湖北省耐多药与广泛耐药肺结核患者治疗效果及转归分析  

The analysis of treatment outcome on MDR-TB and XDR-TB patients in Hubei province

作　　者：杨成凤[1] 叶建君[1] 张玉[1] 张梦娴 周丽平[1] 刘勋[1] 皮琦[1] 周纯辉[1] 侯双翼[1] 

机构地区：[1]湖北省疾病预防控制中心结核病防治研究所,武汉430079

出　　处：《中国防痨杂志》2016年第7期582-587,共6页Chinese Journal of Antituberculosis

基　　金：中国全球基金结核病项目（CHN-S10-G14-T）

摘　　要：目的分析湖北省耐多药与广泛耐药肺结核患者治疗效果及转归情况。方法收集湖北省5个全球基金耐多药结核病项目地区于2006年10月至2014年6月登记的12296例涂阳肺结核患者的耐药筛查及诊治等相关资料。本研究采用以酸性改良罗氏培养基分离培养（简称“传统培养”）筛查为主[99．63％，（12251／12296）1、基因芯片筛查为辅[0．36％，（45／12296）]的方式开展耐多药肺结核筛查。分析涂阳肺结核患者的耐药筛查情况，以及耐多药与广泛耐药肺结核患者发现和纳入治疗情况、治疗6个月末和12个月末痰菌阴转情况、治疗转归情况。结果共确诊耐多药与广泛耐药肺结核患者1493例（1421例MDR-TB，72例XDR-TB），耐多药与广泛耐药肺结核患者检出率为14．22％（1493／10501）。复治患者中耐多药与广泛耐药肺结核患者的检出率为25．30％（1195／4724），高于初治患者E5．16％（298／5777）]，差异有统计学意义（χ2=6255．54，P〈0．05）。不同登记分类复治患者中，复治失败患者耐多药与广泛耐药肺结核患者检出率高达50．43％（232／460）。耐多药与广泛耐药结核病患者纳入治疗率为68．85％（1028／1493），6个月末和12个月末痰菌培养阴转率分别为72．47％（745／1028）和63．23％（650／1028）；耐多药结核病的治疗成功率为62．04％（492／793）。结论本研究复治涂阳患者耐多药检出率高，提示复治患者是耐多药肺结核筛查的重点人群。耐多药肺结核患者的治疗成功率达到项目要求指标，其经验值得推广。Objective To analyze the treatment outcome of multidrug-resistant tuberculosis （MDR-TB） and extensively drug resistant tuberculosis （XDR-TB） patients in Hubei province. Methods 12 296 smear positive TB patients are enrolled between October 2006 and June 2014 from 5 regions within China Global Fund MDR-TB pro- gram. Information about drug-resistance screening and treatment are collected. This study uses modified acidic Lo- wenstein-Jensen medium culture （＂conventional culture＂ in short） as the major screening method （99.63%, 12 251/12 296）, and microarray as the minor screening method （0. 36%, 45/12 296）, to analyze the drug-resistant screening of smear positive TB patients. The diagnosis, enrollment for treatment and sputum conversion rates after 6 and 12 months of treatment for MDR-TB and XDR TB patients are analyzed. Results Of 1493 patients are diag- nosed as MDR-TB （1421） or XDR-TB （72）. The total detection rate for MDR-TB and XDR-TB is 14.22% （1493/10 501）. The detection rates of MDR-TB and XDR-TB are 25.30% （1195/4724） in relapse patients, and 5.16 % （298/5777） in new patients respectively. The difference is statistically significant （χ2= 6255.54, P〈0.05）. In different registration categories, the MDR-TB and XDR-TB detection rate for relapse patients with failed treat- ment is as high as 50.43% （232/460）. The enrollment rate for treatment of MDR-TB and XDR-TB is 68. 8% （1028/1493）. The sputum culture conversion rates are 72.47% （745/1028） and 63.23% （650/1028） after 6 months and 12 months treatment respectively. The treatment success rate for MDRTB is 62.04% （492/793）. Conclusion The detection rate of MDR-TB is high in relapse smear positive patients, which suggests that relapse patients to be the main population for MDR TB screening. The treatment success rate for MDRTB has met the pro- gram requirement, the experience of which is good for generalization.

关 键 词：结核 肺/预防和控制 结核 肺/治疗 抗药性 多种 细菌 

分 类 号：R52[医药卫生—内科学]