1fy07h 发表于 2024-10-3 06:44:20

基于倾向性评分匹配的结核相关阻塞性肺疾患病人肺功能及影像学特征分析


    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">本文引用：<span style="color: black;"><span style="color: black;">王益德, 田宗祥, 李争, 李风森. 基于倾向性评分匹配的结核<span style="color: black;">关联</span>阻塞性肺<span style="color: black;">疾患</span><span style="color: black;">病人</span>肺功能及影像学特征分析. </span></span><span style="color: black;"><span style="color: black;">中国全科医学</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">, 2022, 25(14): 1718-1723 </p>doi:10.12114/j.issn.1007-9572.2022.02.012

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">WANGYide, TIANZongxiang, LIZheng, LIFengsen. Pulmonary Function and Imaging Characteristics of Tuberculosis Associated Obstructive Pulmonary Disease Using Propensity Score-matched Analysis.</span></span><span style="color: black;"><span style="color: black;">Chinese General Practice</span></span><span style="color: black;"><span style="color: black;">, 2022, 25(14): 1718-1723 doi:10.12114/j.issn.1007-9572.2022.02.012</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">慢性阻塞性肺<span style="color: black;">疾患</span>（COPD）是一种<span style="color: black;">平常</span>的以<span style="color: black;">连续</span>性<span style="color: black;">呼气</span>道症状和气流受限为特征的慢性<span style="color: black;">呼气</span>系统<span style="color: black;">疾患</span>。吸烟、生物质燃料暴露等是<span style="color: black;">导致</span>COPD的传统危险<span style="color: black;">原因</span>。本课题组前期的一项流行病学调查<span style="color: black;">表示</span>，肺结核病史<span style="color: black;">一样</span>是<span style="color: black;">导致</span>COPD患病<span style="color: black;">危害</span><span style="color: black;">增多</span>的重要<span style="color: black;">原由</span>，另有队列<span style="color: black;">科研</span>在<span style="color: black;">调节</span>了性别、年龄等混杂<span style="color: black;">原因</span>后<span style="color: black;">发掘</span>肺结核病史可<span style="color: black;">做为</span>气流阻塞性通气功能<span style="color: black;">阻碍</span>的独立预测因子，其相对危险度估计值为1.37；阻塞性肺<span style="color: black;">疾患</span><span style="color: black;">包袱</span><span style="color: black;">科研</span>（the burden of obstructive lung disease，BOLD）<span style="color: black;">亦</span>提示肺结核病史是<span style="color: black;">病人</span>晚年<span style="color: black;">出现</span>气流阻塞的重要危险<span style="color: black;">原因</span>。2013年ALLWOOD等首次提出结核<span style="color: black;">关联</span>阻塞性肺<span style="color: black;">疾患</span>（tuberculosis associated obstructive pulmonary disease，TOPD）的概念。世界卫生组织统计<span style="color: black;">表示</span>2000—2016年<span style="color: black;">大概</span>16%结核病<span style="color: black;">病人</span><span style="color: black;">亡于</span>TOPD等肺结核<span style="color: black;">副作用</span>，在<span style="color: black;">全世界</span>范围尤其是对发展中国家造<span style="color: black;">成为了</span>沉重的社会和经济<span style="color: black;">包袱</span>。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">做为</span>肺结核和COPD的高<span style="color: black;">包袱</span>国家，我国关于TOPD的临床<span style="color: black;">科研</span>和实验研究仍旧非常匮乏，对该病的<span style="color: black;">认识</span>、认识和<span style="color: black;">注重</span>程度<span style="color: black;">不足</span>。为此，本<span style="color: black;">科研</span>拟对TOPD<span style="color: black;">关联</span>临床资料进行回顾性分析，并采用倾向性评分匹配法<span style="color: black;">平衡</span>组间协变量差异以减少<span style="color: black;">科研</span>偏倚、<span style="color: black;">加强</span><span style="color: black;">科研</span>效率，旨在初步探索TOPD<span style="color: black;">病人</span>肺功能及影像学特征。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1　对象与<span style="color: black;">办法</span></h1>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.1　<span style="color: black;">科研</span>对象</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">回顾性分析新疆医科大学第四临床医学院2018年1月至2020年11月临床诊断为TOPD的<span style="color: black;">病人</span>（TOPD组）387例和COPD<span style="color: black;">病人</span>（COPD组）364例，其中TOPD组男218例，女169例；年龄32~95岁，平均年龄（73.3±10.3）岁。COPD组男249例，女115例；年龄41~96岁，平均年龄（76.2±10.5）岁。本项临床<span style="color: black;">科研</span><span style="color: black;">得到</span>新疆医科大学第四临床医学院委员会审核并<span style="color: black;">准许</span>（批号：2020XE-GS083）。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.2　诊断标准</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">TOPD<span style="color: black;">病人</span>诊断需既满足COPD诊断标准，参考2019年版慢性阻塞性肺<span style="color: black;">疾患</span><span style="color: black;">全世界</span>倡议（GOLD）；<span style="color: black;">同期</span>符合《中华人民共和国卫生行业标准-结核病<span style="color: black;">归类</span>（WS 196-2017）》中关于陈旧性肺结核的诊断标准。