High prevalence of drug-resistant tuberculosis, Republic of Lithuania, 2002.

BACKGROUND: Nations of the former Soviet Union have the world's highest reported levels of resistance to anti-tuberculosis drugs. We conducted the first national survey of anti-tuberculosis drug resistance in the Republic of Lithuania. METHODS: We tested Mycobacterium tuberculosis isolates from all incident culture-positive pulmonary TB patients registered in 2002. New patients were those treated for <1 month with any first-line anti-tuberculosis drug (isoniazid [INH], rifampin [RMP], ethambutol, or streptomycin); previously treated patients were those treated for > or =1 month. RESULTS: Of 1163 isolates, 475 (41%) were resistant to at least one first-line drug, and 263 (23%) were resistant to at least INH and RMP (MDR); this included 76/818 (9.3%) from new patients and 187/345 (54%) from previously treated patients. Of 52 MDR isolates randomly selected for extended testing at an international reference laboratory, 27 (51%, 95%CI 38-66) had resistance to pyrazinamide, 21 (40%, 95%CI 27-55) to kanamycin, and 9 (17%, 95%CI 8-30) to ofloxacin. CONCLUSIONS: The prevalence of MDR-TB in Lithuania is among the world's highest. Among MDR-TB isolates, aminoglycoside and fluoroquinolone resistance were common. To combat drug-resistant TB, Lithuania has implemented the WHO global TB control strategy (DOTS), and is developing an MDR-TB treatment program (DOTS-Plus).     

深圳市1999～2008年结核病细菌耐药性监测报告

目的掌握深圳市结核病的耐药状况及其连续变化趁势,评价结核病防治规划的实施效果,为改进结核病防治措施提供依据和参考。方法按世界卫生组织和国际防痨与肺部疾病联合会制定的“全球结核病耐药监测指南”的要求,采用“比例浓度法”,对1999年～2008年每年3～8月份登记的涂片阳性患者痰标本进行分离培养,对阳性的菌株进行菌型鉴定和异烟肼（H）、利福平（R）、乙胺丁醇（E）及链霉素（S）四种药物的敏感性测试。结果 1999年～2008年对6788例培养阳性的菌株进行菌型鉴定和药敏试验,其中非结核分枝杆菌86例、占1.3%;结核分枝杆菌6702例、占98.7%;连续监测10年的结核病耐药性,原发性耐药率从1999年的35.6%下降～2008年的14.9%、原发性耐多药率从1999年的5.4%下降～2008年的4.1%。四种抗结核药的耐药频率顺序由高至低依次为S、H、R、E。结论积极推行肺结核病归口管治,实施高质量的DOTS策略,肺结核病人在结防机构中得到较好管理和治疗,结核病耐药率呈下降趋势。     

Risk factors for drug-resistant tuberculosis among non-US-born persons in New York City.

SETTING: New York City (NYC). OBJECTIVES: To examine the extent to which prior tuberculosis (TB) treatment, length of residence in the United States and other factors are associated with the occurrence of drug resistance among non-US-born persons in NYC. DESIGN: Cases were non-US-born persons diagnosed with TB in NYC from 1998-1999 and from 2001-2002, with an initial Mycobacterium tuberculosis isolate resistant to any first-line anti-tuberculosis drug. Controls were randomly selected from non-US-born persons whose isolates were susceptible to all first-line anti-tuberculosis drugs. RESULTS: Overall, cases with multidrug-resistant (MDR) TB were more likely to have had prior TB treatment; other drug resistance was not associated with prior TB treatment. In a multivariate model, the relationship between MDR-TB and prior treatment remained significant for non-US-born persons regardless of length of time in the U.S. CONCLUSIONS: The findings underscore the utility of monitoring trends in drug resistance among the non-US-born by time in the US and prior treatment to determine where or when drug resistance may be occurring.     

