新涂阳肺结核病人痰菌动态变化对治疗转归的影响  

Transition Trend of Sputum Smear Result and Treatment Outcome in Newly Discovered Smear Positive Pulmonary Tuberculosis Patient

作　　者：许琳[1] 华建昭[1] 李琳[1] 张丽芳[1] 

机构地区：[1]云南省疾病预防控制中心结核病防制科,云南昆明650022

出　　处：《实用预防医学》2008年第2期428-431,共4页Practical Preventive Medicine

摘　　要：目的揭示涂阳肺结核病人治疗前与治疗过程中痰中带菌量的变化与治疗效果的关系。方法利用结核病网络专报信息系统,对2005年1-3月云南省登记治疗的4 654例新涂阳肺结核病人进行回顾性队列研究。结果性别、年龄对治疗过程中痰菌转变无显著性作用。治疗前痰涂片的阳性程度与治疗2月末痰菌量的改变呈线性上升趋势。治疗2月末痰涂片强阳性的病人在治疗3月末仍较为可能出现中等阳性(RRR 47.03)及强阳性(RRR 24.45)。与2月末阴转病人相比,治疗3月末阴性、弱阳性、中等阳性及强阳性的病人,在5月末出现阳性的相对危险度(RRR)依次为4.06,18.25,69.48和55.97。73例(62.4%)死亡和140例(52.8%)失访病例发生在治疗前2个月。68%的死亡病例出现在40岁以上的年龄组。结论在目前DOTS策略执行下,新涂阳肺结核病人治愈率达到85%以上。治疗前肺结核病人的痰菌结果对强化期结束时痰菌阴转有着重要的影响作用,而强化期治疗直接关系到最终治疗效果。应特别关注早期失访病人和老年患者的治疗情况,减少失访和死亡。Objective To identify transition patterns of acid fast bacilli （AFB） load during intensified anti - TB treatment among newly discovered smearpositive PTB patients, and to clarify its association between initial sputum AFB load and followup bacterial load. Methods A retrospective cohort study based on computerized medical record - database was conducted with a cohort of 4,654 new smearpositive TB cases diagnosed and treated in Yunnan Province from January to March in 2005. Results Patients with higher bacillary load before treatment were more likely to remain positive after intensive treatment with a linear trend of RRR, As compared with patients with negative smear at the 2nd month of treatment, patients with negative, weak positive, moderate positive and strong positive at the 3rd month of treatment were more likely be smear positive at the 5th month of treatment （RRR 4.06, 95% CI 1.79-9.19; RRR 18.25, 95% CI 6.62-50.29; RRR 69.48, 95% CI 31.45- 153.49; and RRR 55.97, 95% CI 10.7-292.68）. 52.8% of the total default and 62.4% of the total deaths occurred in the first 2 months. 4.15% of the total default and 4.27% of the total deaths occurred in the 3rd month. 68% of the death cases occurred in the age group of over 40 years. Conclusions Initial sputum smear result is a key factor that influencing smear result after 2 months intensive treatment, but it is not an independent factor for treatment outcome, while smear result at the 2nd month is the strongest predictor for follow- up treatment. Intensive treatment phase is the dominant phase that influencing the quality of treatment. Older patients, especially for the patients over 60 - year-old, may face more serious difficulties for standard intensive treatment. Patients with strong positive smear result at the 2nd month or with positive at the 3rd month should do anti TB drug susceptibility test.

关 键 词：新涂阳肺结核 痰菌阴转 治疗转归 

分 类 号：R52[医药卫生—内科学]