MDR-PTB患者CT征象及治疗转归的危险因素分析

CT signs and risk factors of treatment outcomes in MDR-PTB patients

目的分析耐多药肺结核(MDR-PTB)患者的计算机断层扫描(CT)征象及治疗转归的危险因素。方法回顾性分析2019年2月至2022年3月在陕西省结核病防治院接受治疗的84例MDR-PTB患者临床资料,其中男53例,女31例,年龄(38.52±6.707)岁。经标准化学治疗24个月后按临床治疗转归分为治疗有效组(完成治疗、治愈,57例)与治疗无效组(治疗失败,27例),同期选择84例非MDR-PTB患者为参照组。采用t检验对比参照组与MDR-PTB组治疗前的CT征象,采用χ^(2)检验对比MDR-PTB治疗有效组与治疗无效组临床资料,采用多因素logistic回归分析MDR-PTB患者治疗转归的影响因素。结果MDR-PTB组厚壁空洞、多发空洞、肺损毁、胸膜增厚、肺内播散、肺实变、钙化影、条索影、全肺受累发生率分别为53.57%(45/84)、57.14%(48/84)、9.52%(8/84)、66.67%(56/84)、72.62%(61/84)、58.33%(49/84)、59.52%(50/84)、53.57%(45/84)、29.76%(25/84),参照组分别为19.05%(16/84)、15.48%(13/84)、1.19%(1/84)、16.67%(14/84)、50.00%(42/84)、30.95%(26/84)、17.86%(15/84)、23.81%(20/84)、7.14%(6/84),差异均有统计学意义(均P<0.05);MDR-PTB组斑片影、间质病变及胸腔积液发生率分别为69.05%(58/84)、11.90%(10/84)、60.71%(51/84),参照组分别为61.90%(52/84)、9.52%(8/84)、55.95%(47/84),差异均无统计学意义(均P>0.05)。治疗有效组年龄<60岁、初治、初始痰涂片细菌等级≤2+、初始痰培养细菌等级≤2+、规范用药、治疗6个月后痰培养阴性、无多发空洞、无厚壁空洞、无全肺受累、无胸膜增厚、无肺实变、无钙化影率分别为61.40%(35/57)、66.67%(38/57)、70.18%(40/57)、73.68%(42/57)、78.95%(45/57)、71.93%(41/57)、52.63%(30/57)、56.14%(32/57)、87.72%(50/57)、40.35%(23/57)、49.12%(28/57)、49.12%(28/57),治疗无效组分别为25.93%(7/27)、37.04%(10/27)、44.44%(12/27)、33.33%(9/27)、48.15%(13/27)、40.74%(11/27)、22.22%(6/27)、25.93%(7/27)、33.33%(9/27)、15.52%(5/27)、25.93%(7/27)、22.22%(6/27),差异均有统计学意义(均P<0.05)。logistic回归分析结果显示,年龄、复治、初始痰培养细菌等级3级及以上、多发空洞、厚壁空洞、全肺受累均是MDR-PTB患者治疗转归的危险因素(均P<0.05),治疗6个月后痰培养阴性、规范用药均是患者治疗转归的保护因素(均P<0.05)。结论MDR-PTB患者CT征象具有病灶分布广、形态多样性等特点,其治疗转归受到多种因素的影响,临床应重视对相关因素的干预,改善患者的治疗转归。

Objective To analyze the computerized tomography(CT)features in patients with multidrug-resistant pulmonary tuberculosis(MDR-PTB)and the risk factors of treatment outcomes.Methods The clinical data of 84 MDR-PTB patients treated in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from February 2019 to March 2022 were retrospectively selected,including 53 males and 31 females,aged(38.52±6.70)years,and after standard chemotherapy treatment,they were divided into an effective treatment group(57 cases)and an ineffective treatment group(27 cases)according to clinical treatment outcomes.During the same period,84 non-MDR-PTB patients were retrospectively selected as the reference group.t test was used to compare the CT signs of the reference group and MDR-PTB group before treatment,χ^(2)test was used to compare the clinical data of MDR-PTB treatment effective and ineffective groups,and multivariate logistic regression analysis was used to analyze the influencing factors of treatment outcomes of the MDR-PTB patients.Results In the MDR-PTB group,the incidences of thick-walled cavity,multiple cavity,lung damage,pleural thickening,intrapulmonary spread,consolidation,calcification shadow,strip-cord shadow,and lung involvement were 53.57%(45/84),57.14%(48/84),9.52%(8/84),66.67%(56/84),72.62%(61/84),58.33%(49/84),59.52%(50/84),53.57%(45/84),and 29.76%(25/84),and those in the reference group were 19.05%(16/84),15.48%(13/84),1.19%(1/84),16.67%(14/84),50.00%(42/84),30.95%(26/84),17.86%(15/84),23.81%(20/84),and 7.14%(6/84),with statistically significant differences between the two groups(all P<0.05).The incidences of plaque,interstitial lesion,and pleural effusion were 69.05%(58/84),11.90%(10/84),and 60.71%(51/84)in the MDR-PTB group,and 61.90%(52/84),9.52%(8/84),and 55.95%(47/84)in the reference group,without statistically significant differences between the two groups(all P>0.05).In the effective treatment group,the rates of age<60 years old,initial treatment,initial sputum smear bacterial grade≤2+,initial sputum culture bacterial grade≤2+,standardized medication,negative sputum culture after 6 months of treatment,non-multiple cavities,nonthick-walled cavities,non-lung involvement,non-calcification,non-pleural thickness,and non-lung consolidation were 61.40%(35/57),66.67%(38/57),70.18%(40/57),73.68%(42/57),78.95%(45/57),71.93%(41/57),52.63%(30/57),56.14%(32/57),87.72%(50/57),40.35%(23/57),49.12%(28/57),and 49.12%(28/57),and those in the ineffective treatment group were 25.93%(7/27),37.04%(10/27),44.44%(12/27),33.33%(9/27),48.15%(13/27),40.74%(11/27),22.22%(6/27),25.93%(7/27),33.33%(9/27),15.52%(5/27),25.93%(7/27),and 22.22%(6/27),with statistically significant differences between the two groups(all P<0.05).Multivariate logistic regression analysis showed that age,retreatment,initial sputum culture bacteria grade 3 or above,multiple cavities,thick-walled cavities,and lung involvement were all risk factors for the treatment outcomes of MDR-PTB patients(all P<0.05),and negative sputum culture after 6 months of treatment and standardized medication were protective factors for the treatment outcomes of MDR-PTB patients(both P<0.05).Conclusions The CT signs of MDR-PTB patients are characterized by wide lesion distribution and morphological diversity.The treatment outcomes of MDR-PTB patients is affected by many factors,and clinical intervention on related factors should be paid attention to to improve the treatment outcomes.