成都市公共卫生临床医疗中心129例耐药结核病成年住院患者营养不良的危险因素

目的初步评价成都市公共卫生临床医疗中心129例耐药结核病成年住院患者的营养状况,探索其发生营养不良的危险因素。方法收集2020年1月至2020年12月成都市公共卫生临床医疗中心结核科收治的129例来自四川地区的耐药结核病成年住院患者的流行病学与临床特征资料,采用单因素logistic回归进行自变量的筛选,将P<0.200的变量纳入多因素logistic回归模型,采用条件向前逐步回归法分析,P<0.05为差异有统计学意义。结果59.7%(77/129)的患者存在营养不良。多因素logistic回归分析发现:35~50岁、并发肺外结核者更容易发生总蛋白或白蛋白型营养不良。50~65岁者也更容易出现白蛋白型营养不良,并发肺外结核者还更容易出现低体重营养不良。少数民族、烟年≤10(包·年)、病变累计占有肺野数≤3个可能是总蛋白型营养不良的保护因素,而女性、来自非农村地区以及既往饮酒,可能是贫血的危险因素。结论成都市公共卫生临床医疗中心的耐药结核病成年住院患者普遍存在营养不良,临床上可根据患者的年龄、性别、民族、居住地、吸烟与饮酒状况,以及病变累计占有肺野数、是否并发肺外结核等,及时发现并予以纠正。     

青海地区获得性耐药结核病产生的危险因素及其预测模型的构建

目的 探讨青海地区原发性与获得性耐药结核病的危险因素及临床发病风险预测模型构建.方法 选取2018年7月-2019年7月青海地区132例耐药结核病患者为观察组,青海地区132例非耐药结核病患者为对照组,查阅患者的的临床资料,并自制调查问卷,以问卷调查的方式收集患者的相关信息,分析两组患者的临床指征,采用多因素Logis...     

Risk factors for hepatocellular carcinoma in patients with drug-resistant chronic hepatitis B

AIM:To investigate the risk factors and characteristics of hepatocellular carcinoma(HCC) in the patients with drug-resistant chronic hepatitis B(CHB).METHODS:A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004to December 2012. The patients were divided into two groups:the HCC group(n = 57) and the non-HCC group(n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC.Secondarily,patient and tumor characteristics of HCC patients with na ve CHB(N group,n = 117) were compared to the HCC group(R group,n = 57) to identify any difference in HCC characteristics between them.RESULTS:A significant difference was found for age,platelet count,alpha-fetoprotein(AFP),positivity of HBeAg,seroconversion rate of HBeAg,virologic response,the Child-Pugh score,presence of rtM204I,and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis,age(> 50 years),HBeAg(+),virologic non-responder status,and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein(CRP) and AFP levels,earlier stage tumors,and a shorter mean tumor surveillance period than the N group. However,the total follow-up duration was not significantly different between the two groups.CONCLUSION:13.2% of patients with drug-resistant CHB developed HCC. Age,cirrhosis,YIDD status,HBeAg status,and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.     

Risk factors for transmission of Mycobacterium tuberculosis from HIV-infected tuberculosis patients, Botswana.

OBJECTIVE: To identify risk factors for transmission of Mycobacterium tuberculosis from patients with tuberculosis and human immunodeficiency virus (HIV) infection in Botswana. DESIGN: Transmission was studied in 210 children aged <10 years (contacts) of unknown HIV status exposed to 51 adults with tuberculosis (index cases), including 41/49 (83.7%) with HIV infection. METHODS: Data collected on index cases included demographics, clinical and social characteristics, sputum, HIV, and CD4 lymphocyte results. Tuberculin skin testing was performed on contacts, and their parent or guardian was interviewed. A positive test was defined as > or = 10 mm induration. Skin test results were compared with results obtained from a population survey of children of similar age from the same community. RESULTS: A positive skin test was found in 12.1% of exposed children compared with 6.2% in the community (P = 0.005). Of the infected children, 22 (78.6%) were contacts of a close female relative. The risk of transmission increased with the degree of sputum smear positivity for acid-fast bacilli among female index cases (10.8% if smear 0+, 9.3% if smear 1+,29.4% if smear 2+, 44% if smear 3+, P < 0.001). In multivariate analysis, severe immunodeficiency (CD4 lymphocyte count <200 cells/mm3) among HIV-infected index cases was protective against transmission (OR 0.08, 95%CI 0.01-0.5, P = 0.006). CONCLUSION: The intensity of exposure to tuberculosis patients and the degree of sputum smear positivity for acid-fast bacilli remain important risk factors for transmission of M. tuberculosis during the era of HIV. However, tuberculosis patients with advanced AIDS may be less infectious than patients in earlier stages of AIDS.     

