tbjournalТуберкулез и социально значимые заболеванияTuberculosis and socially significant diseases2413-03462413-0354ООО «Ин-Тренд10.54921/2413-0346-2025-13-4-15-21tbjournal-629Research ArticleЭПИДЕМИОЛОГИЯ ТУБЕРКУЛЕЗАТуберкулез у больных со злокачественными новообразованиями различной локализации – опыт Центрального научно-исследовательского института туберкулезаTuberculosis in patients with malignant neoplasms of various localizations – the experience of the Central Research Institute of Tuberculosishttps://orcid.org/0000-0001-9337-3903КарпинаН. Л.KarpinaN. L.

Карпина Наталья Леонидовна – заместитель директора по научной работе

доктор медицинских наук, доцент

107564, г. Москва, Яузская ал., д. 2 Тел. +7 (499) 785-91-59

Moscow

karpina@rambler.ruhttps://orcid.org/0000-0002-5385-1808ШабалинаИ. Ю.ShabalinaI. Yu.

Шабалина Ирина Юрьевна – ведущий научный сотрудник Центра диагностики и реабилитации заболеваний органов дыхания, врач-эндоскопист

доктор медицинских наук

107564, г. Москва, Яузская ал., д. 2 Тел. +7 (499) 785-30-23

Moscow

bronholog@yandex.ruhttps://orcid.org/0009-0001-4254-5143КолесниковаМ. А.KolesnikovaM. A.

Колесникова Марина Андреевна – врач-фтизиатр Центра диагностики и реабилитации заболеваний органов дыхания, аспирант III года обучения

107564, г. Москва, Яузская ал., д. 2 Тел. +7 (499) 785-90-26

Moscow

kolesnikovam727@gmail.comФГБНУ «Центральный научно-исследовательский институт туберкулеза»РоссияFederal State Budgetary Scientific Institution «Central Research Institute of Tuberculosis»Russian Federation2025110520261341521Copyright © Карпина Н.Л., Шабалина И.Ю., Колесникова М.А., 20262026Карпина Н.Л., Шабалина И.Ю., Колесникова М.А.Karpina N.L., Shabalina I.Y., Kolesnikova M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tb-journal.ru/jour/article/view/629

Цель исследования. Проанализировать спектр клинических форм туберкулеза органов дыхания (ТОД) у пациентов со злокачественными новообразованиями (ЗНО) различной локализации, определить зависимость от периода течения и лечения онкологического процесса, а также оценить относительный риск развития туберкулеза внутри данной когорты.Материалы и методы. В период 2018–2025 гг. на базе ФГБНУ «ЦНИИТ» проведено одноцентровое когортное исследование с включением 61 пациента с верифицированным ТОД и ЗНО. Применяли комплексный диагностический алгоритм, включавший клинико-лабораторное обследование, лучевую диагностику, иммунодиагностику туберкулеза, микробиологические и молекулярно-генетические методы.Результаты. В 90,2% случаев ЗНО имели внелегочную локализацию, наиболее часто встречались рак молочной железы (36,1%), лимфомы (16,5%) и опухоли ЖКТ (14,8%). Среди клинических форм ТОД преобладали инфильтративный (29,5%) и очаговый (24,6%) туберкулез, туберкулез внутригрудных лимфатических узлов (13,1%). У 49,2% пациентов зарегистрирован рецидив ТБ. У 60,7% пациентов ТБ был диагностирован в период ремиссии ЗНО после завершения противоопухолевой терапии. Наибольший относительный риск развития ТОД был ассоциирован с комбинированной химио- и лучевой терапией: RR = 2.8, по сравнению с лучевой терапией, RR = 2.3, по сравнению с химиотерапией, и RR = 2.5, по сравнению с хирургическим лечением (p < 0.05). Перед началом противоопухолевого лечения ни один пациент не был проконсультирован фтизиатром.Заключение. Пациенты с ЗНО, особенно получающие комбинированное противоопухолевое лечение, представляют собой группу высокого риска развития и рецидива туберкулеза, в том числе в периоде ремиссии онкологического заболевания. Необходимы интеграция онкологической и фтизиатрической служб, внедрение обязательного скрининга на туберкулез перед противоопухолевой терапией, индивидуализированных алгоритмов наблюдения, что будет способствовать ранней диагностике туберкулеза, своевременному началу лечения и, как следствие, улучшению прогноза у пациентов с сочетанной патологией.

The aim of the study was to analyze the spectrum of clinical forms of respiratory tuberculosis (RTB) in patients with malignant neoplasms (MN), determine the relationship between the oncological course and treatment period, and assess the relative risk of developing RTB within this cohort.Methods. A single-center cohort study was conducted between 2018 and 2025 at the Central Research Institute of Tuberculosis including 61 patients with verified RTB and MN. A comprehensive diagnostic algorithm was used, including clinical laboratory examination, imaging, TB immunodiagnostics, microbiological, and molecular genetic methods.Results. In 90.2% of cases, malignant neoplasms had extrathoracic localization; the most common were breast cancer (36.1%), lymphomas (16.5%) and gastrointestinal tumors (14.8%). Among the clinical forms of RTB, infiltrative (29.5%), focal (24.6%) TB and TB of the intrathoracic lymph nodes (13.1%) prevailed. Relapse of TB was registered in 49.2% of patients. In 60.7% of patients, RTB was diagnosed during the period of remission of malignant neoplasms after completion of antitumor therapy. The highest relative risk of developing RTB was associated with combined chemo- and radiation therapy: RR = 2.8 compared with radiation therapy, RR = 2.3 compared with chemotherapy and RR = 2.5 compared with surgical treatment (p< 0.05). Before starting antitumor treatment, not a single patient was consulted by a TB specialist.Conclusion. Patients with malignant neoplasms, especially that receiving combination anticancer therapy, represent a high-risk group for the development and recurrence of tuberculosis, including during cancer remission. Integration of oncology and phthisiology services, the implementation of mandatory tuberculosis screening before anticancer therapy, and individualized monitoring algorithms are necessary to facilitate early TB diagnosis, timely initiation of treatment and an improved prognosis in patients with comorbidities.

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The authors declare that there are no conflicts of interest present.