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.3　排除标准</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">合并支气管哮喘、特发性肺间质纤维化、<span style="color: black;">自己</span>免疫性<span style="color: black;">疾患</span>及活动性肺结核等其他<span style="color: black;">呼气</span>系统<span style="color: black;">疾患</span>。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.4　临床资料收集</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">收集两组<span style="color: black;">病人</span>的临床资料，<span style="color: black;">包含</span>性别、年龄、民族、发病年龄、住院天数。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.5　<span style="color: black;">检测</span><span style="color: black;">办法</span>及观察指标</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">本<span style="color: black;">科研</span>采用西门子双源螺旋CT仪<span style="color: black;">得到</span>影像学指标。嘱<span style="color: black;">病人</span>取仰卧位，屏气进行肺尖至肺底扫描，具体<span style="color: black;">要求</span>设定如下：螺距1.2、200 mAs、120 kV，层距与数据重建层厚度均设置为5.0 mm。记录<span style="color: black;">病人</span>病变性质、部位、范围和<span style="color: black;">加强</span>特征。肺功能检测由<span style="color: black;">拥有</span>肺功能资格证的专业技师进行操作，进行严格质量把控。采集<span style="color: black;">病人</span>肺功能指标：第1秒用力呼气容积/用力肺活量（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%pre）、用力肺活量占预计值百分比（FVC%pre）。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">1.6　统计学<span style="color: black;">办法</span></h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">运用</span>EpiData软件录入数据，Stata 13.0和Empower（R）（www.empowerstats.com，X&amp;Y Solutions，Inc.Boston，MA）进行数据分析，肺功能等部分缺失数据采用删除法进行处理。<span style="color: black;">首要</span><span style="color: black;">运用</span>性别、年龄、民族等<span style="color: black;">通常</span>临床资料<span style="color: black;">做为</span>匹配<span style="color: black;">原因</span>进行倾向性评分匹配，<span style="color: black;">详细</span><span style="color: black;">根据</span>1∶2倾向性评分匹配策略进行。计数资料<span style="color: black;">运用</span>频数和<span style="color: black;">形成</span>比<span style="color: black;">暗示</span>，组间比较采用χ2检验；连续性资料若符合正态性和方差齐性检验则<span style="color: black;">运用</span>（x±</span></span><span style="color: black;"><span style="color: black;">s</span></span><span style="color: black;"><span style="color: black;">）描述，两组间比较采用两独立样本</span></span><span style="color: black;"><span style="color: black;">t</span></span><span style="color: black;"><span style="color: black;">检验，反之<span style="color: black;">运用</span>非参数Kruskal-Wallis检验。因肺结核受累叶数属于等级资料，其与肺功能的<span style="color: black;">关联</span>性分析采用Spearman秩<span style="color: black;">关联</span>检验，Spearman秩<span style="color: black;">关联</span>强弱标准为：微弱负<span style="color: black;">关联</span>（|</span></span><span style="color: black;"><span style="color: black;">R</span></span><span style="color: black;"><span style="color: black;">|&lt;0.3）；低度负<span style="color: black;">关联</span>（0.3≤|</span></span><span style="color: black;"><span style="color: black;">R</span></span><span style="color: black;"><span style="color: black;">|&lt;0.5）。设定检验水准为0.05。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">2　结果</h1>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">2.1　临床资料及倾向性评分匹配结果</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倾向性评分匹配前，两组<span style="color: black;">病人</span>性别、年龄、民族比较，差异均有统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.05）。将性别、年龄、民族<span style="color: black;">做为</span>匹配变量进行1∶2倾向性评分匹配操作，分别有47例TOPD<span style="color: black;">病人</span>和94例COPD<span style="color: black;">病人</span>匹配成功。匹配后，两组<span style="color: black;">病人</span>性别、年龄、民族比较，差异均无统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&gt;0.05）。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">匹配前、后TOPD组<span style="color: black;">病人</span>住院天数均长于COPD组，差异有统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.05）；匹配前两组发病年龄比较，差异无统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&gt;0.05）；匹配后TOPD组<span style="color: black;">病人</span>发病年龄<span style="color: black;">小于</span>COPD组，差异有统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.05），见表1。