初治耐多药肺结核临床疗效及其转归队列分析  

A cohort study on the outcome of multidrug-resistant tuberculosis among newly diagnosed cases

作　　者：郝晓晖[1] 姚岚[1] 唐神结[1] 刘一典[1] 孙华[1] 

机构地区：[1]同济大学附属上海市肺科医院结核病诊疗中心,上海市结核（肺）重点实验室,200433

出　　处：《中华传染病杂志》2012年第3期157-161,共5页Chinese Journal of Infectious Diseases

基　　金：国家十一五重大专项课题“特大城市结核病综合防治模式研究”（2009ZX10003-017）

摘　　要：目的了解初治耐多药肺结核的临床疗效及其转归，以进～步提高对初治耐多药肺结核的认识。方法选取上海市肺科医院2006年1月至2009年1月收治的耐多药肺结核患者408例，分为初治组及复治组，观察两组间临床疗效、不良反应等，同时采用队列分析方法对两组转归进行比较，统计学方法应用7。检验。结果初治组痰菌阴转率、病灶吸收率、空洞闭合或缩小率均明显高于复治组，而不良反应发生率在两组间差异无统计学意义（χ2=0．434，P〉0.05）。初治组89例，治愈66例（74．16％），完成疗程8例（8．99％），失败7例（7．87％），死亡3例（3．37％），失访5例（5．62％）；复治组319例，治愈134例（42．01％），完成疗程31例（9．72％），失败116例（36．36％），死亡12例（3．76％），失访26例（8．15％）；初治组治愈率明显高于复治组，两组间差异有统计学意义（χ2=28．783，P〈O．01）。可能的影响因素有患者病程、病灶及空洞范围、一般营养状况、合并症及结核分枝杆菌耐药程度等。结论耐多药肺结核患者中，初治组临床疗效及转归明显好于复治组。加强结核病患者的耐药性监测，早期发现并及时更改化疗方案可提高治愈率。Objective To investigate the anti-tuberculosis treatment response and outcomes in treatment naive patients infected with multidrug-resistant tuberculosis （MDR-TB）. Methods A total of 408 patients who were diagnosed with MDR-TB in Shanghai Pulmonary Hospital from January 2006 to January 2009 were recruited in this study. These patients were divided into two groups based on their previous treatment history： treatment naive group and re-treatment group. The treatment response, outcomes and adverse events were observed. The outcomes of these two groups were compared by cohort analysis and ）C2 test. Results The sputum conversion rates, the lesions absorption rate and the cavity closing or shrinking rate of the treatment naive MDR-TB group were significantly higher than those of the re-treatment group, while the adverse events rate was not significantly different between two groups （χ2=0. 434, P〉0. 05）. Among 89 treatment naive cases, 66 cases （74.16%） were cured, 8（8.99%） completed the full treatment course, 7（7.87%） were treatment failure, 3（3.37%） died, and 5（5.62%） were lost to follow-up. Among the 319 cases of re-treatment MDR-TB group, 134 （42.01%） were cured, 31 （9. 72%） completed the full treatment course, 116 （36.36%） were treatment failure, 12（3. 76%） died, 26（8. 15%） were lost to follow-up. The cure rate of the treatment naive MDR-TB group was significantly higher than that of re-treatment group （χ2 =28. 783, P〈0.01）. The factors influencing the treatment outcomes included the stage of the disease, the range of lesions and cavity, the patients general nutritional status, underlying complications, and the drug resistant strains. Conclusions The anti-tuberculosis treatment outcomes are better in treatment naive patients with MDR-TB infection compared to the treatment experienced and retreated patients. Therefore, the status of the drug resistance should be closely monitored in order to detect MDR TB as early as possible. With the early diagnosis, th

关 键 词：结核 肺 结核 抗多种药物性 药物疗法 治疗结果 

分 类 号：R521[医药卫生—内科学]