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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (11): 1165-1170.doi: 10.3969/j.issn.1000-6621.2020.11.005

• 论著 • 上一篇    下一篇

初治继发性肺结核患者治疗过程中并发颈部淋巴结结核的危险因素分析

任航空, 段李明, 黄大业, 张建华, 严文, 张翠云()   

  1. 710061 西安市胸科医院外科(任航空、段李明、黄大业、张建华),妇儿结核科(严文),浆膜腔结核科(张翠云)
  • 收稿日期:2020-08-28 出版日期:2020-11-10 发布日期:2020-11-13
  • 通信作者: 张翠云 E-mail:jacob117lyj@sohu.com
  • 基金资助:
    西安市卫生和计划生育委员会卫生科研人才培训项目(J201902023);西安市科技计划项目(2019114613YX001SF038(2))

Analysis of risk factors of patients with initial treatment of secondary pulmonary tuberculosis complicated with cervical lymph node tuberculosis

REN Hang-kong, DUAN Li-ming, HUANG Da-ye, ZHANG Jian-hua, YAN Wen, ZHANG Cui-yun()   

  1. Department of Surgical, Xi’an Chest Hospital, Xi’an 710061, China
  • Received:2020-08-28 Online:2020-11-10 Published:2020-11-13
  • Contact: ZHANG Cui-yun E-mail:jacob117lyj@sohu.com

摘要:

目的 探讨初治继发性肺结核患者治疗过程中并发颈部淋巴结结核的危险因素。方法 收集2018年12月至2020年7月于西安市胸科医院住院确诊的符合纳入标准的357例初治继发性肺结核,其中57例并发颈部淋巴结结核(简称“并发组”); 300例未并发颈部淋巴结结核(简称“未并发组”)。并发组中,年龄中位数(四分位数)[M(Q1,Q3)]为30(26,38)岁,其中14~<44岁年龄组有40例,≥44岁年龄组有17例。未并发组中,年龄M(Q1,Q3)为39(32,48)岁,其中14~<44岁年龄组有198例,≥44岁年龄组有102例。对患者年龄、性别、口腔黏膜炎、上呼吸道感染、是否使用免疫抑制剂、肺结核患者病程及痰菌检测情况等7项与颈部淋巴结结核发生情况的相关因素进行分析,分别采用单因素分析及多因素logistic回归分析,以P<0.05为差异有统计学意义。结果 357例初治继发性肺结核患者发生颈部淋巴结结核的单因素分析结果显示,未并发组和并发组在上述各因素中,年龄≥44岁者占比分别为34.0%(102/300)、29.8%(17/57);男性占比分别为45.7%(137/300)、40.4%(23/57);发生口腔黏膜炎者占比分别为11.7%(35/300)、45.6%(26/57);发生上呼吸道感染者占比分别为16.3%(49/300)、36.8%(21/57);使用免疫抑制剂者占比分别为8.0%(24/300)、10.5%(6/57);肺结核患病时间>3个月者占比分别为41.0%(123/300)、38.6%(22/57);痰菌阳性者占比分别为19.3%(58/300)、68.4%(39/57)。两组比较,χ2值分别为0.376、0.547、38.963、12.781、0.397、0.115、58.326,P值分别为0.540、0.459、0.000、0.000、0.529、0.735、0.000。多因素logistic回归分析结果显示,发生口腔黏膜炎(Wald χ2=12.279,OR=3.564,95%CI=1.751~7.255,P=0.004)、发生上呼吸道感染(Wald χ2=9.987,OR=3.092,95%CI=1.535~6.227,P=0.002)及痰菌阳性(Wald χ2=26.320,OR=5.880,95%CI=2.989~11.568,P=0.000)是初治继发性肺结核治疗过程中发生颈部淋巴结结核的危险因素。结论 初治继发性肺结核患者在治疗过程中,发生口腔黏膜炎、上呼吸道感染及痰菌阳性的患者易并发颈部淋巴结结核,可作为临床预防的关注因素。

关键词: 结核,肺, 结核,淋巴结, 并发症, 因素分析,统计学

Abstract:

Objective To investigate the risk factors of patients with initial treatment of secondary pulmonary tuberculosis complicated with cervical lymph node tuberculosis. Methods Three hundred and fifty-seven patients with initial treatment of secondary pulmonary tuberculosis admitted to Xi’an Chest Hospital from December 2018 to July 2020 were enrolled for analysis, including 57 patients complicated with cervical lymph node tuberculosis (concurrent group) and 300 patients without cervical lymph node tuberculosis (non-concurrent group). In the concurrent group, the median age (quartile: Q1,Q3) was 30 (26, 38) years old, with 40 patients aged 14-<44 years old and 17 patients ≥44 years old. In the non-concurrent group, the median age (quartile: Q1,Q3) was 39 (32, 48) years, with 198 patients aged 14-<44 years and 102 patients ≥44 years old. Seven related factors including patients’ age, gender, oral mucositis, upper respiratory tract infection, use of immunosuppressants, time of TB progression and sputum bacteria examination with cervical lymph node tuberculosis were respectively analyzed, using univariate analysis and multivariate logistic regression analysis, with P<0.05 as statistically significant differences. Results Univariate analysis of cervical lymph node tuberculosis in 357 newly treated secondary pulmonary tuberculosis patients showed that the proportions of patients aged ≥44 years old were 34.0% (102/300) and 29.8% (17/57) (χ2=0.376, P=0.540); males accounted for 45.7% (137/300) and 40.4% (23/57) (χ 2=0.547, P=0.459); the incidences of oral mucositis were 11.7% (35/300) and 45.6% (26/57) (χ 2=38.963, P=0.000); the incidences of upper respiratory infection were 16.3% (49/300) and 36.8% (21/57) (χ 2=12.781, P=0.000); the proportions of immunosuppressant users were 8.0% (24/300) and 10.5% (6/57) (χ 2=0.397, P=0.529); the proportions of patients with TB over 3 months were 41.0% (123/300) and 38.6% (22/57) (χ 2=0.115, P=0.735); the proportions of positive sputum bacteria were 19.3% (58/300) and 68.4% (39/57) (χ 2=58.326, P=0.000), respectively in the non-concurrent group and the concurrent group. Multivariate logistic regression results showed that oral mucositis (Wald χ 2=12.279, OR=3.564, 95%CI= 1.751-7.255, P=0.004), upper respiratory tract infection (Wald χ 2=9.987, OR=3.092, 95%CI=1.535-6.227, P=0.002) and sputum positive (Wald χ 2=26.320, OR=5.880, 95%CI=2.989-11.568, P=0.000) were risk factors for the occurrence of cervical lymph node tuberculosis in the course of tuberculosis treatment. Conclusion Among the initially treated patients with secondary pulmonary tuberculosis, patients with oral mucositis, upper respiratory tract infection and positive sputum bacteria are prone to complicated with cervical lymph node tuberculosis, which can be used as factors of concern for clinical prevention.

Key words: Tuberculosis,pulmonary, Tuberculosis,lymph node, Complications, Factor analysis,statistical