Analysis of risk factors for poor outcome of treatment in patients with ulcerous necrotic type bronchial tuberculosis

doi:10. 3969/j.issn.1000-6621.2019.06.009

Abstract

Abstract:

Objective To analyze the factors affecting the efficacy in patients with ulcerous necrotic type bronchial tuberculosis.Methods A total of 105 cases who were first diagnosed with ulcerous necrotic type bronchial tuberculosis by bronchoscopy in the Department of Tuberculosis in Tongji University affiliated to Shanghai Pulmonary Hospital were successively collected from January 2016 to January 2018, and were set as subjects. The clinical data of the patients were collected, and the lesion involved airway sites and levels, the degree of lumen stenosis caused by necrotic materials and mucosal edema, and the imaging characteristics of the chest CT scan under bronchoscopy were recorded.Results Among the 105 patients with ulcerous necrotic type bronchial tuberculosis, 72 cases (68.6%) were effectively treated, and 33 (31.4%) were ineffectively treated. In the ineffective treatment group, 12 cases (36.4%) had a smoking history, 21 cases (63.7%) had a symptom duration (from onset to treatment) ≥ 4 weeks, 10 cases (30.3%) had cavity on chest CT scan, and 12 cases (36.4%) had a lesion involved airway level ≥3. In the effective treatment group, the case numbers of the above four outcomes were 12 (16.7%), 24 (33.3%), 8 (11.1%) and 10 (13.9%), respectively. The differences between the two groups were statistically significant (χ ²=4.98, 8.49, 5.87 and 6.90, respectively, all P values were <0.05). Multivariate logistic regression analysis showed that the smoking history (OR=2.87, 95%CI: 1.01-8.14), symptom duration ≥ 4 weeks (OR=3.48, 95%CI: 1.35-9.01), cavity on chest CT scan (OR=3.27, 95%CI: 1.02-10.55), the lesion involved airway levels ≥ 3 (OR=3.73, 95%CI: 1.23-11.31) were risk factors for the ineffective treatment of ulcerous necrotic type bronchial tuberculosis.Conclusion The strengthening smoking cessation education, enhancement of publicity and education on tuberculosis prevention, and early diagnosis and treatment may contribute to improve the treatment efficiency for the ulcerous necrotic type bronchial tuberculosis.

Key words: Tuberculosis, Bronchi, Bronchoscopy, Risk factors, Factor analysis, statistical

Wen-ting LI,Hong-xia CHEN,Yan YANG. Analysis of risk factors for poor outcome of treatment in patients with ulcerous necrotic type bronchial tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(6): 640-644. doi: 10. 3969/j.issn.1000-6621.2019.06.009

Figures/Tables 4

影响因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
有吸烟史	1.06	0.53	3.94	0.047	2.87(1.01~8.14)
起病至治疗时间≥4周	1.25	0.49	6.61	0.010	3.48(1.35~9.01)
有肺部空洞	1.19	0.60	3.94	0.047	3.27(1.02~10.55)
病变累及≥3层气道	1.32	0.57	5.42	0.020	3.73(1.23~11.31)