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Table 1 Comparative analysis of clinical data before and after propensity score matching between the two groups</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">2.2　肺功能指标</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">匹配前，两组FVC%pre比较，差异无统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&gt;0.05）；TOPD组FEV1/FVC、FEV1%pre均<span style="color: black;">小于</span>COPD组，差异有统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.05）。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">匹配后，两组FVC%pre比较，差异无统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&gt;0.05）；TOPD组FEV1/FVC、FEV1%pre均<span style="color: black;">小于</span>COPD组，差异有统计学<span style="color: black;">道理</span>（</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.05），见表2。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Table 2 Comparison of lung function indexes between the two groups before and after matching propensity score</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">2.3　影像学表现</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">共317例TOPD<span style="color: black;">病人</span>完成影像学<span style="color: black;">检测</span>。TOPD<span style="color: black;">病人</span>肺部CT<span style="color: black;">表示</span>多处钙化结节等结核瘢痕，部分<span style="color: black;">病人</span>存在<span style="color: black;">必定</span>程度的肺气肿和支气管扩张征象，见图1，图2，图3。TOPD<span style="color: black;">病人</span>左肺上、舌、下叶的结核瘢痕阳性分别为176例（55.5%）、120例（37.9%）和126例（39.7%），右肺上、中、下叶的结核瘢痕阳性分别为215例（67.8%）、142例（44.8%）、168例（52.9%）；左肺的支气管扩张征象<span style="color: black;">重点</span>集中在左肺舌叶，右肺<span style="color: black;">重点</span><span style="color: black;">位置于</span>中叶、下叶；肺气肿在双肺间分布较为<span style="color: black;">平衡</span>，见图4。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 1</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p26-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/b48f551bd5ed4f6aa639482725b55427~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=3lgLKRJb6hN2jeP3vIT45fpKoV0%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 1 Pulmonary imaging findings of TOPD patients</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 2</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/41d90efabff9470ab42c2a98810f25d8~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=P4PZZzL%2BBHy5cwFOzRJ%2Fbxmt3ms%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 2 Pulmonary imaging findings of TOPD patients</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 3</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/5681102450534637956bda23d419debc~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=v4Mzn05%2BD8%2F%2FroHCRKf2UrIuUI8%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 3 Pulmonary imaging findings of TOPD patients</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 4</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/db5fbba6ef4342858a93e5a904c2f534~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=mv0kCE30OkcCjE3jOSsoCS9x1Uc%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 4 Distribution of pulmonary imaging featuresof TOPD patients</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">2.4　受累叶数与肺功能的Spearman<span style="color: black;">关联</span>性分析</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">受累叶数与FEV1/FVC、FEV1%pre、FVC%pre均呈负<span style="color: black;">关联</span>（</span></span><span style="color: black;"><span style="color: black;">rs</span></span><span style="color: black;"><span style="color: black;">=-0.202，</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">=0.011；</span></span><span style="color: black;"><span style="color: black;">rs</span></span><span style="color: black;"><span style="color: black;">=-0.456，</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.001；</span></span><span style="color: black;"><span style="color: black;">rs</span></span><span style="color: black;"><span style="color: black;">=-0.442，</span></span><span style="color: black;"><span style="color: black;">P</span></span><span style="color: black;"><span style="color: black;">&lt;0.001），见图5，图6，图7。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 5</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/46bc9604b0264d5481842bc3c895412e~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=iNIC0LyYqMekih1Otpbj0M8dxsE%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 5 Scatter plot of the relationship between the number of affected lobes and pulmonary function FEV1/FVC</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 6</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/41fe0eaddca6410fa563e94b7ddd0fb5~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=peSmDG2tvQHaeqpRhyOfJEIRsag%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 6 Scatter plot of the relationship between the number of affected lobes and pulmonary function FEV1%pre</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">Figure 7</h1>
