耐多药结核病患者临床特征分析

Analysis of Clinical Characteristics of Patients with Multidrug-resistant Tuberculosis

目的 探讨耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者的临床特征。方法 选取2019年1~12月于新疆维吾尔自治区胸科医院住院确诊的61例维吾尔族MDR-TB患者为病例组,另选同期住院确诊的207例维吾尔族抗结核药物敏感结核病(drug-sensitive tuberculosis,DS-TB)患者为对照组,收集两组人口学特征、临床症状、影像学检查和结核分枝杆菌药敏试验结果等住院信息并进行回顾性分析。结果 MDR-TB患者呼吸道症状多以咳嗽、咳痰和胸闷气短为主,咳痰的发生率小于DS-TB组(χ^(2)=5.566,P<0.05),两组间其他主要临床症状的发生率差异均无统计学意义(P均>0.05)。影像学检查结果表明,两组患者肺部病变累及范围较为广泛,MDR-TB组患者肺部空洞发生率显著高于DS-TB组(χ^(2)=17.208,P<0.01)。MDR-TB组患者患有合并症45例(73.8%),两组在各种合并症患病率上比较,差异无统计学意义(P>0.05)。不同抗结核药物耐药关联性分析发现,MDR-TB患者对左氧氟沙星耐药和莫西沙星耐药有相关性,利福喷丁耐药和利福布汀耐药有相关性,r分别为0.85和0.66。结论 MDR-TB患者肺部病变累及范围较为广泛,肺部组织结构破坏严重,以空洞形成为主要方式。与DS-TB组相较,两组临床症状差异方面较少,提示临床特征不足以作为诊断MDR-TB及传播性的依据。

Objective To investigate the clinical characteristics of patients with multidrug-resistant tuberculosis(MDR-TB).Methods The 61 Uyghur MDR-TB patients diagnosed in Xinjiang Uygur Autonomous Region Chest Hospital from January to December 2019 were selected as the case group,and the 207 same-ethnic patients with drug-sensitive tuberculosis(DS-TB) who were hospitalized during the same period were selected as the control group.We collected and analyzed hospitalization information from the two groups,including demographic characteristics,clinical symptoms,imaging examinations and the results of Mycobacterium tuberculosis d rug susceptibility test,retrospectively.Results The respiratory symptoms of MDR-TB patients were mainly cough,sputum expectoration,chest tightness and shortness of breath.The incidence of sputum expectoration was lower than that of the DS-TB group(χ~2=5.566,P0.05).The results of the imaging examination showed that the lung lesions of the two groups were extensively involved.The incidence of pulmonary cavitation in the MDR-TB group was significantly higher than that in the DS-TB group(χ~2=17.208,P0.05).The correlation analysis of different anti-tuberculosis drug resistance found that levofloxacin and rifapentin resistance were related to moxifloxacin and rifabutin resistance in MDR-TB patients,and r were 0.85 and 0.66,respectively.Conclusion The lung lesions of the MDR-TB patients were extensively involved,and the lung structure was severely damaged by the formatting cavities mainly.Compared with the DS-TB group,there were fewer differences in clinical characteristics between the two groups,suggesting that clinical characteristics are not sufficient as evidence for the diagnosis and transmissibility of MDR-TB.