Abstract:

Objective: To analyze the thoracic collapse deformity secondary to stage Ⅲ tuberculous empyema and related influencing factors. Methods: A retrospective study was conducted to collect clinical data of 105 patients with stage Ⅲ tuberculous empyema treated in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 1, 2019 to September 30, 2023, including patient’s gender, age, course of disease, treatment classification, NRS 2000 nutritional score, location of empyema (left/right/bilateral), number of ribs involved in empyema, thickness of parietal pleura, thoracic drainage, thoracic collapse, as well as drug resistance, smoking, complicated with/without pulmonary tuberculosis, diabetes, etc. The incidence of thoracic collapse was analyzed by univariable and multivariable logistic regression analysis. Results: Among 105 patients with stage Ⅲ tuberculous empyema, 56 cases (53.33%) had normal chest (normal chest group) and 49 cases (46.67%) had thoracic collapse (thoracic collapse group). Univariable analysis showed that the median age of the thoracic collapse group (29.0 (23.0, 41.5) years) was lower than that of the normal thoracic group (45.5 (23.5, 56.0) years), the median duration of disease (5.0 (3.0, 12.0) months), the proportion of combination with pulmonary tuberculosis (83.67% (41/49)), and the median NRS 2000 nutritional score (3 (2, 3)), the median parietal pleural thickness (3.15 (2.30, 4.73) mm)) and the median number of ribs involved in empyema (6 (5, 8)) were all higher than those in normal thoracic group (3.0 (1.0, 6.0) months, 66.07% (37/56), 2 (1, 3), 1.08 (0.75, 1.69) mm and 4 (3, 4), respectively), the differences were all statistically significant (Z=-2.041, P=0.041; Z=-2.302, P=0.021; χ²=4.239, P=0.040; Z=-2.321, P=0.020; Z=-6.610, P<0.001; Z=-7.127, P<0.001). Logistic regression analysis showed that age was negatively correlated with thoracic collapse secondary to stage Ⅲ tuberculous empyema (OR (95%CI)=0.933 (0.882-0.987), P=0.016). The course of disease, nutrition score of NRS 2000, thickness of parietal pleura and the number of ribs involved in empyema were positively correlated with thoracic collapse (OR (95%CI)=1.122 (1.006-1.251), P=0.039; OR (95%CI)=3.061 (1.234-7.589), P=0.016; OR (95%CI)=3.001 (1.256-7.174), P=0.013; OR (95%CI)=3.817 (1.791-8.136), P=0.001). Conclusion: Due to the high incidence of thoracic collapse malformation secondary to tuberculous empyema, pleural effusion should be drained as soon as possible, and the anti-tuberculosis treatment principles of “early, combined, appropriate amount, regular, and whole course” should be followed. Attention should be paid to patients with young age, long course of disease, high nutrient score of NRS 2000, increased partical pleural thickness, and more ribs involved in empyema, to further reduce the occurrence of thoracic collapse.

Key words: Empyema, tuberculous, Chest, Musculoskeletal malformations, Factor analysis, statistics, Comparative study