颈部淋巴结结核患者疾病进展的危险因素分析

doi:10.19871/j.cnki.xfcrbzz.2024.01.009

摘要/Abstract

摘要： 目的分析颈部淋巴结结核患者规范抗结核治疗过程中疾病进展的临床特征,并进行相关影响因素分析,为该疾病治疗提供新的理念及依据。方法回顾性分析2020年3月至2022年3月成都市公共卫生临床医疗中心确诊为颈部淋巴结结核并进行规范抗结核治疗患者的临床资料。根据疾病转归分为进展组与未进展组,对两组患者性别、年龄、免疫细胞计数及合并症等基线资料进行统计分析,并对影响疾病进展及复发的相关因素进行单因素与多因素分析。结果本研究共纳入颈部淋巴结结核患者129例,其中进展组70例,未进展组59例。进展组与未进展组患者CD4⁺T淋巴细胞计数（P<0.001）、CD8⁺T淋巴细胞计数（P=0.005）、NK细胞计数（P<0.001）、合并纵隔淋巴结肿大（P<0.001）、初治与复治（P<0.001）、是否耐药（P=0.004）差异有统计学意义（P<0.05）。多因素Logistic回归分析发现较低的NK细胞计数（OR=39.968,95%CI 9.324~171.333,P<0.001）、年龄≤45岁（OR=7.972,95%CI 1.114~60.598,P=0.036）和复治（OR=24.118,95%CI 4.563~127.479,P<0.001）,合并纵隔淋巴结肿大（OR=4.390,95%CI 1.004~19.205,P=0.049）为颈部淋巴结结核疾病进展及复发的独立危险因素。结论较低的NK细胞计数、年龄≤45岁、复治和合并纵隔淋巴结肿大为颈部淋巴结结核患者规范抗结核治疗过程中疾病进展和复发的独立危险因素。

关键词: 颈部淋巴结结核, 淋巴细胞, 进展, 危险因素

Abstract: Objective To analyze the clinical characteristics of cervical lymph node tuberculosis patients in the process of standardized anti-tuberculosis treatment, and analyze the related influencing factors, so as to provide a new idea and basis for the treatment of this kind of diseases. Method A retrospective analysis method was adopted to collect the clinical data of patients diagnosed as cervical lymph node tuberculosis with standardized anti-tuberculosis treatment in Chengdu Public Health Clinical Center from March 2020 to March 2022. According to the prognosis of the disease, the patients were divided into progressive group and non-progressive group. The baseline data such as sex, age, immune cell count and complications of the two groups were statistically analyzed, and the related factors affecting the disease progress were analyzed by univariate and multivariate analysis. Result A total of 129 patients with cervical lymph node tuberculosis were included in this study, including 70 cases in the progressive group and 59 cases in the non-progressive group. The comparative analysis between the progressive group and non-progressive group of cervical lymph node tuberculosis showed significant statistical differences（P<0.05）in CD4⁺T lymphocyte count(P<0.05), CD8⁺T lymphocyte count(P=0.005), NK cell count(P<0.05),combined with mediastinal lymphadenopathy (P<0.05), treatment and retreatment of tuberculosis(P<0.05), and drug resistance (P=0.004). Multivariate analysis showed that lower NK cell count (OR=39.968, 95%CI 9.324-171.333, P<0.05), age equal to or younger than 45 years(OR=7.972, 95%CI 1.114-60.598, P=0.036), retreatment of tuberculosis(OR=24.118, 95%CI 4.563-127.479,P<0.05) and combined with mediastinal lymphadenopathy were independent risk factors for the progression of cervical lymph node tuberculosis. Conclusion This study found that lower NK cell count, age≤45 years old, retreatment of tuberculosis and combined with mediastinal lymphadenopathy were independent risk factors for the progress and recurrence of cervical lymph node tuberculosis during standardized anti-tuberculosis treatment.

Key words: Cervical lymph node tuberculosis, Lymphocyte, Progress, Risk factors

中图分类号:

R522
R654.7

钟明, 李刚, 王宁, 姚晓军, 蒋良双. 颈部淋巴结结核患者疾病进展的危险因素分析[J]. 新发传染病电子杂志, 2024, 9(1): 42-46.

