关键词: 结核, 肺, 再治疗, 疾病特征, 对比研究

Abstract:

Objective To analyze the clinical characteristics of retreated bacterial negative pulmonary tuberculosis in order to improve the diagnosis. Methods A retrospective study was conducted in 201 patients with retreated pulmonary tuberculosis diagnosed and hospitalized in Guangzhou Chest Hospital from February 1, 2020 to July 31, 2020. According to the results of the acid-fast bacilli smear or culture of secretions before treatment, these patients were divided into bacterial positive group (n=146) and bacterial negative group (n=55). The treatment history and clinical data were collected, age, gender, treatment history, drug resistance, clinical symptoms, imaging findings and complications in the two groups were compared. Results (1) Treatment history: among the 201 subjects, 148 (73.6%) patients needed retreatment after drug withdrawal, and 53 (26.4%) patients failed in the initial treatment. Of the 148 patients needed retreatment, 110 (75.3%) in bacterial positive group and 38 (69.1%) in bacterial negative group, the difference of distribution was no statistically significant (χ²=0.804, P=0.375). (2) Clinical symptoms: cough were found 100.0% (n=55) in the bacteria negative group, significantly higher than that in the bacteria positive group (n=127, 87.0%) (χ²=7.905, P=0.005). Fourteen (25.5%) patients in bacterial negative group were found with symptoms of tuberculosis poisoning, significantly lower than that in bacterial positive group (n=61, 41.8%)(χ²=4.553, P=0.033). (3) Imaging findings: 23.6% (13/55) in bacterial negative group had ≥3 cavities in lung lesions, significantly lower than that in bacterial positive group (53.4%, 78/146) (χ²=14.308, P<0.001). (4) Complications: the main type of bronchial tuberculosis in the two groups was scar stenosis. It occurred in 85.7% (12/14) patients of the bacterial negative group, significantly higher than in the bacterial positive group (60.0%, 33/55) (χ²=3.996, P=0.046). Serum albumin ≤40 g/L in 29.1% (16/55) patients in bacterial negative group, significantly lower than in bacterial positive group (54.1%, 79/146)(χ²=10.033, P=0.002). Conclusion Compared with retreated bacterial positive pulmonary tuberculosis, retreated bacterial negative pulmonary tuberculosis patients suffer more cough, less tuberculosis poisoning symptoms, less extensive cavity and hypoproteinemia, and more likely to complicated with scar narrow bronchial tuberculosis.

Key words: Tuberculosis, pulmonary, Retreatment, Disease attributes, Comparative study