复治菌阴肺结核的临床特点分析  

Clinical characteristics of retreated bacterial negative pulmonary tuberculosis patients

作　　者：程武[1] 谭守勇[1] 李艳[1] 李琼 CHENG Wu;TAN Shou-yong;LI Yan;LI Qiong(State Key Laboratory of Respimtoiy Disease,Department of Tuberculosis in Guangzhou Chest Hospitals Guangzhou 510095,China)

机构地区：[1]广州市胸科医院结核内科/呼吸疾病国家重点实验室,510095

出　　处：《中国防痨杂志》2021年第10期1006-1009,共4页Chinese Journal of Antituberculosis

摘　　要：目的分析复治菌阴肺结核的临床特点,以提高其诊断水平。方法采用回顾性研究方法,选取2020年2月1日至7月31日于广州市胸科医院诊断并住院治疗的201例复治肺结核患者为研究对象,根据其治疗前分泌物抗酸杆菌涂片或培养是否阳性分为菌阳组(146例)和菌阴组(55例)。收集研究对象的既往治疗情况及本次治疗的临床资料,对菌阴组和菌阳组研究对象的年龄、性别、治疗史、耐药情况、临床症状、影像学检查结果及并发症情况进行对比分析。结果 (1)治疗史:201例研究对象中,停药后需再次治疗者148例(73.6%),初始治疗失败者53例(26.4%)。停药后需再次治疗者中,菌阳组有110例(75.3%),菌阴组有38例(69.1%),两组分布的差异无统计学意义(χ^(2)=0.804,P=0.375)。(2)临床症状:菌阴组有咳嗽症状者占100.0%(55例),明显高于菌阳组[127例(87.0%)],差异有统计学意义(χ^(2)=7.905,P=0.005)。菌阴组出现结核中毒症状者占25.5%(14例),明显低于菌阳组的41.8%(61例),差异有统计学意义(χ^(2)=4.553,P=0.033)。(3)影像学表现:菌阴组肺部病灶内空洞≥3个者占23.6%(13/55),明显低于菌阳组的53.4%(78/146),差异有统计学意义(χ^(2)=14.308,P<0.001)。(4)并发症:两组并发支气管结核均以瘢痕狭窄型为主,菌阴组占85.7%(12/14),明显高于菌阳组的60.0%(33/55),差异有统计学意义(χ^(2)=3.996,P=0.046)。菌阴组血清白蛋白≤40g/L者占29.1%(16/55),明显低于菌阳组的54.1%(79/146),差异有统计学意义(χ^(2)=10.033,P=0.002)。结论相比于复治菌阳肺结核,复治菌阴肺结核患者咳嗽症状更多见、结核中毒症状较轻、更少发生广泛空洞及低蛋白血症,但并发瘢痕狭窄型支气管结核更为多见。Objective To analyze the clinical characteristics of retreated bacterial negative pulmonary tuberculosis in order to improve the diagnosis. Methods A retrospective study was conducted in 201 patients with retreated pulmonary tuberculosis diagnosed and hospitalized in Guangzhou Chest Hospital from February 1,2020 to July 31,2020.According to the results of the acid-fast bacilli smear or culture of secretions before treatment,these patients were divided into bacterial positive group(n=146)and bacterial negative group(n=55).The treatment history and clinical data were collected,age,gender,treatment history,drug resistance,clinical symptoms,imaging findings and complications in the two groups were compared. Results(1)Treatment history:among the201 subjects,148(73.6%)patients needed retreatment after drug withdrawal,and 53(26.4%)patients failed in the initial treatment.Of the 148 patients needed retreatment,110(75.3%)in bacterial positive group and38(69.1%)in bacterial negative group,the difference of distribution was no statistically significant(χ^(2)=0.804,P=0.375).(2)Clinical symptoms:cough were found 100.0%(n=55)in the bacteria negative group,significantly higher than that in the bacteria positive group(n=127,87.0%)(χ^(2)=7.905,P=0.005).Fourteen(25.5%)patients in bacterial negative group were found with symptoms of tuberculosis poisoning,significantly lower than that in bacterial positive group(n=61,41.8%)(χ^(2)=4.553,P=0.033).(3)Imaging findings:23.6%(13/55)in bacterial negative group had ≥3 cavities in lung lesions,significantly lower than that in bacterial positive group(53.4%,78/146)(χ^(2)=14.308,P<0.001).(4)Complications:the main type of bronchial tuberculosis in the two groups was scar stenosis.It occurred in 85.7%(12/14)patients of the bacterial negative group,significantly higher than in the bacterial positive group(60.0%,33/55)(χ^(2)=3.996,P=0.046).Serum albumin≤40 g/L in 29.1%(16/55)patients in bacterial negative group,significantly lower than in bacterial positive group(54.1%,79/146)(χ^(2)=10.

关 键 词：结核 肺 再治疗 疾病特征 对比研究 

分 类 号：R521[医药卫生—内科学]