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[1]陈 晴,黄 涛,邹莉萍,等.耐多药/泛耐药气管支气管结核的临床特征及接受含贝达喹啉方案治疗后影响早期疗效的危险因素[J].中华肺部疾病杂志,2022,(05):643-648.[doi:10.3877/cma.j.issn.1674-6902.2022.05.006]
　Chen Qing,Huang Tao,Zou Liping,et al.Clinical characteristics of multidrug-resistant/extensively drug-resistant tracheobronchial tuberculosis and risk factors for early efficacy after bedaquiline-containing regimen treatment[J].,2022,(05):643-648.[doi:10.3877/cma.j.issn.1674-6902.2022.05.006]
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耐多药/泛耐药气管支气管结核的临床特征及接受含贝达喹啉方案治疗后影响早期疗效的危险因素(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2022年05期
页码:
643-648
栏目:
论著
出版日期:
2022-10-20

文章信息/Info

Title:
Clinical characteristics of multidrug-resistant/extensively drug-resistant tracheobronchial tuberculosis and risk factors for early efficacy after bedaquiline-containing regimen treatment
作者:
陈 晴; 黄 涛; 邹莉萍; 梁 丽; 吴世幸; 鲁小莉; 孙纪英; 代 莉; 何 畏; 吴桂辉
610000 四川省成都市,成都市公共卫生临床医疗中心结核科
Author(s):
Chen Qing;  Huang Tao;  Zou Liping;  Liang Li;  Wu Shixing;  Lu Xiaoli;  Sun Jiying;  Dai Li;  He Wei;  Wu Guihui.
Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu 610000, China
关键词:
气管支气管结核;  耐多药;  贝达喹啉;  疗效;  危险因素
Keywords:
Tracheobronchial tuberculosis;  Multidrug-resistant;  Bedaquiline;  Efficacy;  Risk factors
分类号:
R562
DOI:
10.3877/cma.j.issn.1674-6902.2022.05.006
摘要:
目的 分析耐多药/泛耐药气管支气管结核患者的临床特征,及在接受含抗结核新药贝达喹啉方案治疗后分析影响早期疗效的危险因素。方法 对2018年3月至2020年12月成都市公共卫生临床医疗中心治疗的耐多药/泛耐药气管支气管结核成年患者进行回顾性队列研究,收集队列中的人口学特征、既往史、个人史、合并症、胸部影像学特征、耐药情况、治疗、镜下特征及预后等临床资料,根据二线抗结核治疗8周末痰培养结核分枝杆菌是否转阴分组,采用Mann-Whitney U检验、连续校正卡方检验或Fisher精确检验比较组间差异,二元Logistic回归方程分析影响早期疗效的危险因素。 结果 共纳入58例耐多药/泛耐药气管支气管结核成人患者,治疗8周末痰菌转阴52例(89.7%)、24周末 56例(96.6%),48周末56例; 治疗8周末痰菌阳性组镜下可见肉芽增殖型比率和病灶累及双侧支气管比例高于痰菌转阴组(50% vs. 7.7%,33.3% vs. 3.8%,P<0.05),其中肉芽增殖型TBTB〔OR=0.079,95%CI(0.010,0.441)〕和镜下双侧支气管受累〔OR=0.066,95%CI(0.005,0.851)〕是影响早期疗效的危险因素(P=0.018,P=0.037)。 结论 耐多药/泛耐药气管支气管结核患者多见于青中年女性,病灶常累及双肺多叶,气管镜下特征以炎症浸润型、双肺上叶支气管受累最多见,肉芽增殖型及镜下病灶累及双侧支气管更容易影响MDR/XDR-TBTB患者的早期疗效,现有抗结核方案及严格随访管理能使早中期痰菌转阴率保持高水平,含贝达喹啉方案有提高早期痰培养阴转率的可能性。
Abstract:
Objective To investigate the clinical characteristics of multidrug-resistant or extensively drug-resistant tracheobronchial tuberculosis(MDR/XDR-TBTB)patients and risk factors for early treatment outcomes after bedaquiline-containing regimen treatment. Methods A retrospective cohort study were conducted in Chengdu Public Health Clinical Center, collecting the clinical records of MDR/XDR-TBTB adult patients from 2018 March to 2020 December. The data of clinical characteristics in demographic, past and personal histories, complications, chest imaging features, drug resistant types, treatments, bronchoscopy features and prognosis were collected respectively. Patients were divided into two groups according to the sputum culture status after 8 weeks of second-line anti-tuberculosis treatments. Mann-Whitney U test, continuous corrected chi-square test or Fisher's exact test were used to compare differences between groups, and binary logistic regression equation was used to analyze the risk factors affecting early efficacy. Results Fifty-eight adult patients with MDR/XDR-TBTB were included, The SCC rate was 89.7%(52/58)at 8 weeks of treatment, 96.6%(56/58)at 24 weeks, and 100%(56/56)(2 cases lost to follow-up)at 48 weeks. The proportion of granulation hyperplasia TBTB and the proportion of lesions involving bilateral bronchi in the sputum-positive group at 8 weeks of treatment were higher than those in the sputum-negative group(50% vs. 7.7%, 33.3% vs. 3.8%, P<0.05). Granulation hyperplasia TBTB〔OR=0.079, 95%CI(0.010, 0.441)〕and bilateral bconchus involving under brochoscopy 〔OR=0.066, 95%CI(0.005, 0.851)〕were independent risk factors for early efficacy of MDR/XDR-TBTB(P=0.018, P=0.037). Conclusions In the current study, MDR/XDR-TBTB were more common in young and middle-aged female. Lesions were more common involving multiple lobes of both lungs. The bronchoscopy features were characterized by inflammatory infiltration type and bilateral upper lobe bronchial involvement. The TBTB type of granulation hyperplasia and lesions involving bilateral bronchi were more likely to affect the early efficacy of patients with MDR/XDR-TBTB. The current anti-tuberculosis regimen and strict follow-up management could keep the negative conversion rate remains a high level, and the bedaquiline-containing regimen has the possibility to improve the negative conversion rate of early sputum culture.

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备注/Memo

备注/Memo:
基金项目: 四川省医学科研课题(S19033,S18027); 成都市医学科研课题(2022262)
通信作者: 何 畏, Email: 3550897@qq.com
吴桂辉, Email: wghwgh2584@sina.com
更新日期/Last Update: 2022-10-20