Clinical and computed tomography findings with drug-resistant and drug-sensitive pulmonary tuberculosis of children in Sichuan region
10.3760/cma.j.cn311365-20241109-00318
- VernacularTitle:四川地区儿童耐药与药物敏感肺结核的临床及CT特征分析
- Author:
Qingqing XIONG
1
;
Zhengxiao WEI
;
Jing AO
;
Li LIANG
;
Yueqin GAO
;
Dongmei WANG
;
Zhu CHEN
Author Information
1. 成都市公共卫生临床医疗中心科研教学部，成都 610066
- Publication Type:Journal Article
- Keywords:
Children;
Tuberculosis, pulmonary;
Drug-resistant;
Drug-sensitive;
Computed tomography
- From:
Chinese Journal of Infectious Diseases
2024;42(11):661-667
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical and chest computed tomography (CT) findings of children with drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB) in Sichuan region.Methods:Active pulmonary tuberculosis children with positive sputum Mycobacterium tuberculosis culture were collected and divided into the drug-resistant and drug-sensitive groups according to the results of the drug susceptibility test who admitted to the Public Health Clinical Center of Chengdu from January 2020 to October 2024. The general data such as age, ethnic, gender, initial or retreatment regimens, body mass index (BMI), clinical symptoms such as cough, sputum, fever, and chest CT features were compared between the two groups. Non-parametric rank sum test, chi-square test or Fisher′s exact probability method were used for comparison between groups. The CT risk factors for the development of DR-PTB were analyzed using binary logistic regression. Results:A total of 110 children were enrolled, including 44(40.00%) males and 66(60.00%) females, with the age of 13.00(12.00, 14.00) years (range from 5.00 to 14.00 years). There were 28 cases in drug-resistant group and 82 in drug-sensitive group. Comparison of the clinical data between the two groups showed that the percentages of retreated patients (25.00%(7/28)) and ethnic minorities (78.57%(22/28)) in the drug-resistant group were higher than those in the drug-sensitive group (1.22%(1/82) and 57.32%(47/82)), which were both statistically significant (Fisher′s exact probability method and χ2=4.03, respectively, both P<0.05). The age of the children in the drug-resistant group was 13.00 (12.00, 13.50) years, which was younger than the age of 13.00 (12.00, 14.00) years in the drug-sensitive group ( U=828.00, P=0.021). There were no statistically differences of gender, BMI, history of bacillus Calmette-Guérin (BCG) vaccination, history of exposure to tuberculosis patients, positive immunological diagnostic tests, and the incidences of cough, sputum, fever, wheezing, shortness of breath and chest pain between the two groups (all P>0.05). Chest CT signs showed that lung lesions involving both right and left lobes accounted for 53.57%(15/28) in the drug-resistant group, and the incidence of solid pulmonary parenchyma (including wall-less cavities) was 92.86%(26/28), which were both higher than those in the drug-sensitive group (15.85%(13/82) and 70.73%(58/82)), and the differences were statistically significant ( χ2=6.95 and 5.66, respectively, both P<0.05). The incidence of small nodules/tree-in-bud pattern in the drug-sensitive group was higher than that in the drug-resistant group (98.78%(81/82) vs 82.14%(23/28)), and the difference was statistically significant (Fisher′s exact probability method, P=0.004). Binary logistic regression showed that bilateral lung involvement and solid pulmonary parenchyma (including wall-less cavities) were positively correlated with DR-PTB in children (odds ratio ( OR)=4.487, 95% confidence internal ( CI) 1.561 to 12.897, P=0.005 and OR=9.670, 95% CI 1.626 to 57.529, P=0.013, respectively). The occurence of small nodules/tree-in-bud was negatively correlated with DR-PTB in children ( OR=0.058, 95% CI 0.006 to 0.584, P=0.016). Conclusions:Among pulmonary tuberculosis children in Sichuan region, ethnic minorities and retreatment patients with DR-PTB are more common than thoses with DS-PTB. Chest CT findings of DR-PTB mainly show multiple solid pulmonary parenchyma with wall-less cavities, and the lesions often involve right and left lung lobes, whereas DS-PTB CT findings mainly show small nodules/tree-in-bud predominantly.
