支气管镜冷冻治疗气管支气管结核时结核分枝杆菌生存状态及疗效的研究

Study on the survival status and efficacy of Mycobacterium tuberculosis during bronchoscopic cryotherapy for tracheobronchial tuberculosis

摘要:

目的 探讨支气管镜不同冷冻频率及时长治疗气管支气管结核（TBTB）时，结核分枝杆菌生存状态及疾病治疗情况。方法 收集2021年9月－2022年1月该院结核分枝杆菌菌株30株（耐多药株15株，敏感株15株），每株细菌分为对照组、实验组1（冷冻处理30 s）、实验组2（冷冻处理1 min）和实验组3（冷冻处理2 min）进行相应处理，观察不同冷冻时间对结核分枝杆菌生存状态的影响。同时选择2021年9月－2022年1月确诊为菌阳TBTB患者62例作为研究对象（冷冻治疗组31例，非冷冻治疗组31例），观察冷冻治疗效果。结果 对照组与实验组1、实验组2与实验组3的秩均值分别为31.17∶29.83和29.78∶31.22，P值分别为0.749和0.733，结核分枝杆菌生存状态差异无统计学意义。对照组与实验组2、对照组与实验组3、实验组1与实验组2、实验组1与实验组3的秩均值分别为43.95∶17.05、43.78∶17.22、43.92∶17.08和43.75∶17.25，差异均有统计学意义（P < 0.05）。实验组2和实验组3中，敏感株与耐多药株秩均值分别为18.53∶12.47和19.97∶11.03，P值分别为0.042和0.003，差异有统计学意义，而耐多药株生长状态较敏感株更差。病灶经过冷冻治疗前后，结核分枝杆菌活菌载量差异具有统计学意义，秩均值分别为37.77和25.23（P < 0.05）。在治疗3个月后，冷冻治疗组有效性（包括显效83.87%与有效9.68%）高于非冷冻处理组（包括显效29.03%和有效41.94%），两组间差异有统计学意义（χ² = 18.96，P = 0.000）；病灶有效清除率93.55%、症状缓解率96.77%及痰菌阴转率93.55%同样高于非冷冻处理组（70.97%、74.19%和70.97%），两组间差异有统计学意义（χ² = 5.42，P = 0.020；χ² = 6.37，P = 0.012；χ² = 5.42，P = 0.020）。结论 经支气管镜下冷冻治疗TBTB有着重要作用，其能够直接针对病灶做有效处理，同时控制并保证足够的冷冻时间和次数，还能够对病灶内结核分枝杆菌起到一定的抑菌和杀菌作用。

Abstract:

Objectives To investigate the survival status and efficacy of Mycobacterium tuberculosis during bronchoscopic cryotherapy for tracheobronchial tuberculosis.Methods Thirty cases of Mycobacterium tuberculosis strains (15 cases of multi-drug resistant strains and 15 cases of sensitive strains) were collected from September 2021 to January 2022. Each strain of bacteria was divided into control group, experimental group 1 (frozen for 30 s), experimental group 2 (frozen for 1 min) and experimental group 3 (frozen for 2 min). Then observed the effects of different freezing time on the survival state of Mycobacterium tuberculosis. 62 cases of confirmed bacterial positive TBTB (31 cases in the cryotherapy group and 31 cases in the non cryotherapy group) from September 2021 to January 2022 were selected as the research object to observe the effect of cryotherapy.Results The average rank values between the control group and the freezing treatment experimental group 1, the experimental group 2 and the experimental group 3 were 31.17∶29.83 and 29.78∶31.22, and the P values were 0.749 and 0.733, respectively, there was no statistically significant difference in the survival status of Mycobacteria. The average rank values between the control group and the experimental group 2, the control group and the experimental group 3, the experimental group 1 and the experimental group 2, the experimental group 1 and the experimental group 3 were 43.95∶17.05, 43.78∶17.22, 43.92∶17.08 and 43.75∶17.25, the differences were statistically significant (all P < 0.05). The average rank values of the sensitive and multi-drug-resistant plants in the experimental group 2 and experimental group 3 were 18.53∶12.47, 19.97∶11.03, and the P values were 0.042 and 0.003, respectively, the differences were statistically significant. The growth status of the multi-drug-resistant plants was worse than that of the sensitive plants. Before and after cryotherapy, the difference in the load of Mycobacterium tuberculosis was also statistically significant. The average rank values were 37.77 and 25.23, and the P < 0.05. After 3 months of cryotherapy, the effectiveness (83.87% and 9.68%) of the cryotherapy group was higher than that of the non cryotherapy group (29.03% and 41.94%), χ² value was 18.96, P value was 0.000, the difference between the two groups was statistically significant. The effective lesion clearance rate of 93.55%, symptom remission rate of 96.77% and sputum negative conversion rate of 93.55% were also higher than those of the non cryotherapy group (70.97%, 74.19%, 70.97%), χ² values were 5.42, 6.37, 5.42, P values were 0.020, 0.012, 0.020, and the differences between the two groups were statistically significant.Conclusion Cryotherapy under bronchoscopy plays an important role in the diagnosis and treatment of TBTB, and it is more direct and effective in the treatment of lesions. Sufficient freezing time and frequency can also have antibacterial and bactericidal effects on Mycobacterium tuberculosis in the lesion.