摘要
目的探讨四川地区儿童耐药肺结核(DR-PTB)和药物敏感肺结核(DS-PTB)患者的临床特征及胸部计算机断层成像(CT)相关特征表现。方法纳入2020年1月至2024年10月成都市公共卫生临床医疗中心收治的痰结核分枝杆菌培养阳性的儿童活动性肺结核患者,按照药物敏感试验结果分为耐药组和敏感组。对比两组患儿的年龄、民族、性别、初复治情况、体重指数等一般资料,咳嗽、咳痰、发热等临床症状,以及胸部CT特征表现,组间比较采用非参数秩和检验、χ^(2)检验或Fisher确切概率法。采用二元logistic回归方程分析儿童肺结核患者发生耐药的CT危险征象。结果共纳入110例肺结核患儿,其中男44例(40.00%),女66例(60.00%),就诊时年龄为13.00(12.00,14.00)岁,范围为5.00~14.00岁。耐药组28例,敏感组82例,耐药组中复治者占25.00%(7/28),少数民族占78.57%(22/28),均高于敏感组[1.22%(1/82)和57.32%(47/82)],差异均有统计学意义(Fisher确切概率法,χ^(2)=4.03,均P<0.05);耐药组患儿的年龄为13.00(12.00,13.50)岁,低于敏感组的13.00(12.00,14.00)岁,差异有统计学意义(U=828.00,P=0.021)。两组间性别、体重指数、卡介苗接种史、与结核病患者接触史、免疫学诊断试验阳性的比例,以及咳嗽,咳痰,发热,喘息、气促,胸痛发生率的差异均无统计学意义(均P>0.05)。胸部CT征象比较:耐药组肺部病灶累及双肺者占53.57%(15/28),肺叶实变影(含无壁空洞)的发生率为92.86%(26/28),均高于敏感组[15.85%(13/82)和70.73%(58/82)],差异均有统计学意义(χ^(2)=6.95、5.66,均P<0.05);而敏感组小结节影/"树芽征"发生率高于耐药组[98.78%(81/82)比82.14%(23/28)],差异有统计学意义(Fisher确切概率法,P=0.004)。二元logistic回归方程显示,病灶累及双肺、实变影(含无壁空洞)的发生与儿童DR-PTB呈正相关[比值比(OR)=4.487,95%可信区间(CI)1.561~12.897,P=0.005;OR=9.670,95%CI 1.626~57.529,P=0.013);小结节影/"树芽征"的发生与儿童DR-PTB呈负相关(OR=0.058,95%CI 0.006~0.584,P=0.016)。结论四川地区儿童肺结核患者中,DR-PTB患儿的少数民族、复治比例高于DS-PTB患儿。儿童DR-PTB的胸部CT特征主要表现为多发实变影(含无壁空洞),病灶常累及双肺野;DS-PTB的CT影像表现则以小结节影/"树芽征"表现为主。
Objective To investigate the clinical and chest computed tomography(CT)findings of children with drug-resistant pulmonary tuberculosis(DR-PTB)and drug-sensitive pulmonary tuberculosis(DS-PTB)in Sichuan region.MethodsActive pulmonary tuberculosis children with positive sputum Mycobacterium tuberculosis culture were collected and divided into the drug-resistant and drug-sensitive groups according to the results of the drug susceptibility test who admitted to the Public Health Clinical Center of Chengdu from January 2020 to October 2024.The general data such as age,ethnic,gender,initial or retreatment regimens,body mass index(BMI),clinical symptoms such as cough,sputum,fever,and chest CT features were compared between the two groups.Non-parametric rank sum test,chi-square test or Fisher′s exact probability method were used for comparison between groups.The CT risk factors for the development of DR-PTB were analyzed using binary logistic regression.ResultsA total of 110 children were enrolled,including 44(40.00%)males and 66(60.00%)females,with the age of 13.00(12.00,14.00)years(range from 5.00 to 14.00 years).There were 28 cases in drug-resistant group and 82 in drug-sensitive group.Comparison of the clinical data between the two groups showed that the percentages of retreated patients(25.00%(7/28))and ethnic minorities(78.57%(22/28))in the drug-resistant group were higher than those in the drug-sensitive group(1.22%(1/82)and 57.32%(47/82)),which were both statistically significant(Fisher′s exact probability method andχ^(2)=4.03,respectively,both P<0.05).The age of the children in the drug-resistant group was 13.00(12.00,13.50)years,which was younger than the age of 13.00(12.00,14.00)years in the drug-sensitive group(U=828.00,P=0.021).There were no statistically differences of gender,BMI,history of bacillus Calmette-Guérin(BCG)vaccination,history of exposure to tuberculosis patients,positive immunological diagnostic tests,and the incidences of cough,sputum,fever,wheezing,shortness of breath and chest pain between the two groups(all P>0.05).Chest CT signs showed that lung lesions involving both right and left lobes accounted for 53.57%(15/28)in the drug-resistant group,and the incidence of solid pulmonary parenchyma(including wall-less cavities)was 92.86%(26/28),which were both higher than those in the drug-sensitive group(15.85%(13/82)and 70.73%(58/82)),and the differences were statistically significant(χ^(2)=6.95 and 5.66,respectively,both P<0.05).The incidence of small nodules/tree-in-bud pattern in the drug-sensitive group was higher than that in the drug-resistant group(98.78%(81/82)vs 82.14%(23/28)),and the difference was statistically significant(Fisher′s exact probability method,P=0.004).Binary logistic regression showed that bilateral lung involvement and solid pulmonary parenchyma(including wall-less cavities)were positively correlated with DR-PTB in children(odds ratio(OR)=4.487,95%confidence internal(CI)1.561 to 12.897,P=0.005 and OR=9.670,95%CI 1.626 to 57.529,P=0.013,respectively).The occurence of small nodules/tree-in-bud was negatively correlated with DR-PTB in children(OR=0.058,95%CI 0.006 to 0.584,P=0.016).ConclusionsAmong pulmonary tuberculosis children in Sichuan region,ethnic minorities and retreatment patients with DR-PTB are more common than thoses with DS-PTB.Chest CT findings of DR-PTB mainly show multiple solid pulmonary parenchyma with wall-less cavities,and the lesions often involve right and left lung lobes,whereas DS-PTB CT findings mainly show small nodules/tree-in-bud predominantly.
作者
熊青青
魏徵霄
敖静
梁丽
高月琴
王冬梅
陈竹
Xiong Qingqing;Wei Zhengxiao;Ao Jing;Liang Li;Gao Yueqin;Wang Dongmei;Chen Zhu(Research and Teaching Department,Public Health Clinical Center of Chengdu,Chengdu 610066,China;Department of Medical Laboratory,Public Health Clinical Center of Chengdu,Chengdu 610066,China;Department of Tuberculosis,Public Health Clinical Center of Chengdu,Chengdu 610066,China;Radiology Department,Public Health Clinical Center of Chengdu,Chengdu 610066,China)
出处
《中华传染病杂志》
CSCD
北大核心
2024年第11期661-667,共7页
Chinese Journal of Infectious Diseases
基金
成都市医学科研课题(2023314)。
关键词
儿童
结核
肺
耐药
敏感
计算机断层扫描
Children
Tuberculosis,pulmonary
Drug-resistant
Drug-sensitive
Computed tomography
