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Abstract：
BACKGROUND: Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR.
METHODS: Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR.
RESULTS: Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81-18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60-46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70-16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB.
CONCLUSIONS: As PR occurred in one of six patients with mediastinal LNTB during anti-tuberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
METHODS: Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR.
RESULTS: Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81-18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60-46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70-16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB.
CONCLUSIONS: As PR occurred in one of six patients with mediastinal LNTB during anti-tuberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
摘要：
背景：反常反应（PR）在淋巴结结核（LNTB）中比在肺结核中更常见，并且在耐药性的鉴别诊断方面存在困难，新的感染,患者依从性差，以及药物不良反应。尽管纵隔LNTB的诊断随着内镜的发展变得更加容易，有限的信息是可用的。这项研究的目的是调查纵隔LNTB的临床过程以及与PR相关的危险因素。
方法：2009年10月至2019年12月对通过超声内镜诊断为纵隔LNTB的患者进行回顾性评估。应用多因素logistic回归分析评价与PR相关的危险因素。
结果：在研究期间接受了内窥镜检查的9,052名患者中，158例诊断为纵隔型LNTB。其中,除纵隔LNTB外，55例（35％）和41例（26％）同时患有肺结核和肺外结核，分别。在完成抗结核治疗的125名患者中，21（17％）在开始抗结核治疗后的中位数为4.4个月发展为PR。在无PR和有PR的患者中，抗结核治疗的中位持续时间分别为6.3和10.4个月。分别。PR的发展与年龄<55岁独立相关(调整后的优势比[aOR]，5.72；95%置信区间[CI]，1.81-18.14；P=0.003），淋巴细胞计数<800/μL(aOR，8.59；95%CI，1.60-46.20；P=0.012），最大淋巴结短轴直径(LN)≥16mm(aOR，5.22；95％CI，1.70-16.00；P=0.004）在诊断纵隔LNTB时。
结论：在抗结核治疗期间，6例纵隔型LNTB患者中有1例发生PR，医生应该注意有危险因素的患者(年龄较小，淋巴细胞减少症,和较大的LN）在诊断时。
方法：2009年10月至2019年12月对通过超声内镜诊断为纵隔LNTB的患者进行回顾性评估。应用多因素logistic回归分析评价与PR相关的危险因素。
结果：在研究期间接受了内窥镜检查的9,052名患者中，158例诊断为纵隔型LNTB。其中,除纵隔LNTB外，55例（35％）和41例（26％）同时患有肺结核和肺外结核，分别。在完成抗结核治疗的125名患者中，21（17％）在开始抗结核治疗后的中位数为4.4个月发展为PR。在无PR和有PR的患者中，抗结核治疗的中位持续时间分别为6.3和10.4个月。分别。PR的发展与年龄<55岁独立相关(调整后的优势比[aOR]，5.72；95%置信区间[CI]，1.81-18.14；P=0.003），淋巴细胞计数<800/μL(aOR，8.59；95%CI，1.60-46.20；P=0.012），最大淋巴结短轴直径(LN)≥16mm(aOR，5.22；95％CI，1.70-16.00；P=0.004）在诊断纵隔LNTB时。
结论：在抗结核治疗期间，6例纵隔型LNTB患者中有1例发生PR，医生应该注意有危险因素的患者(年龄较小，淋巴细胞减少症,和较大的LN）在诊断时。
