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结核性气道狭窄介入治疗后再狭窄的危险因素分析

Analysis of Risk Factors for Restenosis after Interventional Treatment of Tuberculous Airway Stenosis.

作者信息

Huang Wei, Xu Chao, Wei Baochu, Li Xuyang, Wu Fanqi, Hou Yue, Wang Hong

机构信息

Department of Respiratory Medicine, Lanzhou University Second Hospital, Lanzhou, China,

The Second Clinical Medical College of Lanzhou University, Lanzhou, China,

出版信息

Respiration. 2025;104(5):341-348. doi: 10.1159/000542909. Epub 2024 Dec 19.

Abstract

INTRODUCTION

Airway stenosis is the most common and serious complication of tracheobronchial tuberculosis (TBTB). Systemic anti-tuberculosis treatment is the basic treatment for TBTB airway stenosis, and supplemented with tracheoscopic intervention, it can effectively minimize the occurrence of TBTB stenosis or reduce the degree of stenosis; however, some patients still have restenosis after the intervention. However, some patients still have restenosis after intervention.

METHODS

We retrospectively collected the clinical data of patients diagnosed with tuberculous airway stenosis in the Second Hospital of Lanzhou University and Lanzhou Pulmonary Hospital from January 2021 to June 2023. The patients were divided into the restenosis group and the non-restenosis group according to whether or not restenosis occurred in the airway within 1 year of the intervention, and the differences in the clinical data between the two groups were compared, and the variables with statistically significant differences in the univariate analysis were analyzed by multifactorial binary logistic regression.

RESULTS

A total of 154 patients with tuberculous airway stenosis were included in this study, including 64 patients in the restenosis group, and the restenosis rate was 41.6%. Univariate analysis showed that the systemic immune inflammation index (SII) was higher in the restenosis group than in the non-restenosis group, and the composition of diabetic patients, stenosis length >3 cm, and positive antacid staining of tracheal secretions were higher in the restenosis group than in the non-restenosis group (all p < 0.05). The composition of microscopically inactive, anti-tuberculosis treatment before intervention and balloon dilatation was lower (all p < 0.05). Multifactorial binary logistic regression analysis showed that diabetes (OR = 5.758, 95% CI: 1.434-23.119), stenosis length (OR = 6.349, 95% CI: 2.653-15.197), SII (OR = 1.002, 95% CI: 1.001-1.003), anti-tuberculosis treatment before interventional therapy (OR = 0.250, 95% CI: 0.084-0.746), and TBTB microscopic classification and staging (OR = 0.306, 95% CI: 0.099-0.941) were independent influencing factors of restenosis after interventional therapy for tuberculous airway stenosis.

CONCLUSION

Diabetes, stenosis length >3 cm, and high SII were independent risk factors for restenosis after intervention for tuberculous airway stenosis, before interventional anti-tuberculosis treatment and microscopic inactivity were independent protective factors.

摘要

引言

气道狭窄是气管支气管结核(TBTB)最常见且最严重的并发症。全身抗结核治疗是TBTB气道狭窄的基础治疗,辅以气管镜介入治疗,可有效减少TBTB狭窄的发生或减轻狭窄程度;然而,部分患者在介入治疗后仍会出现再狭窄。

方法

回顾性收集2021年1月至2023年6月在兰州大学第二医院和兰州肺科医院诊断为结核性气道狭窄患者的临床资料。根据介入治疗后1年内气道是否发生再狭窄,将患者分为再狭窄组和无再狭窄组,比较两组临床资料的差异,对单因素分析中有统计学意义差异的变量进行多因素二元logistic回归分析。

结果

本研究共纳入154例结核性气道狭窄患者,其中再狭窄组64例,再狭窄率为41.6%。单因素分析显示,再狭窄组全身免疫炎症指数(SII)高于无再狭窄组,糖尿病患者构成比、狭窄长度>3 cm、气管分泌物抗酸染色阳性率再狭窄组高于无再狭窄组(均p<0.05)。镜下无活动、介入治疗前抗结核治疗及球囊扩张的构成比更低(均p<0.05)。多因素二元logistic回归分析显示,糖尿病(OR=5.758,95%CI:1.434-23.119)、狭窄长度(OR=6.349,95%CI:2.653-15.197)、SII(OR=1.002,95%CI:1.001-1.003)、介入治疗前抗结核治疗(OR=0.250,95%CI:0.084-0.746)及TBTB镜下分类分期(OR=0.306,95%CI:0.099-0.941)是结核性气道狭窄介入治疗后再狭窄的独立影响因素。

结论

糖尿病、狭窄长度>3 cm及高SII是结核性气道狭窄介入治疗后再狭窄的独立危险因素,介入治疗前抗结核治疗及镜下无活动是独立保护因素。

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