Comparative Study And Logistic Regression Analysis Of CT Signs Of NTM Lung Disease And Multidrug Resistant Pulmonary Tuberculosis

Objective:non-tuberculous mycobacterium(NTM)lung disease and multidrug-resistant tuberculosis(MDR-TB)are common clinical diseases,but diagnosis is difficult and treatment is different.Early and correct diagnosis plays an important role in treatment.In this study,by comparing the clinical features and chest CT imaging features of patients with NTM lung disease and MDR-TB group,the characteristics and manifestations of NTM lung disease were screened to facilitate early differential diagnosis,improve diagnosis level and contribute to deepening clinical understanding of the two diseases.Methods:Patients admitted to Jiangxi Chest Hospital from February 2020 to January 2022 with complete chest CT imaging data,clinical diagnosis and treatment records,and clear drug-sensitive test results meeting the inclusion criteria were selected.Patients with NTM lung disease meeting the diagnostic criteria were selected as the NTM lung disease group.Patients who met the diagnostic criteria of MDR-TB were classified as the MDR-TB group.A double-blind retrospective analysis was conducted on chest CT image data of the two groups of patients,and a Microsoft Excel information database was established.Including general clinical data(gender,age,clinical findings,etc.)and chest CT imaging findings,These include nodular lesions(lobular central nodule,nodule distribution,etc.),bronchial lesions(bronchiectasis,distribution of bronchiectasis involvement,etc.),cavity lesions(cavity location,cavity size,cavity wall diameter,the ratio of the thickest part to the thinnest part of the cavity,etc.),and other imaging features(lung consolidation,intrapulmonary calcification,hilar and mediastinal lymph node calcification,pleural effusion,IBM SPSS Statistics 22 software was used for statistical analysis.Univariate analysis was carried out for the two groups of variables,chi-square test was selected for counting data,and T-test was used for the two groups of continuous variables conforming to normal distribution,expressed as mean ± standard deviation(x±s).Non-parametric test was used for the two groups of continuous variables that did not conform to the normal distribution,and the median(quartile)[M(Q1,Q3)] was expressed,and P < 0.05 was considered as statistically significant difference.Then,the factors with statistical difference(P < 0.05)were extracted as independent variables,and whether it was NTM lung disease was taken as dependent variable for logistic regression analysis of independent influencing factors of NTM lung disease,and P < 0.05 was regarded as statistically significant difference.Results:(1)Clinical data: The age of the NTM group was older than that of the MDR-TB group(P < 0.05),and there was no statistical significance in gender and clinical manifestations between the NTM group and the MDR-TB group(P > 0.05).(2)Imaging findings: The incidence of central lobular nodules and bronchiectasis in NTM group was higher than that in MDR-TB group(P < 0.05).The cavity diameter of the NTM group was smaller than that of the MDR-TB group[2.46cm(2.00 cm,3.45cm)vs3.68cm(3.12 cm,5.24cm),P < 0.001],and the cavity wall thickness of the NTM group was thinner than that of the MDR-TB group [0.5789cm(0.40 cm,0.75cm)vs1.44cm(1.02 cm,1.97cm),P < 0.001],the ratio of thickest cavity to thinest cavity(irregularity of cavity lesion)was smaller in the NTM group than in the MDR-TB group [2.52(1.67,2.86)vs5.20(3.65,6.03),P < 0.001].In the MDR-TB group,calcification of pulmonary nodules,mediastinal lymph node,pleural effusion and lung destruction were more common(P < 0.05).(3)logistic regression analysis: The results showed that age([OR]:1.077,P=0.014),branch expansion([OR]: 10.74,P=0.013)was an important factor in predicting NTM lung disease.The original data were input into the regression equation to predict the probability of each case developing NTM lung disease.The sensitivity and specificity of the final diagnosis of NTM lung disease were 83.67%(41/49)and 90.69%(39/43).Conclusion:(1)The onset age of patients with NTM lung disease is older than that of patients with MDR-TB.In patients with NTM lung disease,lobular central nodules are more obvious.Bronchiectasis is an important factor in predicting NTM lung disease and MDR-TB,especially the bronchiectasis CT findings located in the right middle lobe and left lingual lobe often suggest that NTM lung disease is more likely than multi-drug resistant tuberculosis(MDR-TB).(2)The cavity lesions in patients with NTM lung disease are smaller in diameter than those in multidrug-resistant tuberculosis(MDR-TB),and the cavity walls in patients with NTM lung disease are thinner and more uniform than those in multidrug-resistant tuberculosis(MDR-TB).When CT imaging features such as nodules calcification,pleural effusion,and lung lesions are present,it should be considered that multi-drug resistant tuberculosis(MDR-TB)is more likely than NTM lung disease.(3)In the differential diagnosis of the two,HRCT examination and logistic regression prediction model can provide imaging basis for the differential diagnosis of the two,which is conducive to the early diagnosis of the two in clinic.