| Objective:To analyze the clinical characteristics of 282 patients with tracheobronchial tuberculosis diagnosed in the Second People’s Hospital of Yan’an and the related influencing factors of airway stenosis found by bronchoscopy for the first time,so as to realize early detection,early diagnosis and early treatment of tracheobronchial tuberculosis and provide theoretical basis for the prevention and treatment of tuberculous airway stenosis in Yan’an.Methods:From May 2018 to April 2020,282 patients with TBTB who underwent bronchoscopy in the Second People’s Hospital of Yan’an were analyzed.According to whether they were complicated with airway stenosis after initial bronchoscopy,they were divided into stenosis group(n=173)and non-stenosis group(n=109).The general data,pathogenic data,laboratory data,radiological data and bronchoscopy data of all patients were collected through the medical record browser of the Second Hospital of Yan’an.Statistical analysis was carried out by SPSS25.0 data statistics software,and the measurement data of normal distribution was expressed as"(?)x±s",and two independent samples were compared between the two groups.The counting data were represented by"[n(%)]",and the two groups were compared byχ~2 test or continuous correctionχ~2 test and Fisher exact probability test.Multivariate logistic regression analysis was used for multivariate analysis;To analyze the manifestations of patients with stenosis under bronchoscope and the related factors of airway stenosis.Results:1.Comparison of clinical data between airway stenosis group and non-airway stenosis group:1.1 General information:The airway stenosis group is female,aged 20-40 years,has no smoking history,and the time of seeing a doctor is more than 30 days,especially complicated with diabetes,and the difference between the two groups is statistically significant(P<0.05);There was no significant difference between the two groups(P>0.05)in the results of residence,contact history of patients with hypertension/cerebral infarction and tuberculosis.1.2 Clinical manifestations:The clinical manifestations of airway stenosis group are cough,expectoration,chest tightness and shortness of breath,while the clinical manifestations of non-airway stenosis group are tuberculosis found by physical examination,and the difference between the two groups is statistically significant(P<0.05);There was no significant difference in clinical manifestations such as bloody sputum,hemoptysis,chest pain,fever and tuberculosis poisoning(P>0.05).1.3 Pathogenic examination of Mycobacterium tuberculosis:The positive rate of lavage fluid pathogens(acid-fast bacilli smear,TB-DNA and Mycobacterium tuberculosis culture)in airway stenosis group was higher than that in non-airway stenosis group,and the difference between the two groups was statistically significant(P<0.05);The results of sputum acid-fast bacilli smear,sputum TB-DNA,sputum Mycobacterium tuberculosis culture,tuberculosis T-SPOT,etc.showed no significant difference between the two groups(P>0.05).1.4 Routine biochemical examination:in airway stenosis group,prealbumin and hematocrit were mainly decreased,while in non-airway stenosis group,leukocyte count,neutrophil absolute value,lymphocyte absolute value,monocyte absolute value and platelet count were mainly increased,and the difference between the two groups was statistically significant(P<0.05);There were no significant differences in the percentage of neutrophils,lymphocytes,monocytes,erythrocytes,hemoglobin,albumin,D-dimer and erythrocyte sedimentation rate(P>0.05).1.5 Radiological examination:Left main branch,right main branch and right middle lobe were the main lesions involved in airway stenosis group,while cavities,multiple cavities and thick-walled cavities were the main lesions in non-airway stenosis group,with statistical significance(P<0.05);There was no significant difference between the two groups in the results of pleural effusion,pleural thickening,nodule/tree bud sign,bronchial lesions,consolidation,ground glass nodules,atelectasis,lesions involving other lobes and lesions involving the number of lobes(P>0.05).2.The results of bronchoscopy in airway stenosis group:2.1 Bronchoscope performance:Among 173 patients with airway stenosis,there were 110 patients with mild airway stenosis,accounting for 63.6%;There were 63 patients with severe airway stenosis,accounting for 36.4%.There were 60 patients with single airway stenosis,accounting for34.7%;There were 113 patients with multiple airway stenosis,accounting for 65.3%.There were 29 patients with stenosis in the left main bronchus,accounting for 16.8%.There were 14 patients with stenosis in the right main bronchus,accounting for 8.1%.There were 61 patients with bronchial stenosis in the upper lobe of left lung,accounting for 35.3%.There were 50 patients in the upper lobe of right lung,accounting for 28.9%.There were 52 patients in the right middle lobe bronchus,accounting for 30.1%.Among the pathological types of stenosis,there were 95 patients with ulcer necrosis,accounting for 54.9%,the highest proportion;There were 58 patients with scar stenosis,accounting for 33.5%;There were 38 patients with inflammatory infiltration type,accounting for 22.0%.2.2 According to the degree of stenosis,the data of subgroups are compared:Among the types of stenosis,there were 67 cases in mild stenosis group and 46 cases in severe stenosis group,accounting for 60.9%and 73.0%respectively,and there was no significant difference between the two groups(P>0.05).Left main branch was common in mild stenosis group and severe stenosis group,with21 cases and 8 cases respectively,accounting for 19.1%and 12.7%.Left upper lobe bronchus was more common,with 38 cases and 23 cases respectively,accounting for 34.5%and 36.5%.There was no significant difference between the two groups in the type and location of stenosis(P>0.05).Among the pathological types related to stenosis,inflammatory infiltration type is prone to mild stenosis,with 31 cases and 7 cases in the two groups,accounting for 28.2%and 11.1%respectively,with statistical significance(P<0.05).Ulcer necrosis type is the most prone to severe stenosis,with 54 cases and 41 cases respectively,accounting for 49.1%and 65.1%,with statistical significance between the two groups(P<0.05).There was no significant difference between the two groups in the degree of granulation proliferation,scar stenosis,wall softening and lymph node fistula(P>0.05).3.The results of binary logistic regression analysis of airway stenosis in patients with stenosis group:Taking whether the first bronchoscopy report after admission was complicated with airway stenosis as the dependent variable,and taking the statistically significant indicators in univariate analysis as the independent variable,binary logistic regression analysis was carried out.The results showed that:Female[OR=2.719,95%CI(1.602,4.616),P<0.05],age[OR=1.041,95%CI(1.007,1.075),P<0.05],complicated with diabetes[OR=4.749,95%CI(1.564,14.414),P<0.05],tuberculosis found in physical examination[OR=0.293,95%CI(0.132,0.653),P<0.05],and the time of seeing a doctor>30 days[OR=2.679,95%CI(1.601,4.481),P<0.05].Female,age,diabetes,and time of seeing a doctor for more than 30 days are independent risk factors for early airway stenosis in patients with tracheobronchial tuberculosis.Smoking and physical examination found that tuberculosis is an independent protective factor for early airway stenosis in patients with tracheobronchial tuberculosis.Conclusion:1.Young female tuberculosis patients with cough,expectoration,chest tightness and shortness of breath are high-risk groups of tracheobronchial tuberculosis,and bronchial screening should be carried out as soon as possible.2.The airway stenosis caused by bronchial tuberculosis is more common in the left lung bronchus.Inflammatory infiltration type is prone to mild stenosis,and ulcer necrosis type is prone to severe stenosis.3.Young women,patients with diabetes mellitus and patients with tracheobronchial tuberculosis who have seen a doctor for more than 30 days are easy to form airway stenosis. |
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