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

doi:10.3760/cma.j.issn.1007-1245.2024.22.020

Abstract

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

摘要：

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χ²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。

关键词:

耐多药结核病, 计算机断层扫描, 转归, 危险因素

Zhang Zhifei, Chen Rui, Cao Zonghua, Zhang Quanwu, Gao Yu, Wang Zhiyong.

CT signs and risk factors of treatment outcomes in MDR-PTB patients [J]. International Medicine and Health Guidance News, 2024, 30(22): 3790-3795.

张志飞陈瑞曹宗华张权武高瑜王志永.

MDR-PTB患者CT征象及治疗转归的危险因素分析 [J]. 国际医药卫生导报, 2024, 30(22): 3790-3795.

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