关键词: 结核, 肺, 结核, 抗多种药物性, 治疗失败, 体层摄影术, X线计算机, 诊断显像, 回顾性研究

Abstract:

Objective To investigate imaging evolution of treatment failure patients with multidrug-resistant tuberculosis, and provide the evidence for the evaluation. Methods Fifty-six cases of MDR-PTB patients who failed to be treated in Dalian tuberculosis hospital were collected. CT examination was carried out every 3 months in the course of treatment. The evolution and outcome of lung CT signs of 56 MDR-PTB patients were observed. According to CT signs, the course of disease can be divided into three types: absorption progressive type in 21 cases (37.5%, 21/56); absorption transforming type in 20 cases (35.7%, 20/56); intermittent progressive type in 15 cases (26.8%, 15/56). χ ² test was used to count the data, with a statistical significance of P<0.05. Results (1) At the 3rd, 6th and 24th month, the negative rate of sputum bacteria was 81.0% (17/21), 61.9% (13/21), 28.6% (6/21) in the absorption progressive type, 90.0% (18/20), 85.0% (17/20), 60.0% (12/20) in the absorption transformation type, and 40.0% (6/15), 26.7% (4/15), 20.0% (3/15) in the intermittent progressive type. There were significant differences in the sputum negative rate of the 3rd, 6th and 24th month among three types (χ ²=11.953,12.248,6.994, P=0.003,0.002,0.030). (2) In 56 patients, the detection rates of tree bud sign, ground glass shadow and nodular shadow were 67.9% (38/56), 21.4% (12/56) and 80.4% (45/56) before treatment, and 8.9% (5/56), 1.8% (1/56) and 60.7% (34/56) after treatment, there were statistically significant differences between before and after treatment (χ ²=41.108,10.530,5.198, P=0.000,0.001,0.023). After treatment, the number of bronchus clustered, fibrosis, damaged lung and bronchiectasis increased significantly, which were 21.4% (12/56), 5.4% (3/56), 5.4% (3/56) and 8.9% (5/56) before treatment, 41.1% (23/56), 17.9% (10/56), 23.2% (13/56) and 37.5% (21/56) after treatment, there were significant differences between before and after treatment.(χ ²=5.029,4.264,7.292,12.823, P=0.025,0.039,0.007,0.000).(3) In the inherent lesions, cavity 37.8% (108/286),nodule 25.9% (74/286),consolidation 16.4% (47/286) and tree in bud 10.8% (31/286) were common; in the new lesions, tree in bud 46.9% (23/49) and nodule 40.8% (20/49) were common. The detection rate of caseous consolidation with cavities in tree in bud cases was 47.4% (9/19) and that in non-tree in bud cases was 18.9% (7/37),which was statistically significant (χ ²=4.979, P=0.026). Conclusion Through continuous observation of CT imaging, treatment failure can be predicted, which suggests that clinical chemotherapy should be adjusted in time to reduce the incidence of irreversible lung injury.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Treatment failure, Tomography, X-ray computed, Diagnostic imaging, Retrospective studies