Radiological and functional evidence of the bronchial spread of tuberculosis: an observational analysis.
Radiological and functional evidence of the bronchial spread of tuberculosis: an observational analysis.
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肺结核支气管扩散的放射学和功能证据：一项观察性分析。
DOI：
10.1016/s2666-5247(21)00058-6
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Barry CE 3rd
中科院分区：
文献类型：
--
作者：
Chen RY;Yu X;Smith B;Liu X;Gao J;Diacon AH;Dawson R;Tameris M;Zhu H;Qu Y;Zhang R;Pan S;Jin X;Goldfeder LC;Cai Y;Arora K;Wang J;Vincent J;Malherbe ST;Thienemann F;Wilkinson RJ;Walzl G;Barry CE 3rd
在抗生素前的人类病理学文献中，结核病的直接支气管传播被广泛描述，但在后抗生素时代，这种描述被忽视了，在后抗生素时代，大多数病理数据来自强调肉芽肿的动物模型。现代技术，如[18F]2-氟-2-脱氧-d -葡萄糖（FDG） PET-CT扫描，可能提供进一步的见解。我们的目的是了解肺部PET-CT扫描正常早期结核消退模式的治疗结核患者随后治愈。在这项观察性分析中，我们分析了来自PredictTB的数据，PredictTB是一项正在进行的前瞻性随机临床试验，该试验检查了南非和中国成功治疗（入组后18个月痰培养阴性）的药敏肺结核患者的连续基线和第4周FDG-PET-CT扫描。年龄18-75岁，GeneXpert MTB/RIF结核阳性，利福平耐药阴性，尚未开始结核病治疗，过去3年内未接受活动性结核病治疗，符合基本安全实验室标准的参与者被纳入，糖尿病，HIV感染或肺外结核包括胸膜结核的参与者被排除在外。扫描由两名读取器评估结核病变的位置（如空洞和实变）、支气管增厚模式以及从基线到治疗第4周的变化。在成功治疗的首批124名参与者（2017年6月22日至2018年9月27日）中，基线时发现了161例主要的根尖腔病变。124名参与者的基线PET-CT扫描中，121名（98%）观察到支气管增厚和非空洞实变病变与空洞相关的炎症。经过4周的治疗，124名参与者中有21名（17%）出现了新的或扩大的病变，这些病变与基线时不存在的支气管炎症有关，特别是基线时有两个或更多蛀牙的参与者和来自南非的参与者。在随后治愈的肺结核患者中，基线时空洞和非空洞病变的位置以及治疗第4周时新病变的位置表明疾病的空洞起源和支气管通过肺部扩散。支气管从空腔的扩散可能在肺结核的扩散中起着比人们所认识的更大的作用。阐明腔内病变动态和结核分枝杆菌在腔内的生存能力可能更好地解释治疗结果，以及为什么一些患者治愈而另一些患者复发。比尔及梅琳达·盖茨基金会、欧洲和发展中国家临床试验伙伴关系、中国科技部、国家自然科学基金委员会、美国国立卫生研究院。摘要的中文、南非荷兰语和科萨语译本见补充资料部分。
Direct bronchial spread of tuberculosis was extensively described in pre-antibiotic human pathology literature but this description has been overlooked in the post-antibiotic era, in which most pathology data come from animal models that emphasise the granuloma. Modern techniques, such as [18F]2-fluoro-2-deoxy-D-glucose (FDG) PET-CT scans, might provide further insight. Our aim was to understand normal early tuberculosis resolution patterns on pulmonary PET-CT scans in treated patients with tuberculosis who were subsequently cured. In this observational analysis, we analysed data from PredictTB, an ongoing, prospective, randomised clinical trial that examined sequential baseline and week 4 FDG-PET-CT scans from participants successfully treated (sputum culture negative 18 months after enrolment) for drug-susceptible pulmonary tuberculosis in South Africa and China. Participants who were aged 18–75 years, GeneXpert MTB/RIF positive for tuberculosis and negative for rifampicin resistance, had not yet started tuberculosis treatment, had not been treated for active tuberculosis within the previous 3 years, and met basic safety laboratory criteria were included and participants with diabetes, HIV infection, or with extrapulmonary tuberculosis including pleural tuberculosis were excluded. Scans were assessed by two readers for the location of tuberculosis lesions (eg, cavities and consolidations), bronchial thickening patterns, and changes from baseline to week 4 of treatment. Among the first 124 participants (enrolled from June 22, 2017, to Sept 27, 2018) who were successfully treated, 161 primarily apical cavitary lesions were identified at baseline. Bronchial thickening and inflammation linking non-cavitary consolidative lesions to cavities were observed in 121 (98%) of 124 participants' baseline PET-CT scans. After 4 weeks of treatment, 21 (17%) of 124 participants had new or expanding lesions linked to cavities via bronchial inflammation that were not present at baseline, particularly participants with two or more cavities at baseline and participants from South Africa. In participants with pulmonary tuberculosis who were subsequently cured, the location of cavitary and non-cavitary lesions at baseline and new lesions at week 4 of treatment suggest a cavitary origin of disease and bronchial spread through the lungs. Bronchial spread from cavities might play a larger role in the spread of pulmonary tuberculosis than has been appreciated. Elucidating cavity lesion dynamics and Mycobacterium tuberculosis viability within cavities might better explain treatment outcomes and why some patients are cured and others relapse. Bill & Melinda Gates Foundation, European and Developing Countries Clinical Trials Partnership, China Ministry of Science and Technology, National Natural Science Foundation of China, and National Institutes of Health. For the Chinese, Afrikaans and Xhosa translations of the abstract see Supplementary Materials section.