结核病初始耐药对短程化疗效果和获得性耐药的影响  

Effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis

作　　者：王庆 王东萍 丁运生 李玉琴 王学中 

机构地区：[1]合肥安徽省胸科医院,233030

出　　处：《安徽医学》2013年第6期687-689,共3页Anhui Medical Journal

基　　金：安徽省卫生厅资助课题(项目编号:2010C091);上海市结核病(肺)重点实验室开放基金(项目编号:2010K06)

摘　　要：目的了解短程化疗对初始耐药结核病患者治疗效果和获得性耐药的影响。方法收集2010年4月至2011年6月就诊的初治涂阳肺结核病例,分析其对抗痨药物的原发耐药性、短程监督化疗的失败率和获得性耐药发生情况。结果 317例初诊患者中,检出耐药结核病为64例(20.19%);耐多药(MDR)结核病24例(7.57%)。短程化疗失败的21例(6.62%)患者中,对抗痨药物敏感组有2例(0.79%);含有利福平或异烟肼耐药的非MDR组患者分别有3例(21.43%)和1例(8.33%);24例MDR组患者有15例(62.50%)短程化疗失败。21例短程化疗失败的患者中发生获得性耐药的有8例。结论抗痨药的初始耐药与短程治疗效果密切相关。结核菌对抗痨药的敏感性快速监测应作为结核患者的常规检查。根据药敏试验结果采取个体化的治疗方案,才能有效防止获得性耐多药结核的发生,提高抗结核治疗效果。Objective To investigate the effect of initial drug resistance on treatment outcome and acquired drug resistance in new patients receiving standardized short-course chemotherapy. Methods During the period of April 2010 through June 2011, patients with smeared positive pulmonary tuberculosis were enrolled. Pretreatment drug resistance and short-course treatment failure and acquired new drug resistance were available for analysis. Results Sixty-four cases （20.19%）were resistant to any anti-tuberculosis drugs in 317 cases, 24 cases （7.57%）tlad muhidrug-rcsistance （MDR）tuberculosis, and 21 cases（6.62%） were involved treatment failure. In patients with pretreatment sus- ceptible to anti-tuberculosis drugs, 2（0.79%） cases involved treatment failure. In patients who had strains with resistance to rifampin and isoni- azid, but not MDR-TB, 3 cases （21.43%）and 1 case （8.33%）involved treatment failure. Fifteen（62.50%） of 24 MDR-TB cases invol＇~ed treat- ment failure. Eight of 21 cases involving treatment failures acquired new multidrug resistance. Conclusion Pretreatment drug resistance is strongly associated with short-course chemotherapy failure. Rapid drug susceptibility testing of mycobacterium tuberculosis should be early diag- nosed as a routine test. According to the drug susceptibility tests, individual chemotherapy can be applied to decrease transmission of drug-re- sistant strains and to prevent the creation of muhidrug-resistant strains.

关 键 词：分枝杆菌 结核 短程化疗 

分 类 号：R521[医药卫生—内科学]