1-2］ 。吸烟、生物质燃料暴露等是造成 COPD 的传 负担国家，结核相关阻塞性肺疾病（TOPD）造成的
统危险因素 ［3］ 。本课题组前期的一项流行病学调查显
危害很大。倾向性评分匹配法作为一种通过对组间协
示，肺结核病史同样是造成 COPD 患病风险增加的重 变量进行均衡调整的数据预处理方法，可以一定程度
要原因 ［4］ ，另有队列研究在调整了性别、年龄等混杂
均衡组间协变量差异。
因素后发现肺结核病史可作为气流阻塞性通气功能障 （2）本研究采用倾向性评分匹配法初步分析了
碍的独立预测因子，其相对危险度估计值为 1.37 ［5］ ；
TOPD 患者的临床、肺功能及影像学特征；肺功能与
阻塞性肺疾病负担研究（the burden of obstructive lung
影像学指标的相关性研究结果提醒临床防治肺结核的
disease，BOLD）也提示肺结核病史是患者晚年发生气 重要性，上述研究结果可为 TOPD 的早期防治提供理
流阻塞的重要危险因素 ［6］ 。2013 年 ALLWOOD 等 ［7］
论依据。
首次提出结核相关阻塞性肺疾病（tuberculosis associated
（3）本研究结果显示，与慢性阻塞性肺疾病
obstructive pulmonary disease，TOPD）的概念。世界卫
（COPD）患者相比，TOPD 患者具有年龄偏低、住
生组织统计显示 2000—2016 年约有 16% 结核病患者死 院时间更长、肺功能阻塞性通气功能障碍更甚等特点，
于 TOPD 等肺结核后遗症 ［8］ ，在全球范围尤其是对发
此外结核受累叶数与肺功能存在负相关关系。
展中国家造成了沉重的社会和经济负担。
作为肺结核和 COPD 的高负担国家，我国关于 1 对象与方法
TOPD 的临床研究和实验研究仍旧非常匮乏，对该病的 1.1 研究对象 回顾性分析新疆医科大学第四临床医
了解、认识和重视程度不够。为此，本研究拟对 TOPD 学院 2018 年 1 月至 2020 年 11 月临床诊断为 TOPD 的
相关临床资料进行回顾性分析，并采用倾向性评分匹配 患者（TOPD 组）387 例和 COPD 患者（COPD 组）364 例，
法均衡组间协变量差异以减少研究偏倚、提高研究效率， 其中 TOPD 组男 218 例，女 169 例；年龄 32~95 岁，平
旨在初步探索 TOPD 患者肺功能及影像学特征。 均年龄（73.3±10.3）岁。COPD 组男 249 例，女 115 例；