Clinical features, diagnosis, and management of multiple drug-resistant tuberculosis since 2002

PURPOSE OF REVIEW: Multiple drug-resistant tuberculosis is increasing globally, particularly in Eastern Europe. This review summarizes advances in our understanding of the epidemiology, diagnosis, and treatment of MDRTB in 2002-2003. RECENT FINDINGS: The annual incidence of multiple drug-resistant tuberculosis globally is unknown because systematic drug resistance data have been produced from only 60 countries internationally. Nevertheless, countries with effective tuberculosis programs see approximately 1% multiple drug-resistant tuberculosis among new cases annually. Hot spots with high rates such as countries of the former Soviet Union exist, and modeling of existing data suggests that between 250,000 and 500,000 new MDRTB cases occur globally. Unfortunately, mortality from multiple drug-resistant tuberculosis, particularly with HIV co-infection, remains high, and the global economic costs are also substantial. Research has produced many rapid and novel diagnostic methods for multiple drug-resistant tuberculosis, but culture-based methods remain the mainstay of analyzing resistance to drugs other than isoniazid and rifampicin. Treatment of multiple drug-resistant tuberculosis is prolonged, and survival requires therapy with at least three agents to which the bacteria are susceptible. Individualized therapy forms the gold standard of treatment, but the high laboratory costs associated with this approach have led to studies of standardized treatment in middle-/low-income countries. Studies in Peru examined both approaches with comparable success. Nevertheless, even standardized treatment requires an accurate survey of drug resistance and an understanding and correction of the causes of the high rates of multiple drug-resistant tuberculosis. SUMMARY: The global rates of multiple drug-resistant tuberculosis are unknown. Rapid and early diagnosis of multiple drug-resistant tuberculosis improves survival and is of a public health benefit. Treatment requires prolonged effective combination chemotherapy.     

2008—2018年广州市结核病患者诊断延误影响因素分析

目的 分析2008—2018年广州市结核病患者诊断延误趋势及影响因素,为制定防治措施提供依据。 方法 通过《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》,收集2008—2018年广州市登记治疗的125180例结核病患者的信息,包括性别、年龄、民族、职业、患者来源、患者分类及并发症发生情况,采用单因素和多因素logistic回归模型分析结核病患者诊断延误的影响因素。 结果 2008—2018年广州市结核病患者从初次就诊至诊断的天数的中位数(四分位数)为5(2,15)d,诊断延误率为27.43%(34343/125180)。单因素分析结果显示,65~102岁年龄组、汉族、职业为教师/医务人员/干部、患者来源为健康检查的诊断延误率分别为29.70%(4610/15524)、27.50%(33829/123013)、33.22%(1320/3974)、37.86%(1017/2686),明显高于年龄25~<45岁(26.69%,13585/50894)、少数民族(23.72%,514/2167)、工人及民工(21.10%,4752/22520)、患者来源为转诊(25.36%,14416/56835),差异均有统计学意义(χ²值分别为65.253、15.291、879.541、570.472,P值均<0.001)。多因素logistic回归分析结果显示,以下特征的结核病患者更容易出现诊断延误: 25~<45、45~<65、65~102岁年龄组[以<25岁年龄组为参照,OR(95%CI)值分别为1.072(1.033~1.110)、1.136(1.090~1.184)、1.168(1.105~1.235)];汉族[以少数民族为参照,OR(95%CI)=1.155(1.044~1.278)];职业为儿童及学生、商业服务、教师/医务人员/干部、农民、离退休人员、家政/家务/待业、其他[以工人及民工为参照,OR(95%CI)值分别为1.730(1.617~1.851)、1.784(1.683~1.890)、1.828(1.698~1.968)、1.167(1.111~1.227)、1.632(1.535~1.736)、1.436(1.378~1.497)、1.525(1.462~1.590)];患者来源为健康检查、接触者检查、因症就诊、因症推荐、追踪 [以转诊为参照,OR(95%CI)值分别为1.704(1.572~1.848)、1.531(1.227~1.910)、1.031(1.003~1.060)、1.346(1.192~1.520)、1.535(1.467~1.606)]。结论 2008—2018年广州市结核病患者诊断延误现象逐年上升。对上述各类诊断延误的影响因素,需要重点加强关注。     

