| Objective: To further understand the risk factors of pulmonary cavity formation in patients with TBTB by analyzing the related factors of pulmonary cavity formation in Yan’an designated tuberculosis hospital,and to provide evidence for tuberculosis prevention and control in Yan ’an City.Methods: A total of 350 patients diagnosed with TBTB by bronchoscopy in Yan ’an Second People’s Hospital(Yan ’an Tuberculosis designated Hospital)from April 1,2018 to March 31,2022 were retrospectively collected.According to the inclusion and exclusion criteria,310 TBTB patients were included in the study,and were divided into non-cavity group and cavity group according to chest CT findings.The general information(gender,age,nature of residence),bad living habits(smoking history,excessive drinking history),medical history(TB contact history,DR-TB,delayed treatment),nutritional indicators(albumin,prealbumin,BMI),complications(tuberculous pleurisy,diabetes),admission routine biochemical examination(blood routine),tuberculosis of 310 patients were collected Related examinations(erythrocyte sedimentation rate,tuberculosis antibody,TSPOT.TB test,sputum smear for acid-fast bacilli,sputum Mycobacterium tuberculosis TBDNA,sputum Mycobacterium tuberculosis culture,lavage fluid smear for acid-fast bacilli,lavage fluid Mycobacterium tuberculosis TB-DNA,lavage fluid Mycobacterium tuberculosis culture,anti-tuberculosis drug sensitivity test),chest CT examination,bronchitis Bronchoscopy was performed.SPASS25.0 statistical software was used for data analysis.The continuous data in accordance with normal distribution were expressed as mean ± standard deviation,and the two groups were compared by two independent sample T test for data analysis.The qualitative data were expressed by the constituent ratio [n(%)],and the chi-square test was used for univariate correlation analysis between the two groups.With the presence or absence of cavitation as the dependent variable and the relevant indicators of the included studies as the independent variables,and the value was assigned,the binary logistic regression equation was used for multivariate analysis.P < 0.05 was considered statistically significant.Results:1.General data analysis of TBTB patientsA total of 310 patients with TBTB who were hospitalized in Yan ’an Second People’s Hospital and diagnosed by bronchoscopy from April 1,2018 to March 31,2022 were included in this study,including 131 males and 179 females,with a male to female ratio of about 1:1.37.There were 217(70.0%)patients under 60 years old and 93(30.0%)patients over 60 years old.The nature of residence in rural areas was higher than that in urban areas(66.8% / 33.2%).2.Pulmonary cavity in TBTB patientsAccording to chest CT findings,310 TBTB patients were divided into two groups:without pulmonary cavity group(non-cavity group)and with pulmonary cavity group(cavity group).There were 218 patients(70.3%)in the non-cavity group and 92 patients(29.7%)in the cavity group.3.Univariate analysis of pulmonary cavity formation in patients with TBTB3.1 General information: there was no significant difference in the nature of residence(P=0.909)between the two groups(P > 0.05).There were significant differences in gender(P=0.005)and age(P=0.045)between the two groups(P < 0.05).3.2 Bad living habits: there were significant differences in smoking history(P<0.001)and excessive drinking history(P=0.035)between the two groups(P< 0.05).3.3 Medical history: there was no significant difference in the history of tuberculosis contact between the two groups(P=0.655)(P > 0.05).In the delayed treatment(P=0.010)and retreatment pulmonary tuberculosis(P=0.045),the differences were statistically significant(P < 0.05).3.4 Clinical data3.4.1 Nutritional indicators: there was no significant difference in the decrease of prealbumin(P=0.695)between the two groups(P > 0.05).There were significant differences in albumin(P=0.033)and BMI(P=0.041)between the two groups(P < 0.05).3.4.2 Special clinical data: there was no significant difference in tuberculous pleurisy(P=0.489)between the two groups(P > 0.05).Diabetes mellitus(P=0.006)between the two groups was statistically significant(P < 0.05).3.4.3 Laboratory tests: Comparing the two groups,The number of erythrocytes(P=0.071),white blood cells(P=0.055),platelets(P=0.160),hemoglobin(0.347),absolute neutrophil count(P=0.152),percentage of neutrophils(P=0.675),absolute lymphocyte count(P=0.966)and lymph nodes were decreased The percentage of cells decreased(P=0.078),the absolute value of monocytes increased(P=0.060),and the percentage of monocytes increased(P=0.749),but the differences were not statistically significant(P >0.05).Tuberculosis related tests included increased erythrocyte sedimentation rate(P=0.081),tuberculosis antibody(P=0.523),acid-fast bacilli in sputum smear(P=0.105),Mycobacterium tuberculosis TB-DNA in sputum(P=0.900),Mycobacterium tuberculosis culture in sputum(P=0.807),acid-fast bacilli in lavage fluid smear(P=0.118),and tuberculosis in lavage fluid There was no significant difference in Mycobacterium TBDNA(P=0.161)and Mycobacterium tuberculosis culture in lavage fluid(P=0.873)between the two groups(P > 0.05).TB positive rate(P=0.001)and drug sensitivity test(P< 0.001)were significantly different between the two groups(P < 0.05).3.4.5 Chest CT findings: pleural effusion(P=0.019),bronchial stenosis(P=0.002),pulmonary nodules(P=0.004),and pulmonary consolidation(P=0.034)were significantly different between the two groups(P < 0.05).Other chest CT findings: pleural thickening(P=0.209),secondary bronchiectasis(P=0.128),atelectasis(P=0.494)were not significantly different between the two groups(P > 0.05).3.4.6 Bronchoscopy: there was no significant difference in the appearance of type Ⅰ(P=0.791),type Ⅱ(P=0.361),type Ⅲ(P=0.833)and type Ⅳ(P=0.127)between the two groups(P > 0.05).4.Multivariate Logistic regression analysisAll the indicators included in the study were used as independent variables,and the presence or absence of cavitation was used as the dependent variable,and their values were assigned separately to establish a binary Logistic regression model.The results showed that smoking history(P=0.017),delayed treatment(P=0.032),diabetes mellitus(P=0.029),T-SPOT.TB test(P=0.008),anti-tuberculosis drug susceptibility test(P=0.001),bronchial stenosis(P=0.022)were the causes of pulmonary cavity formation in patients with TBTB in Yan ’an Second People’s Hospital Risk factors(P < 0.05).Conclusions:1.The incidence of TBTB in Yan ’an City is high in young and middle-aged people,women,and people living in rural areas,suggesting that we should pay more attention to this group of people and strengthen tuberculosis screening.2.Smoking,delay in seeking medical care,diabetes,T-SPOT.TB,drug-resistant PTB and bronchial stenosis were the independent risk factors for pulmonary cavity formation in TBTB patients in Yan ’an City.The results of this study are conducive to early and targeted intervention measures,and provide relevant evidence for the prevention and control of tuberculosis in Yan’an City. |
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