References 13

[1]	中华医学会结核病学分会, 《中华结核和呼吸杂志》编辑委员会. 气管支气管结核诊断和治疗指南(试行). 中华结核和呼吸杂志, 2012,35(8):581-587.
[2]	Hoheisel G, Chan BK, Chan CH , et al. Endobronchial tuberculosis: diagnostic features and therapeutic outcome. Respir Med, 1994,88(8):593-597. doi: 10.1016/S0954-6111(05)80007-1 URL
[3]	Chung HS, Lee JH . Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest, 2000,117(2):385-392. doi: 10.1378/chest.117.2.385 URL
[4]	Kashyap S, Mohapatra PR, Saini V . Endobronchial tuberculosis. Indian J Chest Dis Allied Sci, 2003,45(4):247-256.
[5]	Chuang HC, Su CL, Liu HC , et al. Cigarette smoke is a risk factor for severity and treatment outcome in patients with culture-positive tuberculosis. Ther Clin Risk Manag, 2015,11:1539-1544.
[6]	Simet SM, Sisson JH, Pavlik JA , et al. Long-term cigarette smoke exposure in a mouse model of ciliated epithelial cell function. Am J Respir Cell Mol Biol, 2010,43(6):635-640. doi: 10.1165/rcmb.2009-0297OC URL
[7]	Shprykov AS, Zhdanov VZ, Lazovskaia AL , et al. Tobacco smoke condensate-induced structural changes in Mycobacteria tuberculosis. Probl Tuberk, 2002, ( 2):39-41.
[8]	van Zyl-Smit RN, Binder A, Meldau R , et al. Cigarette smoke impairs cytokine responses and BCG containment in alveolar macrophages. Thorax, 2014,69(4):363-370. doi: 10.1136/thoraxjnl-2013-204229 URL
[9]	Jung SS, Park HS, Kim JO , et al. Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis. Respirology, 2015,20(3):488-495. doi: 10.1111/resp.12474 URL
[10]	Tamura A, Higaki N, Kusaka K , et al. Doctor’s delay in endobronchial tuberculosis. Kekkaku, 2013,88(1):9-13.
[11]	刘国标, 张丽好, 何霞 , 等. 广州市初治涂阳肺结核患者治疗2个月末痰涂片不阴转原因探讨. 中国防痨杂志, 2005,27(6):360-363.
[12]	邝浩斌, 梁敏青, 方琼 , 等. 初治肺结核合并气管支气管结核痰菌阴转及其危险因素分析. 中国防痨杂志, 2013,35(10):812-815.
[13]	屠得华, 万利亚, 王黎霞 . 现代结核病控制理论与实践. 北京: 现代教育出版社, 2009: 120.

临床指标	治疗有效组(72例)		治疗无效组(33例)		χ²值	P值
临床指标	例数	构成比(%)	例数	构成比(%)	χ²值	P值
年龄(岁)					-^a	0.342
≤20	5	6.9	2	6.1
21~	36	50.0	12	36.4
41~	11	15.3	10	30.3
≥61	20	27.8	9	27.2
BMI					0.53	0.466
<18.5	15	20.8	9	27.3
≥18.5	57	79.2	24	72.7
血清白蛋白(g/L)					0.84	0.359
<35	2	2.8	3	9.1
≥35	70	97.2	30	90.9
性别					1.79	0.181
男	23	31.9	15	45.5
女	49	68.1	18	54.5
吸烟史					4.98	0.026
有	12	16.7	12	36.4
无	60	83.3	21	63.6
糖尿病					1.20	0.273
有	3	4.2	4	12.1
无	69	95.8	29	87.9
复治					0.00	1.000
是	6	8.3	3	9.1
否	66	91.7	30	90.9
起病至治疗≥4周					8.49	0.004
是	24	33.3	21	63.6
否	48	66.7	12	36.4
治疗前痰菌阳性					1.38	0.240
是	60	83.3	31	93.9
否	12	16.7	2	6.1
治疗2个月末痰菌阳性					1.12	0.290
是	15	20.8	10	30.3
否	57	79.2	23	69.7
行支气管腔内冷冻消融术					0.27	0.603
是	31	43.1	16	48.5
否	41	56.9	17	51.5

CT扫描所见	治疗有效组(72例)		治疗无效组(33例)		χ²值	P值
CT扫描所见	例数	构成比(%)	例数	构成比(%)	χ²值	P值
肺不张					1.12	0.290
是	6	8.3	5	15.2
否	66	91.7	28	84.8
肺部空洞					5.87	0.015
有	8	11.1	10	30.3
无	64	88.9	23	69.7
病灶范围≥3个肺野					0.17	0.677
是	19	26.4	10	30.3
否	53	73.6	23	69.7

自变量	赋值
吸烟史	有吸烟史=1;无吸烟史=0
起病至治疗时间	起病至治疗时间≥4周=1;起病至治疗时间<4周=0
肺部空洞情况	有肺部空洞=1;无肺部空洞=0
病变气道层数	病变累及≥3层气道=1;病变累及<3层气道=0