我国耐药结核病的危险因素——2007年全国结核病耐药基线调查资料分析

目的 探索新登记、复治患者发生耐药、耐多药结核病的危险因素。 方法2007年4-12月中国进行了全国结核病耐药基线调查,调查覆盖全国31个省、自治区和直辖市,以省分层,采用多阶段整群抽样方法从全国结核病防治系统中随机抽取70个调查点,调查期间每个调查点纳入新登记涂阳新患者51例和复治患者17例。临床医师采用信息表收集患者的相关信息,通过当面询问患者填写治疗史信息,如有可能查阅患者医疗记录进行确认,治疗信息的准确性经另一位临床医师再次询问患者进行复核。采用比例法进行药敏试验,检测药物包括异烟肼、利福平、链霉素、乙胺丁醇、卡那霉素和氧氟沙星。 结果 多因素分析结果表明,对于新登记、治疗时间少于1个月(OR=1.6, 95% CI＝1.1～2.1)发生耐药结核病的风险较高;而女性（OR=1.4, 95% CI＝1.0～2.1）和进行过结核病药物治疗（OR=2.4, 95% CI＝1.5～3.7）是发生耐多药结核病的危险因素。对于复治患者,女性（OR=1.7,95% CI＝1.1～2.7）、既往有过2次及以上治疗且最近1次在结核病专科医院治疗（OR=4.0, 95% CI＝1.2～14.0）发生耐药结核病的风险较高;而女性（OR=2.3, 95% CI=1.5～3.6）、生活在实施DOTS较晚（2000年以后）的地区（OR=1.7, 95% CI＝1.2～2.4）、既往有过2次及以上治疗且最近1次在结核病专科医院外的其他医疗机构治疗（OR=3.3, 95% CI＝2.1～5.2）、既往有过2次及以上治疗且最近1次在结核病专科医院治疗（OR=13.0, 95% CI＝3.9～46.0）是产生耐多药结核病的危险因素。 结论 进行过结核病治疗的新登记产生耐药、耐多药结核病的风险较高;患者为女性、既往有过2次及以上的结核病治疗史是复治患者产生耐药、耐多药结核病的危险因素。     

耐药肺结核患者氟喹诺酮类药物耐药情况及影响因素

目的 分析耐药肺结核患者对氟喹诺酮类药物的耐药情况及影响因素。方法 采用回顾性研究方法,选取2015年1月至2020年12月于首都医科大学附属北京胸科医院确诊并住院治疗的988例耐药肺结核患者作为研究对象。研究对象均经痰液标本分枝杆菌培养阳性,并经菌种鉴定为结核分枝杆菌,均进行了药物敏感性试验(简称“药敏试验”),证实对异烟肼、利福平、利福喷丁、利福布丁、乙胺丁醇、氯法齐明、阿米卡星、丙硫异烟胺、克拉霉素、卡那霉素、卷曲霉素、链霉素等药物中任意一种或一种以上药物耐药。采用比例法药敏试验对氧氟沙星、左氧氟沙星、莫西沙星等进行耐药检测。分析不同特征研究对象对氟喹诺酮类药物的耐药情况,并采用多因素logistic回归模型分析耐药肺结核患者出现氟喹诺酮类药物耐药的影响因素。结果 988例研究对象中,对氟喹诺酮类药物耐药者有431例,耐药率为43.62%。氟喹诺酮类药物耐药者中年龄<18岁者占0.93%(4/431)、初治患者占17.86%(77/431)、北京地区居住者占14.62%(63/431),均明显高于氟喹诺酮类药物敏感者[分别占3.05%(17/557)、36.98%(206/557)、31.42%(175/557)],差异均有统计学意义(χ²值分别为6.154、43.453、37.508,P值均<0.05);利福平耐药者占94.66%(408/431),明显高于氟喹诺酮类药物敏感者[84.38%(470/557)],差异有统计学意义(χ²=25.968,P<0.01);有氟喹诺酮类药物用药史者占3.81%(15/431),与氟喹诺酮类药物敏感者相比[2.98%(15/557)],差异无统计学意义(χ²=0.465,P=0.495)。多因素logistic回归分析显示,利福平耐药[OR(95%CI)=2.704(1.585~4.615)]、有氟喹诺酮类药物用药史[OR(95%CI)=2.661(1.210~5.854)]是耐药肺结核患者发生氟喹诺酮类药物耐药的危险因素;而初治[OR(95%CI)=0.402(0.283~0.571)]及居住在北京[OR(95%CI)=0.411(0.289~0.585)]是耐药肺结核患者发生氟喹诺酮类药物耐药的保护因素。结论 耐药肺结核患者对氟喹诺酮类药物的耐药率较高;复治、利福平耐药、有氟喹诺酮类药物用药史和非北京地区居住患者发生氟喹诺酮类药物耐药的风险增高。     

Trends in drug-resistant tuberculosis in National Higashisaitama Hospital, 1994-2001

