73例耐多药肺结核并发肺毁损的临床特征分析

Clinical features analysis of 73 cases of multidrug-resistant pulmonary tuberculosis complicated with pulmonary destruction

目的分析耐多药肺结核并发肺毁损的临床特征,为结核性毁损肺的诊治及防治提供依据。方法采用回顾性病例系列研究方法,选取从2013年1月—2017年12月来自15个省18家医院确诊的耐多药肺结核患者662例。其中,并发肺毁损患者73例(肺毁损组),未并发肺毁损患者589例(非肺毁损组),分析两组患者的人口学资料、实验室检查、耐药情况、结核病病史、中医证候积分、影像学表现及治疗结局等临床资料。结果肺毁损组患者的平均年龄高于非肺毁损组患者(P<0.05),农民占比高于非肺毁损组患者(P<0.05)。肺毁损组患者的白细胞计数升高、红细胞沉降率加快占比均高于非肺毁损组患者(P<0.05)。两组耐药率比较,差异无统计学意义(P>0.05)。肺毁损组患者的肺结核初次诊断到耐多药肺结核初次诊断时间、耐多药肺结核初次诊断到耐多药肺结核治疗的时间均长于非肺毁损组患者(P<0.05)。肺毁损组患者咳嗽、咳痰、胸痛、气短及潮热等症状严重于非肺毁损组患者(P<0.05)。肺毁损组患者的病灶平均肺叶受累数量多于非肺毁损组患者(P<0.05)。肺毁损组患者的治愈率低于非肺毁损组患者(P<0.05)。结论关注伴有毁损肺高危因素(农民、中年、诊断治疗延迟、肺叶病变广泛等)的耐多药肺结核患者,加强抗结核全程督导治疗,减少肺毁损的发生,提高治愈率。

Objective To analyze the clinical characteristics of multidrug-resistant pulmonary tuberculosis(MDR-TB)complicated by pulmonary destruction,providing insights for the diagnosis,treatment,and prevention of tuberculous destructive lung disease.Methods A retrospective case series study was conducted,selecting 662 patients diagnosed with MDR-TB from January 2013 to December 2017 across 18 hospitals in 15 provinces.Among these,73 patients with concurrent pulmonary destruction(pulmonary destruction group)and 589 patients without pulmonary destruction(non-pulmonary destruction group)were included.Demographic data,laboratory tests,drug resistance,tuberculosis history,Traditional Chinese Medicine syndrome scores,radiological findings,and treatment outcomes were analyzed.Results The average age in the pulmonary destruction group was significantly higher than that in the non-pulmonary destruction group(P<0.05).A higher proportion of patients in the pulmonary destruction group were farmers(P<0.05).Elevated white blood cell counts and accelerated erythrocyte sedimentation rates were more common in the pulmonary destruction group(P<0.05).No significant difference in drug resistance rates was observed between the groups(P>0.05).Time from initial diagnosis of tuberculosis to first diagnosis of MDR-TB and from first diagnosis of MDR-TB to treatment initiation was longer in the pulmonary destruction group(P<0.05).Symptoms such as cough,sputum production,chest pain,dyspnea,and fever were more severe in the pulmonary destruction group(P<0.05).The average number of affected lung lobes was greater in the pulmonary destruction group(P<0.05).The cure rate was lower in the pulmonary destruction group(P<0.05).Conclusions Attention should be given to MDR-TB patients with high-risk factors for pulmonary destruction,such as being middle-aged farmers,experiencing delays in diagnosis and treatment,and extensive lung lobe involvement.Strengthening supervised antituberculosis treatment throughout can reduce the occurrence of pulmonary destruction and improve cure rates.