| Objective:To explore the related factors that affect the negative conversion of sputum smear and the negative effects of smear smear in the initial treatment of smear positive pulmonary tuberculosis patients in Yan’an at the end of 2 months,improve the treatment effect and management level of tuberculosis,and provide evidence for formulating strategies for the tuberculosis prevention and control in Yan’an.Methods:In strict accordance with the acceptance and discharge standards,a total of all newly diagnosed smear positive pulmonary tuberculosis patients in Yan’an tuberculosis designated hospital(Yan’an Second People’s Hospital)from September 1,2020 to October31,2021 were collected by trained trained researchers,and collect the clinical data of patients for three consecutive months.After 2 months of intensive treatment according to HRZE quadruple standard scheme,they were divided into two groups according to the results of sputum smear:the sputum bacteria turned negative at the end of two months(turned negative group)and the sputum bacteria did not turn negative at the end of two months(not turned negative group).The general data,special clinical data,nutritional status data,laboratory examination data[Mycobacterium tuberculosis(MTB)etiological examination data,T lymphocyte subsets(CD3+T,CD4+T,CD8+T count,CD4+/CD8+ratio),routine biochemical examination(WBC,NEU%,NEUT,LYMPH,LYMPH%,HB,PLT)],chest imaging data,bronchoscopic manifestations and diagnosis and treatment data were collected.Application spss26.0 data statistics software for statistical processing,counting data withχ~2.Carry out single factor correlation analysis by test;Wilcoxon signed rank sum test was used for correlation analysis of skew distribution data;Binary logistic regression analysis was used for multivariate analysis to explore the relevant influencing factors of sputum smear not turning negative in patients with smear positive secondary pulmonary tuberculosis in Yan’an Second People’s Hospital at the end of two months.Results:1.Sputum smear turned negative after regular antituberculous drug treatment:1.1 Sputum smears turned negative at the end of one month,two months and three months of antituberculosis treatment:a total of 292 patients were included according to the standard of natriuretic excretion,126 patients turned negative at the end of one month of treatment,the turning negative rate was 43.2%,and the average turning negative days was15.4 days;224 patients turned negative at the end of two months,and the conversion rate was 76.7%.The average number of patients who did not turn negative at the end of one month but turned negative within two months after the start of treatment was 41.6 days;285 patients turned negative at the end of 3 months,with a negative rate of 97.6%.The average number of days of turning negative in patients who did not turn negative at the end of 2 months but turned negative within 3 months after the start of treatment was 72.7 days.1.2 The patients were divided into groups according to the negative sputum smear at the end of two months of treatment:292 patients were included in this study,224 in the negative conversion group,accounting for 76.7%;68 persons in the non negative group,accounting for 23.3%.2.Univariate analysis of sputum bacteria not turning negative at the end of two months:2.1 General information:there were differences in age,smoking,excessive drinking,bronchial tuberculosis,tuberculous pleurisy and diabetes between the two groups(P<0.05).There was no difference in gender,occupation,marital status and tuberculosis exposure history(P>0.05);2.2 Special clinical data:there were differences in bronchial tuberculosis,tuberculous pleurisy and diabetes between the two groups(P<0.05).2.3 Nutritional status:there was no difference in serum prealbumin(PA),albumin(ALB)and body mass index(BMI)between the two groups(P>0.05);2.4 MTB etiological examination:there were differences in the bacterial count of sputum smear,tuberculosis antibody and T-SPOT test between the two groups(P<0.05);2.5 T lymphocyte subsets:there was no difference in the counts of CD3+T,CD4+T,CD8+T and the ratio of CD4+/CD8+between the two groups(P>0.05);2.6 Routine examination at admission:WBC increase,NEU%increase,NEUT increase,LYMPH decrease,LYMPH%decrease and PLT increase between the two groups(P<0.05);but there was no difference in in erythrocyte sedimentation rate and HB decrease(P>0.05);2.7 Chest imaging data:there were differences in the number of pulmonary lobes,cavities,pleural effusion,pleural thickening,adhesion and bronchial stenosis between the two groups(P<0.05);There was no difference in nodule patch cord shadow,caseous pneumonia,secondary bronchiectasis,emphysema,lobar infiltration and lung damage(P>0.05);2.8 The bronchoscopic manifestations:there were differences in the type of scar stenosis between the two groups(P<0.05);There was no difference in inflammatory infiltration type,ulcer necrosis type and granulation proliferation type(P>0.05)2.9 Diagnosis and treatment data:there were differences between the two groups in treatment delay,time to see a doctor,irregular medication history,adverse drug reactions and length of hospital stay(P<0.05).3.Results of multivariate logistic regression analysis:Taking the negative conversion of sputum smear at the end of two months of regular treatment as the dependent variable and the indexes with statistical significance in univariate analysis as the independent variable,the binary logistic regression analysis was used for multivariate analysis.The results showed that smoking,bronchial tuberculosis,the amount of bacteria in sputum smear at the first diagnosis,the number of pulmonary lobes involved,tuberculous pleurisy,increase of NEU%at admission and adverse drug reactions were the independent risk factors for the failure of sputum smear to turn negative in the patients with smear positive secondary pulmonary tuberculosis treated regularly in Yan’an Second People’s Hospital at the end of two months.Conclusion:1.The negative rate of sputum smear was 43.2%at the end of one month,76.7%at the end of two months and 97.6%at the end of three months.It is suggested that the 3-month regimen is safer and more reasonable for the patients with secondary pulmonary tuberculosis who lack sputum data.2.Smoking,bronchial tuberculosis,the amount of bacteria in sputum smear at the first diagnosis,the number of pulmonary lobes involved,tuberculous pleurisy,NEU%increased at admission and adverse drug reactions are independent risk factors for the failure of sputum smear to turn negative at the end of two months of regular treatment of patients with smear positive secondary pulmonary tuberculosis in Yan’an.The research results are conducive to targeted intervention measures,improve the efficiency and management level of tuberculosis treatment,and provide scientific basis for the formulation of tuberculosis prevention and control strategies in Yan’an. |
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