To know the prevalence of resistance to four first-line anti-tuberculosis drugs, we reviewed the results of drug-susceptibility tests of patients with tuberculosis who were admitted to our hospital from 1994 to 2001. Among patients with no prior chemotherapy against tuberculosis, the complete resistance rate was 1.9% for INH, 0.81% for RFP, 5.1% for SM, 0.81% for EB, and 0.32% for multiple drug-resistance (MDR). The acquired resistance rate was 9.7% for INH, 11.5% for RFP, 7.3% for SM, 2.4% for EB, and 6.1% for MDR. There was no significant increase in the prevalence of drug resistance between the first half (1994-1997) and the latter half (1998-2001) of the investigation periods. Compared with the previous reports, our results indicated no increase in the prevalence of drug resistance in tuberculosis patients with no prior treatment and the decrease of prevalence in patients with prior treatment of tuberculosis. A multi-drug regimen consisted of INH, RFP, PZA and EB or SM, which is currently considered as a standard regimen of tuberculosis chemotherapy and used quite widely, does not seem to induce the increase of drug-resistant tuberculosis.     

耐药肺结核患者领悟社会支持的影响因素研究

目的 探索耐药肺结核患者领悟社会支持的相关影响因素。方法 选取2018年1月至2019年8月上海市肺科医院结核科收治的所有耐药肺结核患者160例作为研究对象。采用《领悟社会支持量表》(主要内容包括家庭支持、朋友支持、其他支持)评估患者社会支持程度,根据《领悟社会支持量表》总评分50分为界点将患者分为高分组(68例)和低分组(92例),采用logistic多因素回归分析耐药肺结核患者领悟社会支持的影响因素。结果 logistic多因素回归分析结果显示,年龄>60岁(OR=6.900;95%CI:2.984~15.953;P=0.005)、初中及以下学历(OR=2.870;95%CI:1.236~6.665;P<0.001)、未婚(OR=1.257;95%CI:0.545~2.899;P=0.045)或离异(OR=3.960;95%CI:1.742~9.001;P=0.030)、轻度抑郁(OR=6.325;95%CI:2.910~13.750;P=0.022)或中度及以上抑郁(OR=10.733;95%CI:3.847~29.950;P<0.001)、农村地区(OR=2.294;95%CI:1.209~4.353;P=0.040)、家庭人均月收入<2500元(OR=5.881;95%CI:2.348~14.733;P<0.001)、复治(OR=2.030;95%CI:1.074~3.838;P=0.013)及耐多药(OR=1.860;95%CI:0.854~4.048;P<0.001)或广泛耐药(OR=3.409;95%CI:1.533~7.581;P<0.001)均是耐药肺结核患者领悟社会支持的危险因素。结论 年龄>60岁、初中及以下学历、未婚或离异、抑郁、农村地区、家庭人均月收入<2500元、复治及耐多药或广泛耐药等,是耐药肺结核患者领悟社会支持的危险因素。     

厦门市肺结核耐药流行情况及相关因素分析

目的了解近年来厦门市肺结核患者耐药现状,分析影响耐药结核病产生的因素,以期为制定本地区行之有效的结核病防控措施提供科学的参考依据。方法采用横断面调查,对2011年7月1日至2012年6月30日在厦门市各结核病定点医院门诊登记的所有痰涂片阳性的肺结核患者共776例进行调查。收集患者的基本情况和诊疗信息。收集痰标本培养,培养阳性菌株采用比例法进行药物敏感性试验（异烟肼、利福平、链霉素、乙胺丁醇等）;采用对硝基苯甲酸（PNB）培养法鉴定结核分枝杆菌复合群。排除痰菌培养阴性,菌株污染和非结核分枝杆菌感染47例,最终获得药物敏感性试验结果的729例。利用SPSS18．0软件中非条件logistic回归模型分析结核病耐药发生的可能影响因素。结果厦门市总耐药率为27．2％（198／729）,总耐多药率为9．7％（71／729）,初治耐药率为23．4％（134／573）,复治耐药率为41．0％（64／156）,初治耐多药率为7．3％（42／573）,复治耐多药率为18．6％（29／156）;对四种抗结核药物的耐药率最高的为异烟肼16．5％（120／729）,最低的为乙胺丁醇6．9％（50／729）;复治患者的耐药率显著高于初治患者（X2值为19．286,P〈0．01）,是耐药结核病的危险因素（OR=2．154,95％CI=1．467-3．163,Wald X^2=15．319,P〈0．001）。结论厦门市耐药结核病疫情不容乐观,复治化疗史是耐药结核病产生的重要影响因素。     

