| Objective To investigate the clinical characteristics of patients with ulcer-necrotic tracheobronchial tuberculosis and find out the factors affecting the short-term prognosis..Methods This study adopts a retrospective research method to collect clinical data of patients with ulcer necrotic tracheobronchial tuberculosis who underwent bronchoscopy from July 1,2019 to June 30,2020,and analyzed their clinical characteristics According to the bronchoscopy characteristics and the negative conversion of sputum bacteria after 6 months of treatment,the patients were divided into effective group and ineffective group.Multivariate Logistic regression was used to analyze the factors affecting the patient’s short-term prognosis.In addition,we selected two indexes,PCPE-1 and LECT2,which may be involved in the pathophysiological process of tracheobronchial stenosis,and observed the relationship between these two indexes and the prognosis of the treatment of ulcerative necrotic tracheobronchial tuberculosis.Results The proportion of patients with ulcer necrotic tracheobronchial tuberculosis accounted for 37.9%（258/681）of patients with tracheobronchial tuberculosis,mostly females,with a median age of 35.5 years;the lesions were unilaterally involved in the left main bronchus and distal lumen.Mainly（65.5%）;patients with central airway stenosis accounted for 55.0%;the first clinical symptoms were mainly cough and sputum（80.6%）;90.6% of patients who had symptoms lasted for more than 4 weeks to see a doctor;the vast majority of patients did not merge Resistance（92.2%）.The comparison of clinical characteristics between the effective group and the ineffective group found that the two groups had statistically significant differences in gender,age,diabetic complications,BMI,drug resistance,C-reactive protein and the number of endoscopic treatments（all P<0.05）Among them,the proportion of female patients in the effective group and the proportion of patients undergoing regular endoscopic diagnosis and treatment were higher than those in the ineffective group;the average age of the ineffective group,the proportion of diabetic complications,the proportion of patients with BMI（less than 18.5）,the proportion of drug resistance,and the average value of C-reactive protein were all higher than the effective group.Analysis of factors affecting the patient’s short-term prognosis showed that age（OR=1.055,95%CI（1.031-1.079））,gender（OR=3.412,95%CI（1.386-8.397））,and BMI lower than 18.5（OR=4.825,95%CI（1.126-20.677））,combined diabetes（OR=0.209,95%CI（0.076-0.574））,C-reactive protein（OR=1.043,95%CI（1.013-1.073））,drug resistance（OR= 0.015,95% CI（0.002-0.100））and failure to cooperate with regular bronchoscopy intervention（OR=3.442,95% CI（1.407-8.416））are risk factors that affect the short-term prognosis of patients with ulcerative necrotic bronchial tuberculosis.The serum levels of PCPE-1 and LECT2 in the treatment-ineffective group were higher than those in the treatment-effective group,and both of them could be used as serological indexes to predict the tracheobronchial stenosis of the patients with ulcerative necrotic tracheobronchial tuberculosis.The area under ROC curve of LECT2 and PCPE-1 were 0.872（95% CI: 0.823-0.922,p < 0.000）and 0.718（95% CI:0.622-0.814,p < 0.000）,respectively.Conclusion In the classification of tracheobronchial tuberculosis,the ulcer and necrosis type accounts for a relatively high proportion,and it is more likely to occur in young and middle-aged women with low BMI;early diagnosis and treatment and regular bronchoscopy intervention can improve the prognosis of ulcerative tuberculosis patients.Serum PCPE-1 and;LECT2 may predict the prognosis of patients with ulcerative pulmonary tuberculosis. |
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