Causes and Management of Chest Computed Tomography Lesions Progression in Pulmonary Tuberculosis during Antituberculosis Treatment.

IF 1.6 Q4 INFECTIOUS DISEASES
International Journal of Mycobacteriology Pub Date : 2025-04-01 Epub Date: 2025-06-20 DOI:10.4103/ijmy.ijmy_33_25
Shuangyin Yang, Yanmei Feng, Kuiliang Yang, Jie Pu, Pu Wang
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引用次数: 0

Abstract

Background: Even with early antituberculosis (TB) treatment, some patients with pulmonary TB (PTB) may experience progression of chest computed tomography (CT) lesions. However, there is limited information on the causes and management of this progression during treatment. This study was undertaken to improve clinical understanding of the various causes and management strategies for the worsening of chest CT lesions in patients with PTB.

Methods: A retrospective analysis was performed on the medical records of 61 PTB patients. We evaluated the radiological features, clinical characteristics, laboratory findings, causes, and management of chest CT lesions progression in PTB during anti-TB treatment and compared the characteristics of patients in the paradoxical response (PR) group and the non-PR group.

Results: The most common cause of the chest CT progression lesions was PR, accounting for 50.8% (n = 31) of the cases. Other important causes included insufficient anti-TB treatment (21.3%, n = 13), drug-resistant TB (8.2%, n = 5), and comorbidities such as bacterial infections (8.2%, n = 5), fungal infections (6.6%, n = 4), and lung cancer (4.9%, n = 3). Patients with PR were primarily treated by continuing their anti-TB management, whereas those with non-PR due to other causes received treatment targeting the underlying etiology. PR patients were younger (Mann-Whitney U-test, P < 0.001; 95% confidence interval [CI]: 15.8-32.2)., had more asymptomatic cases (74.2% vs. 4.0%; χ2 test, P < 0.001; odds ratio [OR]: 64.3, 95% CI: 12.5-330.2), showed higher Mycobacterium TB culture positivity (64.5% vs. 30.0%; χ2 test, P = 0.015; OR: 4.2, 95% CI: 1.4-12.6), and had quicker lesion progression than the non-PR group (P = 0.004; 95% CI: 1.0-3.0).

Conclusion: PR is the major cause of chest CT lesion progression in PTB during anti-TB. Continuation of anti-TB therapy can promote the absorption of lesions. Differences between PR and non-PR patients can help clinicians in diagnosing and guiding treatment strategies.

抗结核治疗期间肺结核胸部ct病变进展的原因和处理。
背景:即使早期抗结核(TB)治疗,一些肺结核(PTB)患者可能会经历胸部计算机断层扫描(CT)病变的进展。然而,在治疗过程中,关于这种进展的原因和管理的信息有限。本研究旨在提高临床对PTB患者胸部CT病变恶化的各种原因和处理策略的认识。方法:对61例肺结核患者的病历资料进行回顾性分析。我们评估了抗结核治疗期间PTB患者的放射学特征、临床特征、实验室结果、病因和胸部CT病变进展的处理,并比较了矛盾反应(PR)组和非PR组患者的特征。结果:胸部CT进展性病变最常见的原因是PR,占50.8% (n = 31)。其他重要原因包括抗结核治疗不足(21.3%,n = 13)、耐药结核(8.2%,n = 5)和合并症,如细菌感染(8.2%,n = 5)、真菌感染(6.6%,n = 4)和肺癌(4.9%,n = 3)。PR患者主要通过继续进行抗结核管理来治疗,而由于其他原因导致的非PR患者则接受针对潜在病因的治疗。PR患者较年轻(Mann-Whitney u检验,P < 0.001;95%置信区间[CI]: 15.8-32.2)。无症状病例较多(74.2% vs. 4.0%;χ2检验,P < 0.001;优势比[OR]: 64.3, 95% CI: 12.5-330.2)显示较高的结核分枝杆菌培养阳性(64.5%比30.0%;χ2检验,P = 0.015;OR: 4.2, 95% CI: 1.4-12.6),且病变进展快于非pr组(P = 0.004;95% ci: 1.0-3.0)。结论:PR是PTB抗结核过程中胸部CT病变进展的主要原因。继续抗结核治疗可促进病灶的吸收。PR与非PR患者的差异可以帮助临床医生诊断和指导治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.20
自引率
25.00%
发文量
62
审稿时长
7 weeks
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