254例耐药肺结核患者克拉霉素耐药情况及影响因素分析

目的 分析耐药肺结核患者克拉霉素耐药情况及相关危险因素,为其临床应用提供依据。方法 收集2017年1月至2018年1月在首都医科大学附属北京胸科医院确诊为耐药肺结核的254例患者的临床资料和药物敏感性试验(简称“药敏试验”)结果进行回顾性分析。采用比例法对克拉霉素等16种抗结核药物进行药敏试验检测。采用logistic回归法分析克拉霉素耐药的临床相关危险因素。结果 (1)254例耐药肺结核患者中,17例耐多药/广泛耐药患者对克拉霉素耐药,耐药率为6.69%(17/254),低于其余15种抗结核药物[12.60%(32/254)~95.67%(243/254)]。(2)对克拉霉素耐药的耐多药/广泛耐药患者,对莫西沙星(47.06%,8/17)、氯法齐明(70.59%,12/17)、乙胺丁醇(82.35%,14/17)、阿米卡星(52.94%,9/17)、对氨基水杨酸(76.47%,13/17)、对氨基水杨酸异烟肼(88.24%,15/17)、卷曲霉素(76.47%,13/17)的耐药率均高于对克拉霉素敏感的患者[莫西沙星(11.32%,24/212)、氯法齐明(9.91%,21/212)、乙胺丁醇(41.51%,88/212)、阿米卡星(21.70%,46/212)、对氨基水杨酸(35.85%,76/212)、对氨基水杨酸异烟肼(52.83%,112/212)、卷曲霉素(28.77%,61/212)],差异均有统计学意义(χ ²值分别为16.721、46.987、10.628、6.793、10.930、7.986、16.370,P值均<0.05)。(3)logistic回归分析显示耐药的药品数目>7个[OR(95%CI)=9.328(2.058~42.290)]是克拉霉素耐药的危险因素。结论 耐药肺结核患者克拉霉素的耐药率低于其他常用抗结核药物,多发生在耐多药/广泛耐药患者,耐药的药品数目>7个是患者对克拉霉素产生耐药的主要危险因素。     

Transmission of drug-resistant tuberculosis among treated patients in Shanghai, China

We sought to determine whether patients who had therapy failure with increasingly drug-resistant strains of tuberculosis had primary or acquired drug resistance, by genotyping the initial and subsequent drug-resistant clinical isolates of Mycobacterium tuberculosis collected from patients by the Shanghai Centers for Disease Control and Prevention over the course of a 5-year period. The vast majority of patients (27/32) had primary drug resistance, indicating transmission of a drug-resistant strain of M. tuberculosis. Only 16% (5/32) had acquired drug resistance because of a poor treatment regimen or nonadherence to an adequate regimen. Our findings highlight the urgency of increasing efforts to interrupt the transmission of drug-resistant tuberculosis in communities and facilities in Shanghai, China.     

Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis

Objectives

To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence.

Methods

A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months.

Results

Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting.

Conclusions

BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.     

耐药肺结核患者出院准备度现状及影响因素分析

目的 调查耐药肺结核患者出院准备度,分析其影响因素。方法 采用便利抽样方法,搜集2020年5月至2021年3月在同济大学附属上海市肺科医院住院的117例耐药肺结核患者为研究对象。采用一般资料调查表、出院准备度量表、出院指导质量量表对研究对象进行问卷调查,共发放问卷117份,回收有效问卷117份,有效回收率为100.0%。分析研究对象出院准备度及出院指导质量得分情况;采用线性回归分析影响耐药肺结核患者出院准备度水平的因素。结果 研究对象出院准备度总得分为(91.03±16.06)分,条目均分为(7.59±1.34)分,处于中等水平;出院指导质量总得分为(142.09±18.76)分,条目均分为(7.91±1.52)分,为中等偏上水平。多元线性回归分析显示,年龄>60岁(标准回归系数为-0.209,t=-2.345,P=0.021)、小学及以下文化程度(标准回归系数为0.216,t=2.199,P=0.030)、家庭人均月收入低于2000元(标准回归系数为0.210,t=2.411,P=0.018),以及出院指导质量差(标准回归系数为0.229,t=2.857,P=0.005)的患者出院准备度不足。结论 耐药肺结核患者出院准备度不足,应加强对年龄大、文化程度低、经济条件差的耐药肺结核患者的出院指导,并且提高出院指导质量,根据患者情况给予针对性的干预措施。