初治肺结核合并气管支气管结核痰菌阴转及其危险因素分析  

Analysis of the sputum negative conversion rate and risk factors for primary pulmonary tuberculosis with tracheobronchial tuberculosis

作　　者：邝浩斌[1] 梁敏青[1] 方琼[1] 何桥[1] 程武[1] 邝小佳[1] 廖锦良[1] 谭守勇[1] 

机构地区：[1]广州市胸科医院肺结核科呼吸疾病国家重点实验室,510095

出　　处：《中国防痨杂志》2013年第10期812-815,共4页Chinese Journal of Antituberculosis

基　　金：广东省医学科研项目(A2011497);广州市卫生局科研项目(201102A213156)

摘　　要：目的分析初治肺结核合并气管支气管结核（tracheobronchialtuberculosis，TBTB）的痰菌阴转及其影响因素。方法2011年7月至2012年2月广州市胸科医院住院的初治肺结核患者，经支气管镜检查明确合并TBTB患者共205例，统=予以2-3HRZE／9-10HR治疗，同时根据患者TBTB的不同分型等具体情况进行相应的支气管镜介入治疗，随访6个月以上，分析痰菌2个月末和6个月末的阴转情况，及采用logistic向后逐步删除法多因素回归分析影响阴转的危险因素。结果本组患者2个月末痰菌阴转率为59．0％（121／205）；6个月末痰菌阴转率为90．2％（185／205）。logistic多因素分析显示2个月末痰菌未阴转的危险因素为年龄（OR=1．013，P=0．061，95％CI=0．992～1．035）、病灶范围（OR=2．012，P=0．022，95％CI=0．948～4．273）、空洞数量（OR=1．655，P=0．031，95％ CI=1．116～2．453）和耐药程度（OR=1．298，P=0．047，95％CI=0．7962～2．117）；6个月末痰菌未阴转的危险因素是耐药程度（OR=1．452，P=0．022，95％CI=0．818～2．575）和2个月末检查痰菌阳性（OR=18241．990，P=0．008，95％CI=0．0006．4×10^8）。结论初治肺结核并TBTB2个月末痰菌阴转率偏低，需加强治疗管理，提高依从性。年龄、病灶范围、空洞数量和耐药程度是第2个月末痰菌未阴转的危险因素，耐药程度和2个月末痰菌阳性是6个月末痰菌未阴转的危险因素。Objective To explore the sputum negative conversion rate and risk factors of curative effect for pulmonary tuberculosis （PTB） with tracheobronchial tuberculosis （TBTB）. Methods Two hundred and five pri- mary PTB cases with TBTB were confirmed by bronchoscopy in Guangzhou Chest Hospital from Jul 2011 to Feb 2012, all of whom received chemotherapy of 2-3HRZE/9-10HR and different transbronchoscopic interventional therapy according to TBTB types. After more than 6 months＇ following-up, the sputum negative conversion rates after 2 months treatment and 6 months treatment were analyzed, and risk factors were also analyzed by backward lo- gistic regression analysis. Results After the treatment of 2 months and 6 months, the sputum negative conversion rate were 59.0% （121/205） and 90.20/00 （185/205） respectively. Multiple-factor logistic regression analysis showed that age （OR=1.013, P=0.061, 95%CI=0.992 1.035）, lesion range （OR=2.012, P=0.022, 95% CI=0.948- 4.273）, number of cavity （OR=1.655, P=0.031, 95% CI=1.116 2.453） and drug resistance （OR=1.298, P= 0. 047, 95% CI = 0. 7962-- 2.117） were risk factors of sputum non-negative conversion after 2 months＇ treat- ment. The drug resistance （OR= 1. 452, P=0. 022,95%CI=0. 818--2. 575） and sputum positive after 2 months＇ treatment （ORal8 241. 990, P=0. 008, 95%CI=0. 000--6.4×10^8） were the risk factors of sputum positive after 6 months＇ treatment. Conclusion The sputum negative conversion rate is relatively low for PTB with TBTB after 2 months＇ treatment. It needs to intensify treatment and management and improve treatment compliance. The risk factors of sputum non-negative conversion after 2 months＇ treatment were age, lesion range, number of cavity and drug resistance, while those after 6 months＇ treatment were drug resistance and sputum positive after 2 months＇ treatment.

关 键 词：结核 肺 并发症 结核 肺 药物疗法 结核  支气管 药物疗法 结核  气管 药物疗法 支 气管镜检查 危险因素 

分 类 号：R521[医药卫生—内科学]