| Objective: Through the analysis of the clinical data of 211 patients with tracheobronchial tuberculosis diagnosed in the Second People’s Hospital of Yan’an City and the clinical characteristics of patients with bronchial tuberculosis in the segment and below,in order to further improve the diagnostic efficiency,reduce missed diagnosis and improve the prognosis of patients.Methods: A retrospective analysis was made of the relevant clinical data of 211 patients diagnosed with tracheobronchial tuberculosis（TBTB）in the Second People’s Hospital of Yan’an City（including general data,time of admission to the hospital when symptoms appeared,clinical symptoms,imaging manifestations,etiological data,Bronchoscopy data,tuberculosis,smoking history,etc.）.According to the different parts of the lesion,they were divided into the above-segment group（group A）and the segment and below-segment group,the latter including the pure-segment and below-segment group（group B）and the above-segment and below-segment mixed lesions（group C）.The data of group A and group B（including general information,symptoms,signs,BMI,number of microscopic treatments,sputum negative time,tuberculosis-related examinations,imaging chest CT,bronchoscopy reports,etc.）were compared.Focus on the clinical characteristics of group B.SPSS 25.0 data statistical software was used for statistical processing,measurement data conforming to normal distribution were used for statistical description,and two independent samples t-test was used for comparison between two groups;nonnormal distribution was expressed as M（P25,P75）,and two Comparisons between groups were performed using the Wilcoxon signed rank sum test.The enumeration data were expressed as [n（%）],and the comparison between the two groups was performed using theχ2 test.Results:1.Clinical data of 211 patients with tracheobronchial tuberculosis:1.1 General information: 87 males and 124 females,with a male-to-female ratio of1:1.43;aged 14-74 years,38（26,56）.There were 49 cases of smoking history,accounting for 23.22%;172 cases of pulmonary tuberculosis,accounting for 81.52%.1.2 The distribution of lesions was divided into groups: above-segment group（group A）with 67 cases,accounting for 31.75%;segment and below-segment group with 144 cases,accounting for 68.25%.In the latter group,there were 97 cases in the pure segment and below segment group（group B）,accounting for 45.97%,and 47 cases in the mixed group（group C）with lesions above the segment and below the segment（group C）,accounting for 22.28%.1.3 Clinical features: Among the symptoms,cough and expectoration were the most common,accounting for 84.36%.In chest CT,66.35% of nodules and cord shadows,58.29%of patch and spot shadows,and 20.37% of tube wall thickening and lumen stenosis.The inflammatory infiltrating type（type I）under bronchoscopy was the most,accounting for68.72%;the lesions in the left upper lobe were the most,accounting for 33.18%.The etiological positive rate of bronchoscopic lavage fluid was in the order of Mycobacterium tuberculosis culture > TB-DNA > smear;in the classification,the pathogenic positive rate of lavage fluid of ulcer necrosis type（type II）was the highest,Mycobacterium tuberculosis smear,TB-The positive rates of DNA and culture were 50.45%,60.36% and 69.37%,respectively.2.The comparison between the simple above-segment group（group A）and the simple segment and below-segment group（group B）:2.1 General information: Group A had 67 cases,21 males and 46 females,with a maleto-female ratio of 1:2.19;group B had 97 cases,49 males and 48 females,with a male-tofemale ratio of about 1:1.Both groups A and B were more common in people aged 21 to40 years old.2.2 Clinical features: Cough and expectoration accounted for 83.58% and 60.82% of the symptoms in groups A and B,respectively,and there was a difference between the two groups（P<0.05）.%,there was a difference between the two groups（P<0.05）;the granulation proliferation type accounted for 50.75% and 24.74% in the two groups A and B,respectively,and there was a difference between the two groups（P<0.05）;the scar stenosis type accounted for 26.87%,respectively %,45.36%,there is a difference between the two groups（P<0.05）;the number of people found by physical examination in two groups A and B accounted for 5.97% and 18.56%,respectively,and there was a difference between the two groups（P<0.05）;The average number of treatments under the microscope in the two groups were 5.18±3.58 and 8.81±3.30,respectively,and there were differences between the two groups（P<0.05）.3.A study on the personality characteristics of the simple segment and below group（group B）:3.1Distribution of lesions: pure lesions accounted for 27.84% of segments,subsegments accounted for 19.59%,and sub-sub-segments accounted for 6.19%;segmental,sub-segment,and sub-sub-segment lesions accounted for 46.39%.3.2 Clinical features: Men and women with low breath sounds accounted for 8.16%and 25.00% respectively,and there was a difference between men and women（P<0.05）.Bronchoscopic inflammatory infiltration type was the most,accounting for 64.95%,followed by scar stricture type,accounting for 45.36%.In the scar stenosis type,men and women accounted for 38.63% and 61.36%,respectively,and there was a difference between men and women（P<0.05）.The most lesions were in the right upper lobe,accounting for 34.02%.The order of pathogenic positive rate of various types of bronchoscopy lavage fluid is Mycobacterium tuberculosis culture > TB-DNA > smear;in the classification,the pathogenic positive rate of lavage fluid of ulcer necrosis type（type II）is the highest,and Mycobacterium tuberculosis smear,TB-DNA and culture positive rates were 38.89%,52.78% and 80.56%,respectively.Conclusion:1.In tracheobronchial tuberculosis,the simple segment and sub-segment group accounted for 45.97%,and the mixed group accounted for 22.28%,reminding us that segmental and sub-segment bronchial tuberculosis that is difficult to detect by conventional bronchoscopy is not uncommon,and it is easy to cause tuberculosis progression if not treated in time.If it does not heal,there is a risk of irreversible damage to the airway.2.There are more male patients with simple segment and sub-segmental bronchial tuberculosis;cough is relatively insignificant on symptoms;low breath sounds are common signs;chest CT findings are not typical;inflammatory infiltrating type is most common under bronchoscopy;and the number of microscopic treatments for these patients is more,slower recovery. |
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