Um S-W, Yoon Y S, Lee S-M, Yim J-J, Yoo C-G, Chung H S, Kim Y W, Han S K, Shim Y-S, Kim D K
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Int J Tuberc Lung Dis. 2008 Jan;12(1):57-62.
The university and municipal hospitals in Seoul, Korea.
To evaluate the predictors of persistent airway stenosis following anti-tuberculosis chemotherapy in patients with endobronchial tuberculosis (TB).
Diagnosis of TB was confirmed by microbiology or histopathology. Bronchoscopic examinations revealed that patients had endobronchial lesions compatible with endobronchial TB. Study subjects had at least one follow-up bronchoscopy to evaluate their treatment response. Treatment response was determined by changes in the degree or extent of airway stenosis between the first and last bronchoscopic examinations.
Sixty-seven subjects were recruited retrospectively from Seoul National University Hospital and Seoul National University Boramae Hospital. Persistent bronchostenosis occurred in 41.8% of the patients. In multivariate regression analysis, age >45 years (OR 3.65), pure or combined fibrostenotic subtype (OR 5.54) and duration from onset of chief complaint to the initiation of anti-tuberculosis chemotherapy >90 days (OR 5.98) were identified as independent predictors of persistent airway stenosis. Oral corticosteroids (prednisolone equivalent >or=30 mg/d) did not reduce the frequency of persistent airway stenosis.
Early diagnosis and early administration of anti-tuberculosis chemotherapy before involvement of the deeper airways is important to prevent the development of unwanted sequelae of bronchostenosis.
韩国首尔的大学医院和市立医院。
评估支气管内膜结核患者抗结核化疗后持续性气道狭窄的预测因素。
通过微生物学或组织病理学确诊结核病。支气管镜检查显示患者有与支气管内膜结核相符的支气管内病变。研究对象至少接受一次随访支气管镜检查以评估其治疗反应。治疗反应通过首次和末次支气管镜检查之间气道狭窄程度或范围的变化来确定。
从首尔国立大学医院和首尔国立大学博拉梅医院回顾性招募了67名研究对象。41.8%的患者出现持续性支气管狭窄。在多因素回归分析中，年龄>45岁（比值比3.65）、单纯或混合纤维狭窄亚型（比值比5.54）以及从主要症状出现到开始抗结核化疗的持续时间>90天（比值比5.98）被确定为持续性气道狭窄的独立预测因素。口服皮质类固醇（泼尼松等效剂量≥30mg/d）并未降低持续性气道狭窄的发生率。
在深部气道受累之前尽早诊断并尽早给予抗结核化疗对于预防支气管狭窄不良后遗症的发生很重要。
