初治肺结核合并气管支气管结核痰菌阴转及其危险因素分析

目的分析初治肺结核合并气管支气管结核(tracheobronchial tuberculosis,TBTB)的痰菌阴转及其影响因素。方法2011年7月至2012年2月广州市胸科医院住院的初治肺结核患者,经支气管镜检查明确合并TBTB患者共205例,统一予以2³HRZE/93HRZE/9¹0HR治疗,同时根据患者TBTB的不同分型等具体情况进行相应的支气管镜介入治疗,随访6个月以上,分析痰菌2个月末和6个月末的阴转情况,及采用logistic向后逐步删除法多因素回归分析影响阴转的危险因素。结果本组患者2个月末痰菌阴转率为59.0%(121/205);6个月末痰菌阴转率为90.2%(185/205)。logistic多因素分析显示2个月末痰菌未阴转的危险因素为年龄(OR=1.013,P=0.061,95%CI=0.99210HR治疗,同时根据患者TBTB的不同分型等具体情况进行相应的支气管镜介入治疗,随访6个月以上,分析痰菌2个月末和6个月末的阴转情况,及采用logistic向后逐步删除法多因素回归分析影响阴转的危险因素。结果本组患者2个月末痰菌阴转率为59.0%(121/205);6个月末痰菌阴转率为90.2%(185/205)。logistic多因素分析显示2个月末痰菌未阴转的危险因素为年龄(OR=1.013,P=0.061,95%CI=0.992¹.035)、病灶范围(OR=2.012,P=0.022,95%CI=0.9481.035)、病灶范围(OR=2.012,P=0.022,95%CI=0.948⁴.273)、空洞数量(OR=1.655,P=0.031,95%CI=1.1164.273)、空洞数量(OR=1.655,P=0.031,95%CI=1.116².453)和耐药程度(OR=1.298,P=0.047,95%CI=0.79622.453)和耐药程度(OR=1.298,P=0.047,95%CI=0.7962².117);6个月末痰菌未阴转的危险因素是耐药程度(OR=1.452,P=0.022,95%CI=0.8182.117);6个月末痰菌未阴转的危险因素是耐药程度(OR=1.452,P=0.022,95%CI=0.818².575)和2个月末检查痰菌阳性(OR=18 241.990,P=0.008,95%CI=0.0002.575)和2个月末检查痰菌阳性(OR=18 241.990,P=0.008,95%CI=0.000⁶.4×108)。结论初治肺结核并TBTB 2个月末痰菌阴转率偏低,需加强治疗管理,提高依从性。年龄、病灶范围、空洞数量和耐药程度是第2个月末痰菌未阴转的危险因素,耐药程度和2个月末痰菌阳性是6个月末痰菌未阴转的危险因素。

Analysis of the sputum negative conversion rate and risk factors for primary pulmonary tuberculosis with tracheobron- ehial tuberculosis

Objective To explore the sputum negative conversion rate and risk factors of curative effect for pulmonary tuberculosis （PTB） with tracheobronchial tuberculosis （TBTB）. Methods Two hundred and five pri- mary PTB cases with TBTB were confirmed by bronchoscopy in Guangzhou Chest Hospital from Jul 2011 to Feb 2012, all of whom received chemotherapy of 2-3HRZE/9-10HR and different transbronchoscopic interventional therapy according to TBTB types. After more than 6 months＇ following-up, the sputum negative conversion rates after 2 months treatment and 6 months treatment were analyzed, and risk factors were also analyzed by backward lo- gistic regression analysis. Results After the treatment of 2 months and 6 months, the sputum negative conversion rate were 59.0% （121/205） and 90.20/00 （185/205） respectively. Multiple-factor logistic regression analysis showed that age （OR=1.013, P=0.061, 95%CI=0.992 1.035）, lesion range （OR=2.012, P=0.022, 95% CI=0.948- 4.273）, number of cavity （OR=1.655, P=0.031, 95% CI=1.116 2.453） and drug resistance （OR=1.298, P= 0. 047, 95% CI = 0. 7962-- 2.117） were risk factors of sputum non-negative conversion after 2 months＇ treat- ment. The drug resistance （OR= 1. 452, P=0. 022,95%CI=0. 818--2. 575） and sputum positive after 2 months＇ treatment （ORal8 241. 990, P=0. 008, 95%CI=0. 000--6.4×10^8） were the risk factors of sputum positive after 6 months＇ treatment. Conclusion The sputum negative conversion rate is relatively low for PTB with TBTB after 2 months＇ treatment. It needs to intensify treatment and management and improve treatment compliance. The risk factors of sputum non-negative conversion after 2 months＇ treatment were age, lesion range, number of cavity and drug resistance, while those after 6 months＇ treatment were drug resistance and sputum positive after 2 months＇ treatment.