摘要
目的分析淋巴结结核病(lymph node tuberculosis,LNTB)住院病例的临床流行病学和耐药特征。方法采用回顾性调查方法,收集2013年1月—2022年3月湖南省胸科医院调查结核分枝杆菌培养阳性的LNTB住院病例信息,从医院的电子病历中收集患者的人口统计学、临床特征和药敏检测等数据。描述分析病例临床特征,采用χ^(2)检验比较组间差异。结果共收集到577例LNTB住院病例,其中,男性373例(64.64%);农民352例(61.01%)。年龄分布为3~83岁,20~59岁年龄组占比最高,达72.10%;单纯LNTB组、单纯LNTB合并其他肺外结核病(LNTB alone combined with the other extrapulmonary tuberculosis,LNTB-EPTB)组和单纯LNTB合并肺结核病(LNTB alone combined with pulmonary tuberculosis,LNTB-PTB)组的农民人群占比均高于其他职业人群,差异有统计学意义(χ^(2)=18.479,P=0.018)。长沙市和邵阳市的病例居多,分别占20.10%和14.04%。单纯LNTB组147例(占25.48%),LNTB-PTB组350例(占60.66%),LNTB-EPTB组80例(占13.86%)。颈部的结核性淋巴结在单纯LNTB组所占比例高于LNTB-PTB组和LNTB-EPTB组(81.63%vs.51.71%&55.00%)。3种类型LNTB的结核病灶数分布差异有统计学意义(χ^(2)=547.539,P<0.001)。97.28%的单纯LNTB患者只有1个结核病灶,68.86%LNTB-PTB和56.25%LNTB-EPTB患者有2个病灶。首次分离菌株中,4种一线药物的总耐药率为26.00%,其中,单耐药率、耐多药(multi-drug resistance,MDR)率和多耐药率分别为9.36%、12.48%和4.16%,对异烟肼、链霉素、利福平和乙胺丁醇的耐药率分别为20.62%、18.37%、13.34%和6.07%。20~59岁年龄组的SM耐药率高于<20岁和≥60岁年龄组(21.39%vs.10.26%&10.84%),差异有统计学意义(P<0.05)。西部地区链霉素、异烟肼和利福平耐药率和MDR率均高于中部和东部地区,且西部地区乙胺丁醇和总耐药率均高于东部和中部地区。各类型耐药率在不同性别和职业之间的分布差异无统计学意义。农民、学生、干部、无业人员及其他人员病例的6种耐药类型的耐药率均存在不同的差异,但差异无统计学意义。结论湖南省LNTB具有其临床流行病学和耐药特征,如存在不同的高发地区、合并不同部位和多个病损部位多见,耐药性较严重等,这为更有效地控制结核病流行提供了基础科学数据,有助于改进淋巴结核的诊断、治疗和预防策略。
Objective To analyze the clinical epidemiology and drug resistance characteristics of hospitalized cases of lymph node tuberculosis(LNTB).Methods A retrospective survey method was used to collect the information about the surveyed hospitalized LNTB cases having a culture positive for Mycobacterium tuberculosis in Hunan Chest Hospital from January 2013 to March 2022.Data about the demographic,clinical characteristics and drug susceptibility test of the inpatients were collected from the hospital’s electronic medical records.The clinical characteristics of the inpatients were descriptively analyzed,andχ^(2) test was used to compare the differences between groups.Results A total of 577 hospitalized cases of LNTB were collected,among which 373(64.64%)cases were males and 352(61.01%)cases farmers.The ages of the cases ranged from 3 to 83 years,with the group aged 20-59 years accounting for the highest proportion(72.10%).The proportions of farmers in the groups of LNTB alone,LNTB alone combined with other extrapulmonary tuberculosis(LNTB-EPTB),and LNTB alone combined with pulmonary tuberculosis(LNTB-PTB)were all higher than those in other occupational groups,showing statistically significant differences(χ^(2)=18.479,P=0.018).Most of the cases were reported in Changsha city and Shaoyang city,accounting for 20.10%and 14.04%respectively.There were 147(25.48%)cases in the LNTB alone group,350(60.66%)cases in the LNTB-PTB group and 80(13.86%)cases in the LNTB-EPTB group.The proportion of tuberculous lymph nodes in the neck was higher in the LNTB alone group than in the LNTB-PTB group and the LNTB-EPTB group(81.63%vs.51.71%,81.63%vs.55.00%).There were statistically significant differences in the distribution of number of TB lesions among the three types of LNTB(χ^(2)=547.539,P<0.001).Specifically,97.28%of inpatients with LNTB alone had only one lesion,while 68.86%of inpatients with LNTB-PTB and 56.25%of inpatients with LNTB-EPTB had two lesions.For the initially isolated strains,the overall drug resistance rate to the four first-line anti-tuberculosis drugs was 26.00%,among which the rates of single drug resistance,multi-drug resistance(MDR)and poly-drug resistance were 9.36%,12.48%and 4.16%respectively.The resistance rates to isoniazid(INH),streptomycin(SM),rifampicin(RFP),and ethambutol(EMB)were 20.62%,18.37%,13.34%and 6.07%respectively.The resistance rate to SM was higher in the group aged 20-59 years than in the group aged<20 years and the group aged≥60 years(21.39%vs.10.26%,21.39%vs.10.84%),showing statistically significant differences(P<0.05).The resistance rates to SM,INH and RFP and the MDR rate were all higher in the western region than in the central and eastern regions.The rates of resistance to EMB and total drugs were higher in the western region than in the eastern and central regions.No statistically significant differences were found in the distributions of various types of drug resistance rates between genders and among occupations.Although there were differences in the drug resistance rates for six types of drug resistance among cases of farmers,students,cadres,the unemployed and other individuals,the differences were not statistically significant.Conclusions LNTB in Hunan province has unique clinical epidemiological and drug resistance characteristics,such as different high incidence regions,different sites,common multiple lesions,and serious drug resistance.The results of this study provide basic scientific data for more effective control of tuberculosis epidemic,and are conducive to improving the diagnosis,treatment,and prevention strategies of lymph node tuberculosis.
作者
徐涛
李文彬
孙庆
刘彬彬
余艳艳
方谭玮
谭云洪
XU Tao;LI Wenbin;SUN Qing;LIU Binbin;YU Yanyan;FANG Tanwei;TAN Yunhong(Department of Basic Medicine,Changsha Health Vocational College,Changsha,Hunan 410000,China;Hunan Institute for Tuberculosis Control/Hunan Chest Hospital,Changsha,Hunan 410013,China;Department of Medicine,Hunan Traditional Chinese Medical College,Zhuzhou,Hunan 412000,China)
出处
《实用预防医学》
2025年第11期1295-1300,共6页
Practical Preventive Medicine
基金
湖南省中医药科研课题基金(B2024110)。
关键词
结核病
淋巴结核
临床流行病学
耐药性
tuberculosis
lymph node tuberculosis
clinical epidemiology
drug resistance
