不同类型肺结核患者临床特征差异及其产生耐多药的危险因素分析

Analysis of clinical characteristics differences and risk factors for developing multidrug-resistant in patients with different types of pulmonary tuberculosis

目的探讨不同类型肺结核患者临床特征差异及其产生耐多药的危险因素。方法选取2021年6月至2022年6月安徽省胸科医院收治的240例肺结核患者进行回顾性分析,依照其类型不同分为新发型肺结核组(n=68)、复发型肺结核组(n=46)及慢性肺结核组(n=126)。对比3组患者临床表现及CT征象差异。随后对240例肺结核患者进行随访,对肺结核患者产生耐多药的因素进行单因素分析,并采用多因素Logistics回归模型分析肺结核产生耐多药的影响因素。结果3组患者多出现气管牵拉、咳嗽、全身乏力、胸部疼痛等典型症状,差异均无统计学意义(P>0.05);慢性肺结核组代偿性肺气肿、胸廓塌陷发生率均明显高于新发型肺结核组及复发型肺结核组,复发型肺结核组痰中带血发生率高于新发型肺结核组与慢性肺结核组,新发型肺结核组、复发型肺结核组发热均发生率高于慢性肺结核组,差异均有统计学意义(P<0.05)。慢性肺结核组厚壁空洞患者比例高于复发型肺结核组和新发型肺结核组,复发型肺结核组和新发型肺结核组节段性分布小叶中心结节影、毛玻璃阴影、树芽征患者比例均高于慢性肺结核组,新发型肺结核组肺实变患者比例高于复发型肺结核组及慢性肺结核组,差异均有统计学意义(P<0.05)。单因素分析结果显示,患者类型、既往规律抗结核治疗、肺结核空洞是肺结核患者产生耐多药的危险因素(P<0.05)。多因素Logistic回归分析结果显示,患者类型、肺结核空洞是肺结核患者产生耐多药的独立危险因素(P<0.05)。结论新发型、复发型及慢性肺结核患者气管牵拉、咳嗽、全身乏力、胸部疼痛等典型症状并无明显差异,但代偿性肺气肿、胸廓塌陷、痰中带血、发热等症状具有一定差异,3种不同类型肺结核CT征象具有显著差异,且复发型肺结核及肺结核空洞患者产生耐多药危险程度增加。

Objective To explore the differences in clinical characteristics and risk factors for developing multidrug resistance among patients with different types of pulmonary tuberculosis.Methods A retrospective analysis was conducted on 240 patients with pulmonary tuberculosis admitted to Anhui Chest Hospital from June 2021 to June 2022.They were divided into new onset pulmonary tuberculosis group(n=68),recurrent pulmonary tuberculosis group(n=46),and chronic pulmonary tuberculosis group(n=126)according to their different types.The clinical manifestations and CT features of the three groups of patients were compared.Subsequently,240 patients with pulmonary tuberculosis were followed up,and the factors contributing to the development of multidrug resistance in pulmonary tuberculosis patients were analyzed using univariate analysis,the independent risk factors for the development of multidrug resistance in pulmonary tuberculosis were analyzed using multivariate Logistic regression model.Results Three groups of patients often presented with typical symptoms such as tracheal traction,cough,general fatigue,and chest pain,and there were no statistically significant differences among the three groups(P>0.05).The incidence of compensatory emphysema and chest collapse in the chronic tuberculosis group were higher than those in the new and recurrent tuberculosis groups.The incidence of blood in sputum in the recurrent tuberculosis group was higher than that in the new and chronic tuberculosis groups,the incidence of fever in the recurrent pulmonary tuberculosis group was higher than that in the chronic pulmonary tuberculosis group,the differences were statistically significant(P<0.05).The number of thick walled space in the chronic pulmonary tuberculosis group was higher than that in the recurrent and new pulmonary tuberculosis groups,the number of segmental distribution lobular central nodular shadow,ground glass shadow,and tree bud sign in the recurrent and new pulmonary tuberculosis groups were higher than those in the chronic pulmonary tuberculosis group,the number of pulmonary consolidations in the newly diagnosed pulmonary tuberculosis group was higher than that in the recurrent pulmonary tuberculosis group and chronic pulmonary tuberculosis group,the differences were statistically significant(P<0.05).The results of univariate analysis showed that patient type,previous regular anti tuberculosis treatment,and pulmonary tuberculosis cavity were risk factors of the patients with pulmonary tuberculosis(P<0.05).The results of multivariate analysis showed that patient type and pulmonary tuberculosis cavity were independent risk factors for developing multidrug resistance in pulmonary tuberculosis patients(P<0.05).Conclusion There are no statistically significant differences in typical symptoms such as tracheal traction,cough,systemic fatigue,and chest pain among patients with new,recurrent,and chronic pulmonary tuberculosis.However,there are certain differences in symptoms such as compensatory emphysema,swelling,chest collapse,blood in sputum,and fever.The CT signs of the three different types of pulmonary tuberculosis show significant differences,and patients with recurrent pulmonary tuberculosis and tuberculosis cavities have an increased risk of developing multidrug-resistant diseases.