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OBJECTIVES@#To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis.@*METHODS@#The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB.@*RESULTS@#A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%.@*CONCLUSIONS@#The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.
Subject(s)
Infant , Child , Humans , Bronchoscopy/methods , Constriction, Pathologic/complications , Bronchial Diseases/therapy , Retrospective Studies , Tuberculosis/diagnosis , Airway Obstruction/therapyABSTRACT
Objective@#To analyze the factors affecting the complication of pulmonary atelectasis among children with tracheobronchial tuberculosis (TBTB), so as to provide the reference for the prevention and treatment of pulmonary atelectasis complicated by TBTB.@*Methods@#Children with TBTB admitted to Department of Paediatrics, Linping Division of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as the study subjects from October 2018 to March 2023. Subjects's basic information, etiological examination results and laboratory testing results were collected using a self-designed questionnaire, and factors affecting the complication of pulmonary atelectasis among children with TBTB were identified using a multivariable logistic regression model. @*Results@#A total of 120 children with TBTB were included, with the age of 6 months to 12 years. There were 33 children at ages of less than one year (27.50%), 71 girls (59.17%) and 25 children with TBTB and pulmonary atelectasis (20.83%). Multivariable logistic regression analysis identified less than one year of age (OR=1.720, 95%CI: 1.126-3.358), type Ⅵ of TBTB (OR=1.669, 95%CI: 1.101-2.236), high level of C-reactive protein (OR=1.887, 95%CI: 1.088-2.686) and high level of procalcitonin (OR=1.844, 95%CI: 1.034-2.654) as risk factors for the complication of pulmonary atelectasis in children with TBTB.@*Conclusion@#Less than one year of age, type Ⅵ of TBTB, high level of C-reactive protein and high level of procalcitonin may increase the risk of pulmonary atelectasis in children with TBTB.
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Objective:To investigate the effect of early interventional therapy with fiberoptic bronchoscope in patients with inflammatory infiltrating type (Ⅰ type) tracheobronchial tuberculosis (TBTB).Methods:Using prospective research methods, 306 patients with Ⅰ type TBTB diagnosed by fiberoptic bronchoscopy in the Third People′s Hospital of Kunming City from January 2019 to April 2022 were selected. The patients were divided into observation group and control group according to the random number table method with 153 cases each. The patients in control group were given routine anti-tuberculosis chemotherapy, and the patients in observation group were given routine anti-tuberculosis chemotherapy combined with early interventional therapy with fiberoptic bronchoscope. Sputum smear examination and tuberculosis culture were performed at the end of 1, 3 and 6 months of treatment, and the negative conversion of sputum culture was recorded. Chest X-ray, pulmonary function and fiberoptic bronchoscope were performed at the end of 1, 3 and 6 months of treatment to evaluate the improvement rate of clinical symptoms, effective absorption rate of lesions and effective absorption rate of obstructive pneumonia. The CD 4+, CD 8+, CD 4+/CD 8+, interferon γ (IFN-γ), interleukin-6 (IL-6) and C reactive protein (CRP) before and after treatment were detected. The random walking model of immune inflammation was evaluated. Results:The sputum negative conversion rates at the end of 1, 3 and 6 months of treatment in observation group were significantly higher than those in control group: 64.71%(99/153) vs. 52.29%(80/153), 80.39%(123/153) vs. 62.09%(95/153) and 91.50%(140/153) vs. 73.86%(113/153), and there were statistical differences ( P<0.05 or <0.01). The improvement rate of clinical symptoms at the end of 1 month of treatment in observation group was significantly higher than that in control group: 94.77%(145/153) vs. 66.67%(102/153), and there was statistical difference ( P<0.01); the clinical symptoms disappeared in both groups at the end of 3 and 6 months of treatment. The effective absorption rates of