初始胸部CT特征对非耐药肺结核患者抗结核疗效的预测价值

doi:10.19982/j.issn.1000-6621.20250420

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (5): 670-676.doi: 10.19982/j.issn.1000-6621.20250420

初始胸部CT特征对非耐药肺结核患者抗结核疗效的预测价值

赵小婷¹, 韩晶², 侯志丽³, 丁文龙¹, 张宇洋⁴, 张硕¹, 邢志珩¹()

¹天津大学海河医院/天津市海河医院放射科/天津市呼吸疾病研究所/国家中医药管理局中医药防治传染病重点研究室, 天津 300350
²天津大学海河医院/天津市海河医院医务科/天津市呼吸疾病研究所/国家中医药管理局中医药防治传染病重点研究室, 天津 300350
³天津大学海河医院/天津市海河医院结核科/天津市呼吸疾病研究所/国家中医药管理局中医药防治传染病重点研究室, 天津 300350
⁴天津医科大学海河临床学院, 天津 300350

收稿日期:2025-10-30 出版日期:2026-05-10 发布日期:2026-04-27
通信作者: 邢志珩 E-mail:18920696025@189.cn
基金资助:
天津市教委科研计划项目(2024ZX009)

Predictive value of baseline chest CT features for anti-tuberculosis treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis

Zhao Xiaoting¹, Han Jing², Hou Zhili³, Ding Wenlong¹, Zhang Yuyang⁴, Zhang Shuo¹, Xing Zhiheng¹()

¹Department of Radiology, Haihe Hospital, Tianjin University/Tianjin Haihe Hospital/Tianjin Institute of Respiratory Diseases/TCM Key Research Laboratory for Infectious Disease Prevention and Treatment, National Administration of Traditional Chinese Medicine, Tianjin 300350, China
²Department of Medical Administration, Haihe Hospital, Tianjin University/Tianjin Haihe Hospital/Tianjin Institute of Respiratory Diseases/TCM Key Research Laboratory for Infectious Disease Prevention and Treatment, National Administration of Traditional Chinese Medicine, Tianjin 300350, China
³Department of Tuberculosis, Haihe Hospital, Tianjin University/Tianjin Haihe Hospital/Tianjin Institute of Respiratory Diseases/TCM Key Research Laboratory for Infectious Disease Prevention and Treatment, National Administration of Traditional Chinese Medicine, Tianjin 300350, China
⁴Haihe Clinical College, Tianjin Medical University, Tianjin 300350, China

Received:2025-10-30 Online:2026-05-10 Published:2026-04-27
Contact: Xing Zhiheng E-mail:18920696025@189.cn
Supported by:
Tianjin Municipal Education Commission Scientific Research Plan Project(2024ZX009)

摘要/Abstract

摘要：

目的: 评估治疗初期胸部CT特征预测非耐药肺结核患者不良治疗结局的效能。方法: 采用回顾性、病例-对照研究设计,纳入2017年7月至2024年4月期间天津大学海河医院结核病区收治的非耐药肺结核患者。根据治疗转归纳入预后不良组(118例)并匹配预后良好组(183例)。通过单因素分析及多因素logistic回归分析,系统比较两组患者初始胸部CT特征及临床指标差异,并构建疗效预测模型。采用受试者工作特征曲线(ROC)评估模型的预测效能。结果: 多因素logistic回归分析显示,复治肺结核(OR=6.257,95%CI:2.977~13.153,P<0.001)、初始CT显示空洞(OR=1.994,95%CI:1.116~3.564,P=0.020)、支气管扩张(OR=3.610,95%CI:1.395~9.341,P=0.008)、纤维索条影(OR=1.889,95%CI:1.073~3.328,P=0.028)、受累肺叶数>3个(OR=2.293,95%CI:1.241~4.237,P=0.008)以及血肌酐降低(OR=3.074,95%CI:1.539~6.137,P=0.001)是治疗预后不良的独立危险因素。最终建立的预测模型公式为:logit(p)=-2.327+1.834×复治肺结核+0.690×空洞+1.284×支气管扩张+0.636×纤维索条影+0.830×受累肺叶数>3+1.123×血肌酐降低,模型AUC达0.808(95%CI:0.759~0.857)。结论: 基于治疗初始胸部CT影像特征联合临床指标构建的预测模型,对非耐药肺结核患者的治疗转归具有良好的预测价值。

关键词: 结核,肺, 预后, 因素分析,统计学, 危险因素, 体层摄影术,X线计算机

Abstract:

Objective: To investigate the predictive value of baseline chest CT imaging features for predicting treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis during the treatment phase. Methods: A retrospective case-control study design was employed. Patients with non-drug-resistant pulmonary tuberculosis admitted at Tianjin University Haihe Hospital between July 2017 and April 2024 were enrolled. Patients were categorized into a poor prognosis group (n=118) based on treatment outcomes and matched with a good prognosis group (n=183). Differences in baseline chest CT features and clinical indicators between the two groups were systematically compared using univariate analysis and logistic regression analysis. An efficacy prediction model was subsequently constructed. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis identified the following as independent risk factors for poor treatment prognosis: retreated tuberculosis (OR=6.257, 95%CI: 2.977-13.153, P<0.001), baseline CT showing cavity (OR=1.994, 95%CI: 1.116-3.564, P=0.020), bronchiectasis (OR=3.610, 95%CI: 1.395-9.341, P=0.008), fibrous stripe (OR=1.889, 95%CI: 1.073-3.328, P=0.028), involvement of more than three lung lobes (OR=2.293, 95%CI: 1.241-4.237, P=0.008), and decreased serum creatinine (OR=3.074, 95%CI: 1.539-6.137, P=0.001). The final prediction model formula was established as: logit(p)=-2.327+1.834×(Retreated tuberculosis)+0.690×(Cavity)+1.284×(Bronchiectasis)+0.636×(Fibrous stripe)+0.830×(Involved lung lobes>3)+1.123×(Decreased serum creatinine). The model achieved an area under the curve (AUC) of 0.808 (95%CI: 0.759-0.857). Conclusion: The prediction model constructed based on baseline chest CT imaging features combined with clinical indicators showed good predictive value for the treatment outcomes of patients with non-drug-resistant pulmonary tuberculosis.