Zhong Ming, Li Gang, Wang Ning, Yao Xiaojun, Jiang Liangshuang. Analysis of risk factors of disease progression in patients with cervical lymph node tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(1): 42-46.

参考文献

[1] LEKHBAL A, CHAKER K, HALILY S, et al.Treatment of cervical lymph node tuberculosis: When surgery should be performed? A retrospective cohort study[J]. Ann Med Surg (Lond), 2020: 55: 159-163.
[2] 王海江,郑硕,黄丕来,等. 功能性区域颈部淋巴结清扫术治疗脓肿型和溃疡窦道型颈部淋巴结结核回顾性分析[J/CD].新发传染病电子杂志,2021, 6(4):275-279.
[3] 邵琤, 薛宗锡, 游佩涛, 等. 240例颈淋巴结结核的回顾性分析[J].新疆医学, 2016, 46(9):1170-1173.
[4] BRUZGIELEWICZ A, RZEPAKOWSKA A, OSUCH-WÓJCIKEWICZ E, et al. Tuberculosis of the head and neck-epidemiological and clinical presentation[J]. Arch Med Sci, 2014, 10(6) 1160-1166.
[5] FLYGER TF, LARSEN SR, KJELDSEN AD.Granulomatous inflammation in lymph nodes of the head and neck—a retrospective analysis of causes in a population with very low incidence of tuberculosis[J]. Immunol Res, 2020, 68(4):198-203.
[6] YAO M, ZHU ZH, LIAN NF, et al.Treatment for 15 cases of cervical tuberculosis[J]. J Chin Med, 2017, 130(14):1751-1752.
[7] KARLEEN C, SANIASIAYA J.Cervical tuberculous lymphadenitis[J]. BMJ case reports, 2021, 14(5):e241807
[8] 刘汉武, 林逢春. 颈部淋巴结结核的CT表现[J]. 中国现代药物应用, 2013, 7(14):41-42.
[9] 郑秋婷,董常峰,陆普选,等.彩色多普勒超声与多层螺旋CT扫描在颈部淋巴结结核诊断中的应用对比分析[J/CD].新发传染病电子杂志,2017,2(3):218-222.
[10] 孟艳枝, 张强, 孙利杰, 等. 颈部淋巴结结核超声表现及病理对照分析[J].湖南师范大学学报(医学版), 2015, 5:86-88.
[11] OUÉDRAOGO RWL, AMONA FM, IKOUEBE ATONOBOMA S, et al. Lymph Node Tuberculosis in Otolaryngological Practice:A Study of 68 Cases at the Sourô Sanou University Hospital of Bobo Dioulasso, Burkina Faso[J]. ORL J Otorhinolaryngol Relat Spec, 2022, 84(5):412-416.
[12] LI WX, ZHU Y, DONG Y, et al.Diagnosis and Management of Occult Cervical Tuberculous Lymphadenopathy[J]. Ear Nose Throat J, 2022, 101(6):359-364.
[13] KHURANA AK, GUPTA V, JOSHI D, et al.Determinants of lymph node resolution in patients of tubercular lymphadenitis treated with anti tuberculous chemotherapy: A hospital based longitudinal study[J]. Indian J Tuberc, 2021, 68(2): 215-220.
[14] KIMURA Y, SHIMADA M, KAWASHIMA M, et al.Relapse of cervical tuberculous lymphadenitis immediately after completion of effective anti‐tuberculosis treatments[J].Case Reports, 2020, 8(4):e00555.
[15] 孙希希, 曹南, 黄斌, 等. AIDS合并颈部淋巴结结核在不同CD4+T细胞水平的超声表现特征[J/CD]. 中华医学超声杂志(电子版), 2019, 16(1):20-25.
[16] LIANG C, LI S, YUAN J, et al.Attenuated Cytokine-Induced Memory-Like Natural Killer Cell Responses to Mycobacterium tuberculosis in Tuberculosis Patients[J]. Infect Drug Resist, 2023, 16: 2349-2364.
[17] ZHOU Y, LAN H, SHI H, et al.Evaluating the diversity of circulating natural killer cells between active tuberculosis and latent tuberculosis infection[J]. Tuberculosis, 2022, 135: 102221.
[18] 姚岚,肖和平. 颈部淋巴结结核发生结核性脓肿的危险因素分析[J].中国防痨杂志,2019,41(1):53-56.