lesions at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 73.20%(112/153) vs. 51.63%(79/153) and 96.73%(148/153) vs. 85.62%(131/153), and there were statistical differences ( P<0.01); all the lesions were absorbed at the end of 6 months of treatment in both groups. The effective absorption rates of obstructive pneumonia at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 78.43% (120/153) vs. 39.87%(61/153) and 89.54%(137/153) vs. 79.08%(121/153), and there were statistical differences ( P<0.01 or <0.05); all obstructive pneumonia were absorbed at the end of 6 months of treatment in both groups. There were no statistical differences in CD 4+, CD 8+, CD 4+/CD 8+, IL-6, IFN-γ and CRP before treatment between the two groups ( P>0.05); the CD 4+, CD 4+/CD 8+ and IFN-γ after treatment in observation group were significantly higher than those in control group: 0.343 ± 0.032 vs. 0.311 ± 0.023, 1.37 ± 0.18 vs. 1.12 ± 0.16 and (38.47 ± 3.50) ng/L vs. (20.52 ± 2.96) ng/L, the CD 8+, IL-6 and CRP were significantly lower than those in control group: 0.251 ± 0.020 vs. 0.268 ± 0.021, (19.40 ± 3.31) ng/L vs. (34.58 ± 5.82) ng/L and (10.41 ± 2.87) mg/L vs. (17.47 ± 3.14) mg/L, and there were statistical differences ( P<0.01). The evaluation results of random walking model showed that CD 4+, CD 8+, CD 4+/CD 8+, IFN-γ, IL-6 and CRP in the observation group were better than those in the control group in the maximum random fluctuation, number of walking steps, positive walking growth rate, random fluctuation power law value, comprehensive improvement rate, recording times of comprehensive evaluation index and expected improvement value. Conclusions:Early interventional therapy with fiberoptic bronchoscope can effectively assist systemic drug therapy in patients with Ⅰ type TBTB, which can accelerate focus absorption, promote sputum negative conversion, enhance cellular immunity and effectively inhibit inflammatory reaction.
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Objective This study investigated the use of interventional bronchoscopic techniques in management of patients with tracheobronchial tuberculosis.Methods In this retrospective study,we analyzed the clinical data of 76 patients with endobronchial tuberculosis.All patients underwent bronchoscopy examination and diagnosed by pathology.According to different treatments,the patients were divided into two groups,the observation group (56 cases) adopted by bronchoscopy and chemotherapy and the control group (20 cases) adopted by chemotherapy only.The general features,treatment effectiveness in the two groups were compared and analyzed.Results Compared with the control group,the sputum negative rate,the recovery rate of symptom,and the total effective rate were higher (P ＜ 0.05).No severe side effects were found in the two groups.There was a positive relationship among frequency of bronchoscopy,the area of lesion (r =0.296,P =0.025 ＜ 0.05) and the type of histology (r =0.323,P =0.014 ＜ 0.05).Conclusions It is concluded that interventional bronchoseopic techniques are useful in management of patients with endobronchial tuberculosis.
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Objective To assess the value of four different techniques of detecting the Mycobacterium tuberculosis (MTB) in bronchoalveolar lavage fluid (BALF) in the diagnosis of tracheobronchial tuberculosis. Methods A total of 98 patients diagnosed as tracheobronchial tuberculosis were selected from May 1,2013 to June 30,2016. The clinical data was analyzed retrospectively,and the positive rates of MTB of the 960 cultrue, the direct smears , the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were compared. Results The positive rates of the 960 cultrue,the direct smears,the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were 20.4%(20/98),15.3%(15/98),70.4%(69/98) and 74.5%(73/98),respectively. Among the four techniques ,the positive rates of the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were significantly higher than those of the 960 cultrue and the direct smears(P 0.05). Conclusions The modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay for detecting the MTB in BALF have high clinical value in the diagnosis of tracheobronchial tuberculosis.