Key words: Tuberculosis,pulmonary, Prognosis, Factor analysis, statistical, Risk factors, Tomography, X-ray computed

中图分类号:

R521
R81

赵小婷, 韩晶, 侯志丽, 丁文龙, 张宇洋, 张硕, 邢志珩. 初始胸部CT特征对非耐药肺结核患者抗结核疗效的预测价值[J]. 中国防痨杂志, 2026, 48(5): 670-676. doi: 10.19982/j.issn.1000-6621.20250420

Zhao Xiaoting, Han Jing, Hou Zhili, Ding Wenlong, Zhang Yuyang, Zhang Shuo, Xing Zhiheng. Predictive value of baseline chest CT features for anti-tuberculosis treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(5): 670-676. doi: 10.19982/j.issn.1000-6621.20250420

图/表 6

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因素	预后良好组(183例)	预后不良组(118例)	统计检验值	P值
性别[例(构成比,%)]			χ²=1.220	0.269
女性	59(32.24)	31(35.28)
男性	124(67.76)	87(82.72)
年龄[岁,M(Q₁,Q₃)]	57.00(34.00,68.00)	51.00(33.00,63.00)	U=9524.500	0.084
治疗分类[例(构成比,%)]			χ²=48.143	<0.001
初治	170(92.90)	71(60.17)
复治	13(7.10)	47(39.83)
影像学征象[例(发生率,%)]
空洞	50(27.32)	67(56.78)	χ²=26.199	<0.001
支气管扩张	9(4.92)	20(16.95)	χ²=11.927	0.001
纤维索条影	77(42.08)	73(61.86)	χ²=11.236	0.001
实变	58(31.69)	50(42.37)	χ²=3.556	0.059
钙化	57(31.15)	56(47.46)	χ²=8.139	0.004
结节	170(93.41)	115(97.46)	χ²=2.473	0.116
胸腔积液	41(22.40)	39(33.05)	χ²=4.167	0.041
淋巴结肿大	23(12.57)	22(18.64)	χ²=2.083	0.149
树芽征	162(88.52)	114(96.61)	χ²=6.158	0.013
毁损肺	4(2.19)	11(9.32)	χ²=7.716	0.005
受累肺叶数量[例(构成比,%)]			χ²=21.172	<0.001
≤3	85(46.45)	24(20.34)
>3	98(53.55)	94(79.66)
实验室检查结果[例(发生率,%)]
白细胞计数升高	17(9.29)	16(13.56)	χ²=1.340	0.247
红细胞计数降低	57(31.15)	47(39.83)	χ²=2.392	0.122
中性粒细胞百分比升高	27(14.75)	37(31.36)	χ²=11.811	0.001
血红蛋白降低	66(36.07)	57(48.31)	χ²=4.447	0.035
血小板升高	28(15.30)	22(18.64)	χ²=0.579	0.447
AST升高	164(89.62)	101(85.59)	χ²=1.103	0.294
ALT降低	29(15.85)	35(29.66)	χ²=8.177	0.004
尿素升高	19(10.38)	18(15.25)	χ²=1.579	0.209
肌酐降低	23(12.57)	38(32.20)	χ²=17.117	<0.001
总蛋白降低	56(30.60)	28(23.73)	χ²=1.684	0.194
白蛋白降低	93(50.82)	52(44.07)	χ²=1.310	0.252
白球比降低	67(36.61)	66(55.93)	χ²=10.858	0.001

变量	赋值
预后不良	0=否,1=是
治疗分类	1=复治,0=初治
空洞	1=有,0=无
支气管扩张	1=有,0=无
纤维索条影	1=有,0=无
钙化	1=有,0=无
毁损肺	1=有,0=无
受累肺叶数量	>3个=1,≤3个=0
中性粒细胞百分比升高	1=是,0=否
ALT降低	1=是,0=否
肌酐降低	1=是,0=否
白球比降低	1=是,0=否

影像学征象	初治组(241例)	复治组(60例)	χ²值	P值
支气管扩张	21(8.71)	8(13.33)	1.178	0.278
纤维索条影	113(46.89)	37(61.67)	4.197	0.040

初始胸部CT特征对非耐药肺结核患者抗结核疗效的预测价值

Predictive value of baseline chest CT features for anti-tuberculosis treatment outcomes in patients with non-drug-resistant pulmonary tuberculosis

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变量	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
复治肺结核	1.834	0.379	23.404	<0.001	6.257	2.977~13.153
空洞	0.690	0.296	5.429	0.020	1.994	1.116~3.564
支气管扩张	1.284	0.485	7.003	0.008	3.610	1.395~9.341
纤维索条影	0.636	0.289	4.854	0.028	1.889	1.073~3.328
肌酐降低	1.123	0.353	10.132	0.001	3.074	1.539~6.137
受累肺叶数量>3	0.830	0.313	7.023	0.008	2.293	1.241~4.237
常量	-2.327	0.321	52.641	<0.001	0.098	-

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