    <div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://p3-sign.toutiaoimg.com/tos-cn-i-qvj2lq49k0/01a5ac178fb049c094bcadb176c863a7~noop.image?_iz=58558&amp;from=article.pc_detail&amp;lk3s=953192f4&amp;x-expires=1728088469&amp;x-signature=rYtc2fsqmXcour%2Fj4xhexIgGf1o%3D" style="width: 50%; margin-bottom: 20px;"></div>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">Figure 7 Scatter plot of the relationship between the number of affected lobes and pulmonary function FVC%pre</span></span></strong></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">3　讨论</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">本<span style="color: black;">科研</span>提示TOPD<span style="color: black;">病人</span><span style="color: black;">拥有</span>年龄偏低、住院时间更长、肺功能阻塞性通气功能<span style="color: black;">阻碍</span>更甚等特点，<span style="color: black;">另外</span>，该病影像学的结核受累叶数与肺功能存在负<span style="color: black;">关联</span>关系。需要说明的是，尽管<span style="color: black;">科研</span>尝试采用倾向性评分匹配方式对两组间协变量进行<span style="color: black;">调节</span>以减少回顾性<span style="color: black;">科研</span>固有的<span style="color: black;">选取</span>性偏倚，<span style="color: black;">然则</span>受回顾性<span style="color: black;">科研</span>证据等级偏低及样本量有限等影响，<span style="color: black;">以上</span>结论仍有待多中心高质量的前瞻性<span style="color: black;">科研</span>进一步证实。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">一项荟萃分析结果显示，肺结核与COPD存在<span style="color: black;">显著</span>正<span style="color: black;">关联</span>关系，这一联系在40岁以下人群中尤为<span style="color: black;">明显</span>，提示肺结核可能会<span style="color: black;">引起</span>COPD的<span style="color: black;">出现</span>或提前<span style="color: black;">出现</span>。本<span style="color: black;">科研</span>纳入的TOPD与COPD<span style="color: black;">病人</span>的年龄分别为（73.3±10.3）岁和（76.2±10.5）岁，发病年龄分别为（59.0±12.8）岁、（60.4±13.8）岁，倾向性评分匹配后这种差异仍然存在，与YAKAR等<span style="color: black;">科研</span>结论一致。TOPD<span style="color: black;">病人</span>年龄偏低可能与肺结核<span style="color: black;">关联</span>肺损害<span style="color: black;">出现</span>较早，而吸烟、传统生物质燃料暴露等其他<span style="color: black;">原因</span><span style="color: black;">关联</span>的肺损害<span style="color: black;">出现</span>较慢且晚<span style="color: black;">相关</span>。<span style="color: black;">另外</span>，本<span style="color: black;">科研</span><span style="color: black;">亦</span><span style="color: black;">表示</span>TOPD<span style="color: black;">病人</span>的住院天数长于COPD组。<span style="color: black;">日前</span>关于此现象<span style="color: black;">关联</span><span style="color: black;">科研</span>仍然存在矛盾，LEE等<span style="color: black;">报告</span>的一项病例对照<span style="color: black;">科研</span><span style="color: black;">表示</span>TOPD<span style="color: black;">病人</span>与COPD<span style="color: black;">病人</span>相比，咯血现象更加<span style="color: black;">平常</span>，然而两组<span style="color: black;">病人</span>在<span style="color: black;">呼气</span>症状、病情加重和住院时间方面无<span style="color: black;">明显</span>差异。反观<span style="color: black;">科研</span><span style="color: black;">办法</span>，本<span style="color: black;">科研</span>仅将性别、年龄、民族等基线数据进行匹配分析，而LEE等除此之外<span style="color: black;">亦</span>将肺功能FEV1<span style="color: black;">做为</span>匹配变量进行分析。<span style="color: black;">以上</span><span style="color: black;">科研</span><span style="color: black;">办法</span>的差异提示两组<span style="color: black;">病人</span>在基线<span style="color: black;">平衡</span><span style="color: black;">状况</span>下TOPD组可能住院时间更长，然而在基线资料和肺功能<span style="color: black;">平衡</span>的<span style="color: black;">状况</span>下，两组<span style="color: black;">病人</span>的病情加重和住院时间方面可能无<span style="color: black;">明显</span>差异。当然，<span style="color: black;">以上</span>两种<span style="color: black;">办法</span>均为小样本的病例对照<span style="color: black;">科研</span>，<span style="color: black;">关联</span>结论仍待深入<span style="color: black;">科研</span>。