230例新发年轻肺结核临床特征和耐药情况  

Clinical characteristics and drug-resistance in pulmonary tuberculosis in 230 young patients

作　　者：杨剑 杨江华 孙健 YANG Jian;YANG Jianghua;SUN Jian(Department of Infectious Diseases,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院感染性疾病科,安徽芜湖241001

出　　处：《皖南医学院学报》2018年第6期551-553,共3页Journal of Wannan Medical College

基　　金：安徽省卫生厅中医药科研项目(2012ZY60)

摘　　要：目的:研究新发年轻肺结核临床特征和耐药情况,为芜湖地区年轻人群肺结核诊疗策略提供参考。方法:收集弋矶山医院2012～2017年诊治的芜湖地区26岁以下新发肺结核患者病例资料230例,回顾性分析其临床特征和耐药情况,采用χ~2检验比较2012～2014年和2015～2017年两组的初始耐药率差异。结果:新发年轻肺结核患者就诊症状多样,并以非典型临床肺结核和无痰患者为主(82. 2%,63. 5%);多数患者肺部病变较重(病变范围≥2个肺野占76. 5%);合并其他结核病以结核性胸膜炎(56. 9%)和颈部淋巴结核(18. 1%)为主。78例结核菌株中,总耐药率为20. 5%,耐多药率为3. 8%; 4种一线抗痨药中,以耐异烟肼为主(16. 7%); 2015～2017年组总耐药率高于2012～2014年组(29. 3%vs. 10. 8%),差异有统计学意义(P<0. 05)。结论:芜湖地区年轻肺结核疫情不容乐观,临床表现多不典型且肺部病变偏重,无痰患者较多导致痰检难度加大,2015～2017年来以异烟肼耐药为主的初始耐药肺结核有加重趋势。Objective:To investigate the clinical features and drug resistance in new pulmonary tuberculosis(PTB)in young patients for evidences to scientifically plan diagnosis and treatment measures in the young population in Wuhu area.Methods:The clinical data were collected in 230 new cases of PTB in the young population under 26 years of age diagnosed and treated in our hospital between 2012 and 2017.Retrospective analysis was performed regarding the clinical features and incidences of drug-resistance.Chi-square test was used to analyze the ratio difference of initial drug resistance to tuberculosis between 2012~2014 and 2015~2017.Results:Various symptoms were seen in the 230 new cases.Clinically,most patients were characterized by atypical symptoms(82.2%)and absence of sputum(63.5%)as well as serious lung lesion(76.5%were involved in over two lesions in the pulmonary field).Tuberculous pleurisy(56.9%)and cervical lymphatic TB(18.1%)were commonly seen in patients concomitant with other tuberculosis.The total rate of drug resistant to TB was 20.5%and that of multi-drug resistance,3.8%in the 78 strains isolated.Of the 4 first line drugs against tuberculosis,resistance to isoniazid is most seen(16.7%).The initial rate of drug-resistance to TB was higher in 2015~2017(29.3%)than in 2012~2014(10.8%).The difference was significant(P<0.05).Conclusion:PTB appears more prevalent in young population in Wuhu area.The clinical features are associated with atypical and serious pulmonary symptoms.Sputum study is more difficult due to freedom of sputum,and the resistance to isoniazid tend to increase in the past three years.

关 键 词：肺结核 临床特征 耐药 

分 类 号：R521[医药卫生—内科学]