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