<span style="color: black;">另外</span>，<span style="color: black;">日前</span>非结核分枝杆菌肺病有日渐<span style="color: black;">增加</span>趋势，其病理、影像学及临床特征与肺结核<span style="color: black;">非常</span><span style="color: black;">类似</span>，本<span style="color: black;">科研</span>纳入的陈旧性肺结核可能包含一部分非结核分枝杆菌肺病<span style="color: black;">病人</span>，并未对其进行进一步划分。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">日前</span>关于TOPD<span style="color: black;">病人</span>肺功能特征的<span style="color: black;">科研</span><span style="color: black;">逐步</span><span style="color: black;">增加</span>。PLIT等<span style="color: black;">科研</span><span style="color: black;">发掘</span>肺结核<span style="color: black;">病人</span><span style="color: black;">一般</span>在确诊结核病后6个月内<span style="color: black;">显现</span>最大限度地肺功能丧失；结核<span style="color: black;">爆发</span>次数的<span style="color: black;">增多</span><span style="color: black;">亦</span>加速了FEV1<span style="color: black;">损害</span>，在1次、2次和3次结核<span style="color: black;">爆发</span>后平均损失分别为153 ml、326 ml和410 ml；一项前瞻性<span style="color: black;">科研</span>结果<span style="color: black;">表示</span>，即便肺结核<span style="color: black;">病人</span>接受了抗结核治疗后肺功能得到改善，仍然有28%和24%的<span style="color: black;">病人</span><span style="color: black;">显现</span>残余气流限制或限制性模式。本<span style="color: black;">科研</span><span style="color: black;">发掘</span>TOPD<span style="color: black;">病人</span>的肺功能指标FEV1/FVC、FEV1%pre均<span style="color: black;">小于</span>COPD<span style="color: black;">病人</span>，提示TOPD<span style="color: black;">病人</span>肺功能阻塞性通气功能<span style="color: black;">阻碍</span>较COPD<span style="color: black;">病人</span>更严重。<span style="color: black;">日前</span><span style="color: black;">导致</span>TOPD<span style="color: black;">病人</span>肺功能改变的机制<span style="color: black;">科研</span>仍然较少。本<span style="color: black;">科研</span>采用Spearman秩<span style="color: black;">关联</span>分析结果<span style="color: black;">表示</span>，结核<span style="color: black;">导致</span>受累叶数与肺功能指标FEV1/FVC、FEV1%pre、FVC%pre均呈负<span style="color: black;">关联</span>，尽管这种<span style="color: black;">相关</span>非常微弱，但仍提示TOPD<span style="color: black;">病人</span>肺功能降低可能与结核瘢痕等结核<span style="color: black;">副作用</span><span style="color: black;">引起</span>肺组织结构形态学改变<span style="color: black;">相关</span>。HWANG等<span style="color: black;">科研</span><span style="color: black;">亦</span><span style="color: black;">发掘</span>，有影像学改变的<span style="color: black;">病人</span>其GOLD分级更高。然而，<span style="color: black;">亦</span>有<span style="color: black;">科研</span><span style="color: black;">表示</span>气流阻塞<span style="color: black;">出现</span>在影像学改变小的<span style="color: black;">病人</span>中，提示影响TOPD<span style="color: black;">病人</span>肺功能的<span style="color: black;">原由</span>并非单纯的结核<span style="color: black;">导致</span>影像学受累，<span style="color: black;">亦</span>可能与慢性气道炎症等其他<span style="color: black;">原因</span><span style="color: black;">相关</span>。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">总之，本<span style="color: black;">科研</span>初步分析了TOPD<span style="color: black;">病人</span>的临床、肺功能及影像学特征。肺功能与影像学指标的<span style="color: black;">关联</span>性<span style="color: black;">科研</span>结果提示临床防治肺结核的重要性，尤其是<span style="color: black;">针对</span>临床上<span style="color: black;">已然</span><span style="color: black;">显现</span>结核<span style="color: black;">导致</span>肺组织受累的<span style="color: black;">病人</span>，加强其肺功能监测和<span style="color: black;">初期</span><span style="color: black;">干涉</span>性治疗，可能<span style="color: black;">针对</span>预防TOPD的<span style="color: black;">出现</span>或减缓该病<span style="color: black;">发展</span><span style="color: black;">拥有</span>重要<span style="color: black;">道理</span>。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本文无利益冲突。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">本文表格略</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献略</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">基于倾向性评分匹配的结核<span style="color: black;">关联</span>阻塞性肺<span style="color: black;">疾患</span><span style="color: black;">病人</span>肺功能及影像学特征分</a>析</p>




b1gc8v 发表于 2024-10-13 15:35:34

对于这个问题，我有不同的看法...

m5k1umn 发表于 2024-10-18 13:53:43

论坛是一个舞台，让我们在这里尽情的释放自己。

b1gc8v 发表于 2024-10-24 21:57:58

论坛的成果是显著的，但我们不能因为成绩而沾沾自喜。

nykek5i 发表于 2024-10-31 13:20:49

这夸赞甜到心里，让我感觉温暖无比。

4zhvml8 发表于 2024-11-13 06:30:35

外链发布社区 http://www.fok120.com/
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