初次复治肺结核患者出现耐药的原因分析  

Causes of drug resistance in initial retreatment of pulmonary tuberculosis patients

作　　者：王玉红[1] 王智慧[1] 董雅坤[1] 谢兰品[1] 杨帆[1] 王秋梅[1] 池跃鹏[1] 梁亚充 WANG Yuhong;WANG Zhihui;DONG Yakun;XIE Lanpin;YANG Fan;WANG Qiuhai;CHI Yuepeng;LIANG Yachong(Department of Tuberculosis,Chest Hospital of Hebei Province,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院结核科,河北石家庄050041

出　　处：《安徽医药》2017年第12期2323-2326,共4页Anhui Medical and Pharmaceutical Journal

基　　金：河北省科技计划项目(132777249)

摘　　要：目的对初次复治肺结核患者的复发与治疗资料进行整理,分析初次复治肺结核出现肺结核的原因,并对患者产生原发性耐药、获得性耐药的发生原因、临床处置以及治疗对策。方法选取242例复治肺结核患者,对所选患者进行肺结核复治的原因分析,并对患者出现的耐药类型,耐药情况进行分析,总结患者出现原发性耐药或获得性耐药的原因以及对策,并对患者的治疗进行分析,总结经验。结果不同年龄段不同耐药性患者的单耐药率、多耐药率、耐多药率、广泛耐药率、利福平耐药率差异无统计学意义(P>0.05),青年组患者的获得性耐药发生率高于中年组和老年组患者,可见不同年龄段肺结核患者的耐药率相似但差异无统计学意义(P>0.05),治疗不良反应发生率6.74%,患者用药时间0~4个月时的耐药性值明显低于用药5~8个月的患者以及用药9~12个月的患者,患者中出现并发症患者的任一药物耐药率为40.14%,未出现并发症的患者任一药物耐药率为43.00%。结论继发性耐药是我国初次复治肺结核患者耐药的主要类型,用药时间越长,耐药率越高,在临床治疗过程中,应提高治疗效果,减少耐药的发生,同时对结核病的传染源进行有效控制,减少原发耐药的发生。Objective To summarize the recurrence and treatment data of pulmonary tuberculosis patients in Chest Hospital of Hebei Province,to analyze the causes of pulmonary tuberculosis in primary tuberculosis patients and to analyze the causes of primary drug resistance and acquired resistance,disposal and treatment strategies.MethodsA total of242patients with tuberculosis were enrolled.The causes of tuberculosis resuscitation,the types and consequences of drug resistance were analyzed.Meanwhile,the causes of primary drug resistance or acquired resistance as well as the countermeasures were summarized.Data of treatment was analyzed and experience of treatment was summed up.ResultsThere were no significant differences in the rates of single drug resistance,multi drug resistance,resistance to various drugs,extensive drug resistance and rifampicin resistance among different drug resistant patients in different age groups(P>0.05).The rate of acquired drug resistance among patients of youth group was higher than those of middle age group and elderly group.The drug resistance rates of patients were similar among different age groups yet there were no significant differences(P>0.05).The incidence of adverse drug reactions was6.74%.The time of drug use was0to4months.Drug resistance rate of patients with0to4month drug use was significantly lower than patients with5to8month drug use and patients with9to12month drug use.The any drug resistance rates of patients with complications and patients without complications were40.14%and43.00%.ConclusionsSecondary drug resistance is the main type of drug resistance in the first retreatment of pulmonary tuberculosis patients in China.The longer the time of drug use,the higher the drug resistance rate.During the clinical treatment,we should improve the treatment effect and reduce the occurrence of drug resistance.Meanwhile,tuberculosis infection source should be controlled effectively to reduce the incidence of primary resistance.

关 键 词：复治肺结核 原发性耐药 获得性耐药 

分 类 号：R521[医药卫生—内科学]