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。
Objective To explore the endoscopic characteristics of multidrug-resistant tuberculosis(MDR-TB)combined with tracheobronchial tuberculosis(TBTB).Methods248MDR-TB as study group,they hospitalized from October1st2008to June31st,2016.274cases of non MDR-TB with bacteria positive as control group over2015,all of them received bronchoscopy,sputum cultured and drug sensitivity tested of Isoniazid and Rifampicin.We analyzed the results of bronchoscopy and demographic data.Results248cases of MDR-TB patients,of175(70.56%)were diagnosed TBTB by bronchoscopy,of73(29.44%)without TBTB.274cases of non MDR-TB with bacteria positive patients,of146(53.28%)were diagnosed TBTB,of128(46.72%)non TBTB,the difference of comparisons was statistically significant(χ2=16.42,P=0.000).MDR-TB combined with TBTB median age was32years,non MDR-TB combined with TBTB median age42years,the difference was statistically significant(U=9932.00,P=0.001).Among the MDR-TB patients,of75(42.86%)TBTB in the upper right bronchial,of71(40.57%)upper left bronchus,while non MDR-TB patients,of70(47.95%)and60(41.10%),there was no statistically significant difference(χ2=2.44,P=0.786).Among the MDR-TB,of76(43.43%)were inflammation infiltration type,of11(6.29%)were necrosis type,of13cases(7.43%)granulation proliferative type,of72(41.14%)were scar stricture type,of3(1.71%)tube wall softening type.Among the non MDR-TB,in turn,TBTB type were50(34.25%),41(28.08%),9(6.16%),40(27.40%),5(3.43%),the difference were statistically significant(χ2=30.50,P=0.000).Conclusions The detection rate of TBTB was higher in MDR-TB patients,that common occur in younger patients.TBTB common infringe on upper right bronchial and upper left bronchus,TBTB type most are inflammatory infiltration type and scar stricture type.More attention should be paid to bronchoscopy among MDRTB patients.
作者
邝浩斌
梁敏青
袁园
谢艺开
覃红娟
冯治宇
叶锦泉
张宏
谭守勇
Hao-bin Kuang;Min-qing Liang;Yuan Yuan;Yi-kai Xie;Hong-juan Qin;Zhi-yu Feng;Jin-quan Ye;Hong Zhang;Shou-yong Tan(Department of Pulmonary Tuberculosis, Guangzhou Chest Hospital,Guangzhou, Guangdong 510095, China)
出处
《中国内镜杂志》
北大核心
2017年第12期32-35,共4页
China Journal of Endoscopy
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)
关键词
结核
肺
抗多种药物性
气管支气管结核:支气管镜
tuberculosis
pulmonary
multidrug-resistant
tracheobronchial tuberculosis
bronchoscopy
