耐多药肺结核合并气管支气管结核的内镜特点分析*

Endoscopic characteristics of multidrug-resistant tuberculosis combined with tracheobronchial tuberculosis*

摘要:

目的 探讨耐多药肺结核（MDR-TB）合并气管支气管结核（TBTB）的内镜特点。方法 纳 入广州市胸科医院2008 年10 月1 日-2016 年6 月30 日住院的MDR-TB 患者248 例为研究组，并选取 2015 年全年住院菌阳非MDR-TB 患者274 例为对照组，所有患者进行支气管镜检查、痰培养结核杆菌及 异烟肼和利福平药物敏感性试验。分析支气管镜检查结果、人口资料。结果 248 例MDR-TB 患者，支 气管镜检查诊断TBTB 175 例（70.56%），无TBTB 73 例（29.44%）。274 例菌阳非MDR-TB 患者支气管 镜检查诊断TBTB 146 例（53.28%），无TBTB 128 例（46.72%），两组比较差异有统计学意义（χ2=16.42、 P =0.000）。MDR-TB 合并TBTB 中位年龄32 岁，非MDR-TB 合并TBTB 中位年龄42 岁，差异有统计学 意义（U =9 932.00、P =0.001）。在MDR-TB 患者中，TBTB 侵犯右上支气管75 例（42.86%）、左上支气管 71 例（40.57%），非MDR-TB 患者中则为70 例（47.95%）和60 例（41.10%），差异无统计学意义（χ2=2.44、 P =0.786）。MDR-TB 患者中TBTB 的分型分别是炎症浸润型76 例（43.43%）、溃疡坏死型11 例（6.29%）、 肉芽增殖型13 例（7.43%）、疤痕狭窄型72 例（41.14%）、管壁软化型3 例（1.71%），淋巴结瘘型0 例（0.00%）， 非MDR-TB 中，TBTB 分型依次是50 例（34.25%）、41 例（28.08%）、9 例（6.16%）、40 例（27.40%）、5 例（3.43%）和1 例（0.68%），差异有统计学意义（χ2=30.50、P =0.000）。结论 MDR-TB 合并TBTB 有 较高的检出率，常见青年患者，多侵犯右上支气管和左上支气管，以炎症浸润型和疤痕狭窄型为主，需要重视 MDR-TB 患者的支气管镜检查。

Abstract:

Objective To explore the endoscopic characteristics of multidrug-resistant tuberculosis (MDR-TB) combined with tracheobronchial tuberculosis (TBTB). Methods 248 MDR-TB as study group, they hospitalized from October 1st 2008 to June 31st, 2016. 274 cases of non MDR-TB with bacteria positive as control group over 2015, all of them received bronchoscopy, sputum cultured and drug sensitivity tested of Isoniazid and Rifampicin. We analyzed the results of bronchoscopy and demographic data. Results 248 cases of MDR-TB patients, of 175 (70.56%) were diagnosed TBTB by bronchoscopy, of 73 (29.44%) without TBTB. 274 cases of non MDR-TB with bacteria positive patients, of 146 (53.28%) were diagnosed TBTB, of 128 (46.72%) non TBTB, the difference of comparisons was statistically significant (χ2 = 16.42, P = 0.000). MDR-TB combined with TBTB median age was 32 years, non MDR-TB combined with TBTB median age 42 years, the difference was statistically significant (U = 9 932.00, P = 0.001). Among the MDR-TB patients, of 75 (42.86%) TBTB in the upper right bronchial, of71 (40.57%) upper left bronchus, while non MDR-TB patients, of 70 (47.95%) and 60 (41.10%), there was no statistically significant difference (χ2 = 2.44, P = 0.786). Among the MDR-TB, of 76 (43.43%) were inflammation infiltration type, of 11 (6.29%) were necrosis type, of 13 cases (7.43%) granulation proliferative type, of 72 (41.14%) were scar stricture type, of 3 (1.71%) tube wall softening type. Among the non MDR-TB, in turn, TBTB type were 50 (34.25%), 41 (28.08%), 9 (6.16%), 40 (27.40%), 5 (3.43%), the difference were statistically significant (χ2 = 30.50, P = 0.000). Conclusions The detection rate of TBTB was higher in MDR-TB patients, that common occur in younger patients. TBTB common infringe on upper right bronchial and upper left bronchus, TBTB type most are inflammatory infiltration type and scar stricture type. More attention should be paid to bronchoscopy among MDRTB patients.