[1]	LIU Xiao-li, LEI Li-mei, GUO Zhou-li, HUANG Yin, XU Jing, ZHAO Xia, WANG Yan, FU Li. Study on the relationship of stigma and social support of tuberculosis patients [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 1002-1008.
[2]	Academic Working Committee of Chinese Antituberculosis Association, Editorial Board of Chinese Journal of Antituberculosis . Expert consensus of clinical application of fixed-dose combination formulations [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 885-893.
[3]	JIN Hong-jian. The construction of tuberculosis prevention and control service system at county level in China needs to be strengthened urgently —— Comments and suggestions of an old tuberculosis control and prevention worker [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 896-902.
[4]	ZHANG Can-you, XIA Hui, CHENG Jun. Testing and reporting requirements for Class Ⅱ biosafety cabinet in tuberculosis laboratory [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 903-909.
[5]	ZHOU Lin, LIU Er-yong, MENG Qing-lin, CHEN Ming-ting, ZHOU Xin-hua, GAO Wei-wei, LIN Ming-gui, XIE Ru-ming. Evaluation of the quality of pulmonary tuberculosis diagnosis after the implementation of the newly revised WS 288-2017 Diagnosis for pulmonary tuberculosis standards [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 910-915.
[6]	LIU Er-yong, WANG Qian, ZHOU Lin, ZHANG Guo-qin, ZHANG Xiu-lei, MA Yong-cheng, YANG Shu-min, WANG Cui, MENG Qing-lin, CHEN Ming-ting, LIN Ming-gui, TU De-hua.. Analysis of diagnostic quality of pulmonary tuberculosis with negative etiology in some areas of China [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 916-920.
[7]	MENG Qing-lin, LI Jin-lan, LIN Ding-wen, MA Yong-cheng, HOU Shuang-yi, LIU Nian-qiang, ZHOU Lin. Analysis of the awareness about knowledge on the updated TB diagnosis standard among the practitioners in TB control institutions [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 921-925.
[8]	WANG Qian, ZHOU Lin, LIU Er-yong, ZHAO Yan-lin, LI Tao, CHEN Ming-ting, YANG Li-jia, WANG Jia.. A survey on the diagnostic ability of tuberculosis in the county-level medical institutions in China [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 926-930.
[9]	LI Ting, HE Jin-ge, SU Qian, LI Jing, LI Yun-kui, GAO Wen-feng, GAO Yuan, YANG Wen. Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County, Sichuan Province [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 931-936.
[10]	LI Yun-kui, HE Jin-ge, SU Qian, LI Ting, LI Jing, GAO Wen-feng, YANG Wen, MAO Guang-yu. Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County, Sichuan Province [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 937-941.
[11]	SU Qian, XIA Yong, LU Jia, WANG Dan-xia, HE Jin-ge. Analysis on the epidemiological characteristics of pulmonary tuberculosis among children aged 0-14 in Sichuan Province from 2009 to 2018 [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 942-947.
[12]	DENG Ya-li, ZHANG Tian-hua, LIU Wei-ping, ZHANG Hong-wei, MA Yu, LI Peng.. Temporal and spatial clustering analysis of pulmonary tuberculosis incidence in Shaanxi Province from 2014 to 2018 [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 948-955.
[13]	DONG Xiao, ZHAO Zhen, LIU Nian-qiang, WANG Sen-lu, CUI Yan. Analysis of the finding characteristics of pulmonary tuberculosis in the elderly population in Xinjiang Uygur Autonomous Region during 2009—2017 [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 956-961.
[14]	MA Ting-long, HAN Yi, CHENG Xu, LIU Zhi-dong. Clinical observation on treatment effectiveness of transdermal ultrasound-mediated drug delivery combined with oral anti-tuberculosis drug in patients with chest wall tuberculosis [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 968-972.
[15]	NAN Hai, ZHANG Yun, YANG Xin-ting, DUAN Hong-fei. Meta-analysis on the diagnostic value of GeneXpert MTB/RIF for bone and joint tuberculosis [J]. Chinese Journal of Antituberculosis, 2020, 42(9): 973-980.