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目的 探讨肺结核患者并发气管支气管结核(tracheobronchial tuberculosis,TBTB)与耐多药肺结核(multidrug-resistant pulmonary tuberculosis,MDR-PTB)发生的相关性.方法 选取2015年1月1日至12月31日在广州市胸科医院肺结核科住院的344例肺结核患者作为研究对象.所选患者均已行支气管镜检查,同时结核分枝杆菌培养阳性并有异烟肼(H)和利福平(R)药物敏感性试验(简称“药敏试验”)结果.采用回顾性病例对照研究法,收集患者年龄、性别、支气管镜检查结果、初复治情况、肺部空洞情况、病程、并发症、痰检验结果等数据进行单因素和logistic多因素回归分析.结果 344例患者中,MDR-PTB者70例(20.35％),非MDR-PTB者274例(79.65％);并发TBTB者199例(67.85％),无TBTB者145例(42.15％).199例并发TBTB者中MDR-PTB者53例(26.63％),非MDR-PTB者146例(73.37％).70例MDR-PTB者中并发TBTB者53例(75.71％)、无TBTB者17例(24.29％).单因素分析显示,MDR-PTB患者病程＞24个月、复治、肺部有空洞、并发TBTB的构成比分别为44.28％(31/70)、77.14％ (54/70)、81.43％ (57/70)、75.71％ (53/70),高于非MDR-PTB者的13.87％(38/274)、15.69％(43/274)、59.49％(163/274)、53.28％ (146/274),差异均有统计学意义(x2值分别为54.34、103.99、11.64、11.50,P值均＜0.05).logistic多因素分析显示,复治[OR值(95％CI 值):17.37(8.90～33.88)]、肺部有空洞[OR值(95％CI值):2.91 (1.36～6.23)]、并发TBTB[OR值(95％CI值):2.70(1.33～5.49)]为MDR-PTB发生的危险因素.199例并发TBTB患者分为炎症浸润型75例(37.69％)、溃疡坏死型44例(22.11％)、肉芽增殖型10例(5.03％)、疤痕狭窄型63例(31.66％)、管壁软化型5例(2.51％)、淋巴结瘘型2例(1.00％),TBTB分型与MDR-PTB发生无相关性(r=0.03,P=0.717).结论 TBTB是发生MDR-PTB的危险因素,应当重视在肺结核并发TBTB者中筛查MDR-PTB,在MDR-PTB者中筛查TBTB,做到早期诊断、合理治疗.“,”Objective To explore the relationship of tracheobronchial tuberculosis (TBTB) and multidrug-resistant pulmonary tuberculosis (MDR-PTB).Methods A total of 344 pulmonary TB patients hospitalized in Pulmonary Tuberculosis Department of Guangzhou Chest Hospital from January 1 to December 31,2015,were selected.All of them were with positive Mycobacterium tuberculosis culture and received bronchoscopy,furthermore,drug sensitivity of isoniazid and rifampicin were tested.Data,including age,gender,bronchoscopy,initial treatment or re-treatment,pulmonary cavity,course of disease,complications,result of sputum test,etc.,were retrospectively collected using one-way analysis of variance (ANOVA) and logistic multi-factor regression analysis.Results Of the 344 patients,70 (20.35％) were MDR-PTB,274 (79.65％) were non-MDR-PTB;199 (57.85％) complicated with TBTB,and 145 (42.15％) without TBTB.Among the 70 MDR-PTB patients,53 (75.71％) were complicated with TBTB,while 17 (24.29％) without TBTB.Results of ANOVA indicated that among MDR-PTB patients,44.28％％ (31/70) with the course of the disease over 24 months,77.14％ (54/70) recurrent,pulmonary cavity were found in 81.43％ (57/70),and 75.71％ (53/70) complicated with TBTB,which were significantly higher than those of non-MDR-PTB (13.87％ (38/274),15.69％ (43/274),59.49％ (163/274) and 53.28％ (146/274),respectively) (x2 =54.34,103.99,11.64,11.50,all P＜ 0.05).According to multivariate logistic regression analysis,re-treatment TB (OR (95％CI):17.37 (8.90-33.88)),pulmonary cavity (OR (95％CI):2.91 (1.36-6.23)),and TBTB (OR (95％CI):2.70 (1.33-5.49)) were risk factors of MDR-PTB.Of the 199 patients complicated with concurrent TBTB,in 75 cases (37.69 ％) were of inflammatory infiltration type,44 (22.11％) were of ulcers necrosis type,granulation proliferation type were found in 10 cases (5.03％),63 (31.66％) were of scar stricture type,5 (2.51％) were of tube wall softening type and lymphatic fistula type were in 2 cases (1.00％);there was no relationship between TBTB types and MDR-PTB (r=0.03,P=0.717).Conclusion TBTB was a risk factor for MDR-PTB.More attention should be paid in screening MDR-PTB among TBTB patients,as well as screening TBTB in MDR-PTB patients,to facilitate early diagnosis and reasonable treatment.