MTBDRplus在初治2个月末涂阳肺结核治疗中的应用  

The application of MTBDRplusin treatment new tuberculosis for smear positive at the end of two months

作　　者：黄富礼 周祖模 刘伟[3] 孙峰[4] 黄何清 吴刚 金嘉琳[4] 

机构地区：[1]西南医科大学附属医院感染科,四川泸州646000 [2]浙江诸暨市人民医院感染科,311800 [3]杭州市疾病预防控制中心,310021 [4]复旦大学附属华山医院感染科,上海200040

出　　处：《重庆医学》2016年第34期4791-4794,共4页Chongqing medicine

基　　金：四川省泸州市科技局资助项目[2014-s-45(7/12)];西南医科大学附属第一医院博士基金(14047)

摘　　要：目的运用分子线性探针技术（MTBDRplus）对2个月末涂片阳性的初治肺结核患者进行快速耐药检测及个体化治疗指导，并观察其预后。方法选择基线及2个月朱痰涂片仍为阳性的初治肺结核患者随机分两组，分别予以传统直接观察（或面视）下的短程化疗（Directly Observed Treatment＋short course chemotherapy，DOTs）方案及分子药敏指导治疗，并比较预后。结果在分子药敏指导治疗组中成功率，完全敏感的为74．4％，单耐异烟肼为87．5％，单耐利福平100．0％，耐多药结核75．0％；DOTs方案组中，成功率为单耐异烟肼25．0％，单耐利福平耐和耐多药结核均为0．0％。两组预后χ^2分析显示差异有统计学意义（P=0．044）。结论MTBDRplus应用在2个月末涂阳初治肺结核患者中可改善预后。Objective Individualize treatment new tuberculosis -patients whose smear positive at the end of two months after treatment by MTBDRplus and describe the treatment outcomes among patients in Zhejiang province. Methods We prospectively enrolled sputum smear positive at the end of two months after treatments. For two groups,one group received World Health Organ7 ization recommended initial treatment regimen[without DST（Drug sensitivity test） results3, the other treatment according to the results of molecular line-probe assay（GenoType MTBDRplus）. Treatment responses were monitored using sputum smear, culture and chest radiography. Results The success rate of totally sensitive patients were 74.4% ,87.5% single resistant to isoniazid,rifampin resistant single 100M and MDR-TB 75% in MTBDRplus molecular susceptibility guidance treatment group;in the conventional treatment group,the success rate of treatment were 25 % single＇ resistant to isoniazid, rifampin resistant 0 % single and MDR-TB 0%. Chi square analysis showed that,molecular susceptibility guide therapy group and traditional therapy group and its prognosis is statistically significant （P=0. 044）. Conclusion Molecular line-probe assay（MTBDRplus）improved the initial treatment of smear positive at the end of two months after treatment tuberculosis patients prognosis.

关 键 词：结核 肺 分子探针技术 预后 MTBDRplus 初治 2个月末涂阳 

分 类 号：R521[医药卫生—内科学]