关键词:

耐多药结核病, 计算机断层扫描, 转归, 危险因素

Abstract:

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, χ² 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, non- thick-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.

Key words:

Multidrug-resistant pulmonary tuberculosis, Computerized tomography, Outcomes, Risk factors