耐多药肺结核合并气管支气管结核的内镜特点分析

发布时间：2018-04-29 15:48

本文选题：结核 + 肺　；参考：《中国内镜杂志》2017年12期

【摘要】：目的探讨耐多药肺结核(MDR-TB)合并气管支气管结核(TBTB)的内镜特点。方法纳入广州市胸科医院2008年10月1日-2016年6月30日住院的MDR-TB患者248例为研究组,并选取2015年全年住院菌阳非MDR-TB患者274例为对照组,所有患者进行支气管镜检查、痰培养结核杆菌及异烟肼和利福平药物敏感性试验。分析支气管镜检查结果、人口资料。结果 248例MDR-TB患者,支气管镜检查诊断TBTB 175例(70.56%),无TBTB 73例(29.44%)。274例菌阳非MDR-TB患者支气管镜检查诊断TBTB 146例(53.28%),无TBTB 128例(46.72%),两组比较差异有统计学意义(χ~2=16.42、P=0.000)。MDR-TB合并TBTB中位年龄32岁,非MDR-TB合并TBTB中位年龄42岁,差异有统计学意义(U=9 932.00、P=0.001)。在MDR-TB患者中,TBTB侵犯右上支气管75例(42.86%)、左上支气管71例(40.57%),非MDR-TB患者中则为70例(47.95%)和60例(41.10%),差异无统计学意义(χ~2=2.44、P=0.786)。MDR-TB患者中TBTB的分型分别是炎症浸润型76例(43.43%)、溃疡坏死型11例(6.29%)、肉芽增殖型13例(7.43%)、疤痕狭窄型72例(41.14%)、管壁软化型3例(1.71%),淋巴结瘘型0例(0.00%),非MDR-TB中,TBTB分型依次是50例(34.25%)、41例(28.08%)、9例(6.16%)、40例(27.40%)、5例(3.43%)和1例(0.68%),差异有统计学意义(χ~2=30.50、P=0.000)。结论 MDR-TB合并TBTB有较高的检出率,常见青年患者,多侵犯右上支气管和左上支气管,以炎症浸润型和疤痕狭窄型为主,需要重视MDR-TB患者的支气管镜检查。
[Abstract]:Objective to investigate the endoscopic features of multi-drug resistant pulmonary tuberculosis (MDR-TB) combined with tracheobronchial tuberculosis (TBTB). Methods 248 MDR-TB patients hospitalized in Guangzhou chest Hospital from October 1, 2008 to June 30, 2016 were selected as study group and 274 non- patients as control group. Bronchoscopy was performed in all patients. Sputum culture of Mycobacterium tuberculosis and isoniazid and rifampicin drug sensitivity test. The results of bronchoscopy and demographic data were analyzed. Results in 248 patients with MDR-TB, TBTB was diagnosed by bronchoscopy in 175 cases (70.56), TBTB in 73 cases (29. 4444%). 274 cases of non MDR-TB patients with TBTB were diagnosed by bronchoscopy in 53.28 cases and TBTB 128 cases in 46.72 2 cases. The difference between the two groups was statistically significant (蠂 216.42 P0. 000). MDR-TB with TBTB was 32 years old. The median age of non MDR-TB patients with TBTB was 42 years old, the difference was statistically significant. In 75 cases of MDR-TB, 75 cases were involved in the right superior bronchus, 71 cases were involved in the left upper bronchus, and 70 cases were involved in the right superior bronchus, and 70 cases in the non-MDR-TB patients. There was no significant difference between the two groups (蠂 2 / 2. 4% P 0.786. MDR-TB). The types of TBTB in the patients with MDR-TB were inflammatory infiltration type (76 cases) and necrotic ulcer type (43.43%), and there was no significant difference between them (蠂 2 / 2 / 4 P = 0.786. MDR-TB). The TBTB was classified as inflammatory infiltrating type in 76 cases and necrotic ulcer type in 76 cases. There were 11 cases with 6.29m, 13 cases with proliferation of granulation, 71.14 with scar stenosis, 3 with softening of the wall, 0 with lymph node fistula, 50 with MDR-TB, 41 with 6.1608 and 40 with 6.4040, and 1 with 0.68. The difference was statistically significant (蠂 ~ 2 ~ (2) P ~ (30.50) P ~ (0.000) P ~ (0. 000) and 1 (n = 1) were significant (蠂 ~ (2) ~ (2) ~ (30.50) P ~ (0.000), respectively (P < 0.05), and the difference was significant (蠂 ~ (2 / 20) P ~ (0.50) P ~ (0.000) and 0.68 (P ~ (0.000) (P < 0.05), and there were significant differences between the two groups (蠂 ~ (2 +) ~ (30. 50) P ~ (0) 0.000). Conclusion the detection rate of MDR-TB combined with TBTB is high. The most common young patients involved in the right superior bronchus and left superior bronchus were mainly inflammatory infiltrating type and scar stenosis type. We should pay attention to the bronchoscopy of MDR-TB patients.
【作者单位】：广东省广州市胸科医院肺结核科;
【基金】：广州市医药卫生科技重大项目(No:20151A031002) 广州市科技局广州市临床医学研究与转换中心试点建设项目(No:155700012)
【分类号】：R521

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