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Objective To explore the endoscopic characteristics of multidrug-resistant tuberculosis (MDR-TB) combined with tracheobronchial tuberculosis (TBTB). Methods 248 MDR-TB as study group, they hospitalized from October 1st 2008 to June 31st, 2016. 274 cases of non MDR-TB with bacteria positive as control group over 2015, all of them received bronchoscopy, sputum cultured and drug sensitivity tested of Isoniazid and Rifampicin. We analyzed the results of bronchoscopy and demographic data. Results 248 cases of MDR-TB patients, of 175 (70.56%) were diagnosed TBTB by bronchoscopy, of 73 (29.44%) without TBTB. 274 cases of non MDR-TB with bacteria positive patients, of 146 (53.28%) were diagnosed TBTB, of 128 (46.72%) non TBTB, the difference of comparisons was statistically significant (χ2 = 16.42, P = 0.000). MDR-TB combined with TBTB median age was 32 years, non MDR-TB combined with TBTB median age 42 years, the difference was statistically significant (U = 9932.00, P = 0.001). Among the MDR-TB patients, of 75 (42.86%) TBTB in the upper right bronchial, of71 (40.57%) upper left bronchus, while non MDR-TB patients, of 70 (47.95%) and 60 (41.10%), there was no statistically significant difference (χ2 = 2.44, P = 0.786). Among the MDR-TB, of 76 (43.43%) were inflammation infiltration type, of 11 (6.29%) were necrosis type, of 13 cases (7.43%) granulation proliferative type, of 72 (41.14%) were scar stricture type, of 3 (1.71%) tube wall softening type. Among the non MDR-TB, in turn, TBTB type were 50 (34.25%), 41 (28.08%), 9 (6.16%), 40 (27.40%), 5 (3.43%), the difference were statistically significant (χ2 = 30.50, P = 0.000). Conclusions The detection rate of TBTB was higher in MDR-TB patients, that common occur in younger patients. TBTB common infringe on upper right bronchial and upper left bronchus, TBTB type most are inflammatory infiltration type and scar stricture type. More attention should be paid to bronchoscopy among MDR-TB patients.
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Objective To investigate the reasons of tracheobronchial tuberculosis misdiagnosis and its clinical charac?teristics as well as the diagnostic value of bronchoscope. Methods Clinical data of 92 cases of misdiagnosis of tracheobron?chial tuberculosis by electronic bronchoscopy in our department from January 2006 to January 2012 were analyzed retrospec?tively. Bronchoscopy, endoscopic biopsy, brushing, lavage and radiological images were all compared. Results Clinical symptoms and laboratory tests showed no specificity in diagnostic value;Chest X-ray was not typical. Bronchial stenosis was seen in 45 cases(48.9%)and bronchial obstruction was seen in 6 cases(6.5%)as shown in chest CT while no abnormality in the bronchus was seen in 41 cases(44.6%). Bronchoscopy revealed 28 cases (30.4%) of inflammatory infiltration, 14 cas?es (15.2%) of necrotizing ulceration, 35 cases (38.0%) of granulation hyperplasia and 15 cases (16.3%) of Scar stricture. En?doscopic biopsy confirmed 56 cases (60.9%), while bronchoscopic brushing and examination of acid-fast bacillus approved 32 cases (34.8%). Then, bronchoscopic lavage of acid-fast bacillus verified 39 cases (42.4%). Lastly, tuberculosis bacterium culture ascertained 75 cases (81.5%). Conclusion Bronchoscopy of local lesion with brush, lavage and biopsy is the most sensitive and specific diagnostic method to diagnose tracheobronchial tuberculosis. It has great clinical value in preventing tracheobronchial tuberculosis misdiagnosis.
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Objective To discuss the clinical value of electronic bronchoscopic intervention in treatment of tracheobronchial tuberculosis. Methods Clinical features of 45 patients with tracheal and bronchial tuberculosis which were confirmed by electronic bronchoscope and treated by bronchoscopic intervention were retrospectively analyzed from January 2007 to December 2013 in our hospital. Results The efficiency of bronchoscopic intervention is 88.9%, of which 28 cases achieved a significant effect (accounting for 62.2%). Conclusion Electronic bronchoscopic intervention is a preferred way in treatment of tracheobronchial tuberculosis.