摘要目的:探讨成人气管支气管结核（TBTB）发生肺不张的危险因素。方法:回顾性分析成都市公共卫生临床医疗中心2018年2月至2021年12月收治的TBTB成年患者（≥18岁）的临床资料，共纳入258例患者，男女比例1∶1.43，中位年龄31（24，48）岁。收集患者临床特征、既往误诊/漏诊情况、肺不张情况、出现症状到发生肺不张和行支气管镜检查时长、支气管镜检查和介入治疗干预情况等临床资料，根据是否并发肺不张分组，比较两组差异，采用二元logistic回归方程分析发生肺不张的危险因素。结果:肺不张发生率为14.7%，左肺上叶多发（26.3%），出现症状至发生肺不张的中位时间为130.50（29.75，358.50）d，发生肺不张至行气管镜检查中位时间为5（3，7）d。肺不张组中位年龄、既往误诊率、出现症状到做支气管镜的时长均高于无肺不张组，既往接受支气管镜检查及介入治疗率、空洞率均低于无肺不张组（均 P<0.05）；肺不张组瘢痕狭窄型、管腔闭塞型的比例高于无肺不张组，炎症浸润型、溃疡坏死型的比例低于无肺不张组（均 P<0.05）；中心型气道中最常见病变部位为左主支气管（26.0%）。年龄更大（ OR=1.036，95% CI：1.012~1.061）、既往有误诊（ OR=2.759，95% CI：1.100~6.922）、出现症状到做支气管镜检查时间更长（ OR=1.002，95% CI：1.000~1.005）、瘢痕狭窄型（ OR=2.989，95% CI：1.279~6.985）是成人TBTB发生肺不张的独立危险因素（均 P<0.05）。肺不张患者接受介入治疗后86.7%最终肺复张或部分复张。 结论:成人TBTB肺不张的发生率为14.7%，左肺上叶多发，管腔闭塞型100%并发肺不张，年龄更大、误诊、出现症状到做支气管镜时间更长和进展为瘢痕狭窄型并发肺不张的可能性更高。成人TBTB患者亟需早诊早治以降低肺不张发生率和提高肺复张率。

abstractsObjective:To investigate the risk factors for pulmonary atelectasis in adults with tracheobronchial tuberculosis(TBTB).Methods:Clinical data of adult patients (≥18 years old) with TBTB from February 2018 to December 2021 in Public Health Clinical Center of Chengdu were retrospectively analyzed. A total of 258 patients were included, with a male to female ratio of 1∶1.43. The median age was 31(24, 48) years. Clinical data including clinical characteristics, previous misdiagnoses/missed diagnoses before admission, pulmonary atelectasis, the time from symptom onset to atelectasis and bronchoscopy, bronchoscopy and interventional treatment were collected according to the inclusion and exclusion criteria. Patients were divided into two groups according to whether they had pulmonary atelectasis. Differences between the two groups were compared. Binary logistic regression was used to analyze the risk factors for pulmonary atelectasis.Results:The prevalence of pulmonary atelectasis was 14.7%, which was most common in the left upper lobe (26.3%). The median time from symptom onset to atelectasis was 130.50(29.75,358.50)d, and the median time from atelectasis to bronchoscopy was 5(3,7)d. The median age, the proportion of misdiagnosis of TBTB before admission, and the time from symptom onset to bronchoscopy in the atelectasis group were higher than those without atelectasis, and the proportion of receiving bronchoscopy examination and interventional therapy previously, and the proportion of pulmonary cavities were lower than those without atelectasis (all P<0.05). The proportions of cicatrices stricture type and lumen occlusion type in the atelectasis group were higher than those without atelectasis, while the proportions of inflammatory infiltration type and ulceration necrosis type were lower than those without atelectasis (all P<0.05). Older age ( OR=1.036, 95% CI: 1.012-1.061), previous misdiagnosis( OR=2.759, 95% CI: 1.100-6.922), longer time from symptom onset to bronchoscopy examination ( OR=1.002, 95% CI: 1.000-1.005) and cicatrices stricture type ( OR=2.989, 95% CI: 1.279-6.985) were independent risk factors for pulmonary atelectasis in adults with TBTB (all P<0.05). Of the patients with atelectasis who underwent bronchoscopy interventional therapy, 86.7% had lung reexpansion or partial reexpansion. Conclusions:The prevalence of pulmonary atelectasis is 14.7% in adult patients with TBTB. The most common site of atelectasis is left upper lobe. The TBTB type of lumen occlusion is complicated by pulmonary atelectasis in 100% of cases. Being older, misdiagnosed as other diseases, longer time from onset of symptoms to bronchoscopy examination, and being the cicatrices stricture type are factors for developing pulmonary atelectasis. Early diagnosis and treatment are needed to reduce the incidence of pulmonary atelectasis and increase the rate of pulmonary reexpansion.