| 黄 宁,朱新进,黄建桂,左金宝,罗俊楠,袁应鑫.耐多药肺结核患者的胸部CT征象分析及其治疗转归的影响因素探讨[J].,2023,(6):1071-1075 |
| 耐多药肺结核患者的胸部CT征象分析及其治疗转归的影响因素探讨 |
| Analysis of Chest CT Signs of Multidrug-Resistant Pulmonary Tuberculosis Patients and Discussion of Influencing Factors on Treatment Outcome |
| 投稿时间：2022-09-21 修订日期：2022-10-17 |
| DOI：10.13241/j.cnki.pmb.2023.06.014 |
| 中文关键词: 耐多药肺结核 胸部CT征象 治疗转归 影响因素 |
| 英文关键词: Multidrug-resistant pulmonary tuberculosis Chest CT signs Treatment outcome Influence factor |
| 基金项目:广东省自然科学基金项目（2019A15150010915） |
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| 中文摘要: |
| 摘要 目的：分析耐多药肺结核（MDR-PTB）患者的胸部计算机断层扫描（CT）征象，并探讨其治疗转归的影响因素。方法：选取2017年1月~2020年10月期间东莞市第六人民医院收治的MDR-PTB患者（n=138）作为观察组，另选取东莞市第六人民医院同期收治的非MDR-PTB患者110例作为对照组，对比两组的胸部CT征象。观察组患者接受标准化方案治疗，按照是否治疗成功将其分为成功组（n=78）和失败组（n=60），根据病历资料获取患者的临床资料，采用单因素和多因素Logistic分析MDR-PTB患者治疗转归的影响因素。结果：病变分布范围中：观察组的2个肺叶及以下例数占比低于对照组，全部肺叶侵犯例数占比高于对照组（P<0.05），两组3个肺叶例数占比组间对比无统计学差异（P>0.05）。病变形态中：两组的多发空洞、合并支扩、合并气胸、实变、多发播散结节、条索、合并毁损、胸膜增厚例数占比组间对比有统计学差异（P<0.05）。而两组胸腔积液、斑片例数占比组间对比无统计学差异（P>0.05）。单因素分析显示，MDR-PTB患者的治疗转归与存在药物不良反应、病变分布范围、既往使用二线抗结核药物史、治疗6个月后痰细菌学转阴、规律服药、初始痰涂片等级有关（P<0.05）。多因素Logistic回归分析显示，既往使用二线抗结核药物史、存在药物不良反应、初始痰涂片等级为++ ~++++是MDR-PTB患者治疗转归的危险因素，而规律服药、治疗6个月后痰细菌学转阴是其保护因素（P<0.05）。结论：MDR-PTB患者病变范围较广，肺叶受累数量多，且易出现肺实质损害。同时存在药物不良反应、规律服药、既往使用二线抗结核药物史、初始痰涂片等级、治疗6个月后痰细菌学转阴是MDR-PTB患者治疗转归的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the chest computed tomography (CT) signs of multidrug-resistant pulmonary tuberculosis (MDR-TB) patients, and to explore the influencing factors of its treatment outcome. Methods: 138 cases of MDR-PTB patients who were admitted to Dongguan Sixth People's Hospital from January 2017 to October 2020 were selected as the observation group, and 110 non-MDR-PTB patients who were admitted to Dongguan Sixth People's Hospital during the same period were selected as the control group. The chest CT signs in the two groups were compared. The patients in the observation group received standardized treatment, and they were divided into success group (n=78) and failure group (n=60) according to the success of treatment. The clinical data of patients were obtained according to the medical records, and the influencing factors of treatment outcome of MDR-PTB patients were analyzed by univariate and multivariate Logistic analysis. Results: In the distribution of lesions, the proportion of cases with 2 lobes and below in the observation group was lower than that in the control group, and the proportion of cases with all lobes invasion was higher than that in the control group (P<0.05). There was no statistically significant difference in the proportion of cases with 3 lobes in the two groups (P>0.05). In the morphology of lesions, there were statistically significant differences in the proportion of cords, consolidation, multiple disseminated nodules, multiple cavities, combined with branching, combined with damage, combined with pneumothorax, and pleural thickening in the two groups (P<0.05). There were no statistically significant differences in the proportion of plaques and pleural effusion in the two groups (P>0.05). Univariate analysis showed that the treatment outcome of MDR-PTB patients was related to the history of previous use of second-line anti-tuberculosis drugs, distribution of lesions, regular medication, presence of adverse drug reactions, sputum bacteriology turning negative at 6 months after treatment, and initial sputum smear grade (P<0.05). Multivariate Logistic regression analysis showed that history of using second-line anti-tuberculosis drugs, presence of adverse drug reactions and initial sputum smear grade of ++ ~++++ were risk factors for treatment outcome of MDR-PTB patients, while regular medication and sputum bacteriology turning negative at 6 months after treatment were protective factors (P<0.05). Conclusion: MDR-PTB patients have a wide range of lesions, a large number of lung lobes are involved, and are prone to lung parenchymal damage. At the same time, history of previous use of second-line anti-tuberculosis drugs, regular medication, presence of adverse drug reactions, sputum bacteriology turning negative at 6 months after treatment, and initial sputum smear grade are the influencing factors of treatment outcome in MDR-PTB patients. |
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