耐多药肺结核临床及影像特征分析  

Analysis of clinical and imaging features of multi-drug resistant pulmonary tuberculosis

作　　者：龚磊 何江涛 王珊珊 Gong Lei;He Jiangtao;Wang Shanshan(Department of Radiology,the Fourth People′s Hospital of Lianyungang,Lianyungang 222000,China;Department of Respirtory Medicine,the Fourth People′s Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]连云港市第四人民医院放射科,连云港222000 [2]连云港市第四人民医院呼吸科,连云港222000

出　　处：《实用医技杂志》2024年第8期544-548,共5页Journal of Practical Medical Techniques

基　　金：连云港市卫生科技项目(202337)。

摘　　要：目的分析耐药肺结核患者临床及影像特征,探讨其影响因素。方法收集2022年6月至2024年1月江苏省连云港市第四人民医院住院治疗的肺结核患者资料,依据药敏试验结果分为耐药组和敏感组,比较2组人口学资料、临床特征、实验室检查及影像学特征,并通过二项多因素logistic分析耐药性肺结核感染的影响因素。结果110例肺结核病患者中,耐药肺结核50例,药物敏感60例。临床特征分析发现耐药组复治、合并慢性阻塞性肺疾病(COPD)所占比例较敏感组高,差异有统计学意义(P<0.05)。CT图像分析表明耐药组空洞、支气管扩张较敏感组多见,而敏感组树芽征较耐药组发生率高,差异均有统计学意义(P<0.05)。二项logistic回归分析空洞[OR值(95%CI)=4.726(2.044,10.927),P<0.05]、合并COPD[OR值(95%CI)=2.888(1.012,8.244),P<0.05]是肺结核耐药的风险因素。结论患有COPD、发生空洞的肺结核患者是产生结核耐药的风险因素,临床上需全程督导管理,实行个性化的治疗方案,以提高耐药肺结核的治愈率。Objective To analyze the clinical and imaging features of patients with multi-drug resistant pulmonary tuberculosis,and to explore its influencing factors.Methods Pulmonary tuberculosis patients hospitalized in the Fourth People′s Hospital of Lianyungang City,Jiangsu Province from June 2022 to January 2024 were collected as the research subjects.According to the results of drug sensitivity test,they were divided into drug-resistant group and sensitive group.The demographic data,clinical characteristics,laboratory examination and imaging characteristics of the two groups were compared,and the influencing factors of drug-resistant pulmonary tuberculosis infection were analyzed by binomial multivariate logistic analysis.Results Among the 110 patients with pulmonary tuberculosis,50 were drug-resistant tuberculosis and 60 were drug-sensitive.The analysis of clinical characteristics showed that the proportion of retreatment and chronic obstructive pulmonary disease in the drug-resistant group was higher than that in the sensitive group,and the difference was statistically significant(P<0.05).CT image analysis showed that the cavity and bronchiectasis in the drug-resistant group were more common than those in the sensitive group,while the incidence of tree bud sign in the sensitive group was higher than that in the drug-resistant group,and the differences were statistically significant(P<0.05).Binary logistic regression analysis showed that cavity[OR(95%CI)=4.726(2.044,10.927),P<0.05]and chronic obstructive pulmonary disease[OR(95%CI)=2.888(1.012,8.244),P<0.05]were risk factors for drug resistance of pulmonary tuberculosis.Conclusion Patients with chronic obstructive pulmonary disease and cavitary pulmonary tuberculosis are risk factors for drug resistance to tuberculosis.Clinically,it is necessary to supervise the whole process and implement personalized treatment programs to improve the cure rate of multi-drug resistant tuberculosis.

关 键 词：结核分枝杆菌 广泛耐药结核 体层摄影术 螺旋计算机 

分 类 号：R521[医药卫生—内科学] R816.4[医药卫生—临床医学]