| Objective: To investigate the clinical features of tracheobronchial tuberculosis in order to raise awareness of tracheobronchial tuberculosis.METHODS: The clinical data of patients admitted to the Southwest Medical University Affiliated Hospital from January 2014 to December 2016,who underwent bronchoscopic examination in the Department of Endoscopic Medicine and were definitely diagnosed as tracheobronchial tuberculosis by pathological histology or etiological examination,were retrospectively analyzed.The general data,laboratory tests,imaging examinations,and bronchoscopic features were compared between the old and non-elderly groups.Results: 1.A total of 230 patients,including 85 males and 145 females,with a male to female ratio of 1:1.71.The number of patients aged 40 to 50 is the highest;the incidence of females aged 20 to 30 years is significantly higher than that of males;60 to 70 The incidence rate of males between 50 and 60 years old is higher than that of females.There were 171 non-elderly patients,including 52 males and 119 females.The male to female ratio was 1:2.29.There were 59 elderly patients,including 34 males and 25 females,with a male to female ratio of 1.36:1;the non-elderly group had a higher incidence than the elderly group.2.Visiting departments: 184 in respiratory medicine,33 in infectious diseases,6 in thoracic surgery,ENT,interventional,rehabilitation,breast surgery,and cardiology.The initial diagnosis of pulmonary infection was 50 cases,106 cases of pulmonary tuberculosis,lung mass or atelectasis in 53 cases.3.Onset time: 34 cases ranging from 1 day to 10 years,symptom duration less than 1 month,110 cases with persistent symptoms from 1 month to 1 year,86 cases with symptoms lasting longer than 1 year.4.Symptoms and Signs: Patients with bronchial tuberculosis in the elderly had significantly more dyspnea than those in the non-elderly group(,2=14.248,P=0.000).The symptoms of cough and tuberculosis poisoning(fatigue,hot flashes,There was no statistically significant difference in symptoms such as wasting,fever,chest pain,and hemoptysis.There were 101 cases of pulmonary rales,42 cases of coarse breath sounds,58 cases of reduced breath sounds,34 cases of dullness in dubious examinations,79 cases of abnormal examination,and 1 case of thoracic deformity.5.Etiology and histology: In 230 patients in this study,94 were positive for acid-fast bacillus,111 were positive for acid-fast staining on bronchoscopic brush,28 were positive for alveolar lavage,and 150 were taken for histopathological biopsy.Among them,the positive rate was 82%(123/150).There was no significant difference in the positive rates of acid-fast bacillus,bronchoscopic brush,and pathological biopsy between non-elderly and elderly patients with tracheobronchial tuberculosis(P>0.05).6.Immunological examination: There were 116 patients with tuberculosis protein microarray,the positive rate was 51.7%(60/116),including 14 cases in the elderly group and 46 cases in the non-senile group.There was no significant difference in the positive rate between the two groups.(P>0.05).There were 128 patients tested for gamma interferon release,with a positive rate of 78.9%(101/128),including 20 in the elderly group and 81 in the non-elderly group.The positive rate was higher in the non-elderly group.Statistically significant(?2=5.144,P=0.023).The sensitivity of the ?-interferon release assay was higher than that of the tuberculosis protein chip,and the difference was statistically significant(?2=69;P=0.000).7.Thoracic CT examination: CT imaging diagnosing bronchus in the elderly and non-elderly patients Stenosis,atelectasis,pulmonary cavities,pleural effusion,obstructive pneumonia,hilar,mediastinal lymphadenopathy,pleural adhesions thickening,and lung mass were not statistically significant.In the two groups of patients misdiagnosed as lung cancer,the misdiagnosis rate in the elderly group was 16.9% higher than that in the non-elderly group 8.8%.The non-elderly group had a higher rate of tuberculosis diagnosis than the elderly group.8.Tracheobronchial subtyping: Type I(inflammation infiltration)of 82 cases,including 30 males and 52 females;76 cases of type II(ulcer necrosis),including 20 males,56 females,and III(granulose)Proliferation type)10 cases,including 3 males and 7 females;IV type(scar-stenosis type)115 cases,including 36 males and 79 females: V type(wall softening type)28 cases,including 4 males,There were 24 females;0(lymph node type)0 patients.The incidence of type I,type II,and type IV in the non-elderly group was higher than that in the old group(?2=5.610;P=0.018;?2=21.828;P=0.000;?2=28.384;P=0.000);type III and V There was no significant difference in incidence between the two groups(?2=2.163;P=0.141;?2=3.299;P=0.069).9,tracheobronchial tuberculosis lesions: occurred in the trachea in 35 cases;46 cases of lesions in both lungs;right bronchial diffuse lesions in 10 cases,19 cases of left bronchial diffuse lesions;occur in the right main bronchus in 12 cases;right upper lobe 26 cases of bronchus;29 cases of right middle segmental bronchus;8 cases of right lower lobe dorsal segment;8 cases of right lower lobe basal segment;42 cases of left main bronchus;30 cases of left superior lobe segment;11 cases of left upper ligule segment;left lower lobe There were 19 cases in the segment and 23 cases in the left lower lobe.10.Relationship between microscopic classification and sputum infection: 35 cases of type I(inflammatory infiltration),19 cases of sputum positive,21 cases of type II(ulcer necrosis),7 cases of sputum positive,and type IV(scar type)In 56 cases,13 cases were positive for sputum;6 cases were type V(wall softening),4 cases were positive for sputum,and no types existed for type III(granulosis proliferation)and type VI(lymph node sputum).There were 112 cases of both types of lesions and above,and 51 cases of positive sputum.Conclusions: 1.In this study,bronchial tuberculosis was the most common among patients aged 40 to 50 years.Among young men and women,the incidence of bronchial tuberculosis was more common among young women aged 20 to 30 years.Need to be vigilant.2.The most common symptoms of bronchial tuberculosis are cough,sputum,dyspnea,and most of the examinations are arpeggios.About one-third of patients have no signs.3.The gamma interferon release assay,the tuberculosis protein chip and the chest CT have some significance for the diagnosis of tracheobronchial tuberculosis.4.Bronchoscopy is the most definitive method for diagnosing airway diseases of tracheobronchial tuberculosis.It can identify the lesion location,lesion type,and lesion stage.The incidence of non-elderly group in type I II type IV group tracheobronchial tuberculosis was higher than that in the elderly group. |
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