Ⅲ期结核性脓胸继发胸廓塌陷畸形情况及相关影响因素分析  

Analysis of thoracic collapse deformity secondary to stageⅢtuberculous empyema and its related influencing factors

作　　者：刘鑫 仵倩红 陈其亮 郭乐 Liu Xin;Wu Qianhong;Chen Qiliang;Guo Le(Department of Tuberculosis Surgery,Shaanxi Provincial Tuberculosis Prevention and Control Hospital/Shaanxi Provincial Fifth People’s Hospital,Xi’an 710100,China;Shaanxi Second Provincial People’s Hospital(Shaanxi Province Geriatric Hospital),Xi’an 710005,China;Department of Tuberculosis,Shaanxi Provincial Tuberculosis Prevention and Control Hospital/Shaanxi Provincial Fifth People’s Hospital,Xi’an 710100,China)

机构地区：[1]陕西省结核病防治院/陕西省第五人民医院结核外科,西安710100 [2]陕西省第二人民医院(陕西省老年病医院),西安710005 [3]陕西省结核病防治院/陕西省第五人民医院结核内科,西安710100

出　　处：《结核与肺部疾病杂志》2024年第4期283-288,共6页Journal of Tuberculosis and Lung Disease

摘　　要：目的:分析Ⅲ期结核性脓胸继发胸廓塌陷畸形情况及相关影响因素。方法:采用回顾性研究方法,收集2019年1月1日至2023年9月30日陕西省结核病防治院收治的105例Ⅲ期结核性脓胸患者相关临床资料,包括患者性别、年龄、病程、治疗分类、NRS 2000营养评分、脓胸部位(左/右/双侧)、脓胸累及肋骨数、壁层胸膜厚度、胸腔引流、胸廓塌陷情况,以及是否耐药、吸烟、合并肺结核、合并糖尿病等,对患者是否发生胸廓塌陷进行单因素和二元logistic回归分析。结果:105例Ⅲ期结核性脓胸患者中,56例(53.33%)胸廓正常(胸廓正常组),49例(46.67%)发生胸廓塌陷(胸廓塌陷组)。单因素分析显示,胸廓塌陷组的年龄[29.0(23.0,41.5)岁]低于胸廓正常组[45.5(23.5,56.0)岁],病程[5.0(3.0,12.0)个月]、合并肺结核[83.67%(41/49)]、NRS 2000营养评分[3(2,3)分]、壁层胸膜厚度[3.15(2.30,4.73)mm]和脓胸累及肋骨数[6(5,8)根]均高于胸廓正常组[分别为3.0(1.0,6.0)个月、66.07%(37/56)、2(1,3)分、1.08(0.75,1.69)mm和4(3,4)根],差异均有统计学意义(Z=-2.041,P=0.041;Z=-2.302,P=0.021;χ^(2)=4.239,P=0.040;Z=-2.321,P=0.020;Z=-6.610,P<0.001;Z=-7.127,P<0.001)。二元logistic回归分析显示,年龄与Ⅲ期结核性脓胸继发胸廓塌陷呈负相关[OR(95%CI)=0.933(0.882~0.987),P=0.016],病程、NRS 2000营养评分、壁层胸膜厚度及脓胸累及肋骨数均与Ⅲ期结核性脓胸继发胸廓塌陷呈正相关[OR(95%CI)=1.122(1.006~1.251),P=0.039;OR(95%CI)=3.061(1.234~7.589),P=0.016;OR(95%CI)=3.001(1.256~7.174),P=0.013;OR(95%CI)=3.817(1.791~8.136),P=0.001]。结论:结核性脓胸继发胸廓塌陷畸形发生率较高,应尽早引流胸腔积液,并遵循“早期、联合、适量、规律、全程”的抗结核治疗原则,对低龄、病程较长、NRS 2000营养高评分、壁层胸膜厚度增加、脓胸累及肋骨数较多的患者予以关注,进一步降低胸廓塌陷的发生。Objective:To analyze the thoracic collapse deformity secondary to stageⅢtuberculous empyema and related influencing factors.Methods:A retrospective study was conducted to collect clinical data of 105 patients with stageⅢtuberculous empyema treated in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 1,2019 to September 30,2023,including patient’s gender,age,course of disease,treatment classification,NRS 2000 nutritional score,location of empyema(left/right/bilateral),number of ribs involved in empyema,thickness of parietal pleura,thoracic drainage,thoracic collapse,as well as drug resistance,smoking,complicated with/without pulmonary tuberculosis,diabetes,etc.The incidence of thoracic collapse was analyzed by univariable and multivariable logistic regression analysis.Results:Among 105 patients with stageⅢtuberculous empyema,56 cases(53.33%)had normal chest(normal chest group)and 49 cases(46.67%)had thoracic collapse(thoracic collapse group).Univariable analysis showed that the median age of the thoracic collapse group(29.0(23.0,41.5)years)was lower than that of the normal thoracic group(45.5(23.5,56.0)years),the median duration of disease(5.0(3.0,12.0)months),the proportion of combination with pulmonary tuberculosis(83.67%(41/49)),and the median NRS 2000 nutritional score(3(2,3)),the median parietal pleural thickness(3.15(2.30,4.73)mm))and the median number of ribs involved in empyema(6(5,8))were all higher than those in normal thoracic group(3.0(1.0,6.0)months,66.07%(37/56),2(1,3),1.08(0.75,1.69)mm and 4(3,4),respectively),the differences were all statistically significant(Z=-2.041,P=0.041;Z=-2.302,P=0.021;χ^(2)=4.239,P=0.040;Z=-2.321,P=0.020;Z=-6.610,P<0.001;Z=-7.127,P<0.001).Logistic regression analysis showed that age was negatively correlated with thoracic collapse secondary to stageⅢtuberculous empyema(OR(95%CI)=0.933(0.882-0.987),P=0.016).The course of disease,nutrition score of NRS 2000,thickness of parietal pleura and the number of ribs involved in empyema were posit

关 键 词：脓胸 结核性 胸部 肌肉骨骼畸形 因素分析 统计学 对比研究 

分 类 号：R561.6[医药卫生—呼吸系统]