172例年轻初治Ⅲ型肺结核耐药状况和抗痨效果调查分析  

Drug-resistance in 172 initiative cases of young type-3 pulmonary tuberculosis patients

作　　者：孙健 杨剑[1] 杨进孙[1] 杨江华[1] SUN Jian;YANG Jian;YANG Jin-sun;YANG Jiang-hua(Department of Infecitous Diseases,the First Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院附属弋矶山医院感染性疾病科,芜湖241000

出　　处：《中国人兽共患病学报》2018年第11期1059-1062,共4页Chinese Journal of Zoonoses

基　　金：安徽省卫生厅中医药科研项目(No.2012zy60)资助~~

摘　　要：目的了解近年芜湖地区年轻初治肺结核耐药状况和抗痨效果。方法对芜湖地区172例26岁以下新发Ⅲ型肺结核诊疗并随访2年,研究其耐药谱和抗痨效果,并比较不同职业组自行停药率差异及不同治愈标准组复发率差异。结果172例初治患者中,菌阳率为33.7%,总耐药率和耐多药(MDR)率分别为25.9%和3.4%。4种一线抗痨药耐药率依次为异烟肼(17.2%)、链霉素(13.8%)、利福平(3.4%)和乙胺丁醇(3.4%)。10例不规律用药致初治失败患者中,自行停药6例,无业者自行停药率显著高于其他职业(10.4%∶2.1%),连续校正χ2检验提示差异有统计学意义(χ2=6.853,P<0.01);复治成功6例,2年复发率为33.3%;多次复治未愈4例,MDR占50%。162例初治完成者中,X线治愈115例,仅临床治愈29例,Fisher确切概率法提示两组2年复发率差异无统计学意义(P>0.05);复治失败10例中,初始耐药率为20%,获得性耐药率为50%。结论芜湖地区年轻初始耐药肺结核不容乐观,以耐异烟肼为主的初始耐药结核和不规律用药是抗痨失败、诱导耐药和结核病复发的主因。对多数年轻初始肺结核患者采取短期抗痨方案达到临床治愈即可停药,但应警惕初始耐药结核,并对无业者为主的重点人群加强肺结核防治宣传。We aimed to evaluate the drug-resistance and efficacy of anti-tuberculosis treatment(ATT)in young initiative pulmonary tuberculosis(PTB)patients in Wuhu.The 172 initiative type-3 PTB cases under 26 yrs in Wuhu during 2010 and 2015,were obtained short-term ATT and followed up for 2 yrs.Chi-squared test and Fisher’s Exact test were used to analyze the cessation rates of two career groups and post-year relapse rates of two groups with different curative standards,respectively.In the 172 cases,bacteria positive rate was 33.7%,the total drug-resistant(DR)and multi-drug resistant(MDR)rates were 25.9%and 3.4%,respectively.The DR rates to isoniazid,streptomycin,rifampicin and ethambutol were 17.2%,13.8%,3.4%and 3.4%,respectively.In 10 cases with irregular medication,the percentage of poor patient adherence was 60%.The cessation rate of unemployed(10.3%)was much higher than that of other careers(2.1%)and the difference had statistical significance by Chi-squared test(χ2=6.853,P<0.01).Six unemployed patients with ATT recovered and the post-year relapse rate was 33.3%,while the other four failed,of which the MDR rate was 50%.In 162 cases with full course of ATT,115 got X-ray cure,29 just got clinical cure,and the post-year relapse rates of such two groups had no statistical difference by Fisher’s Exact test(P>0.05).In 18 cases failing in the initiative ATT,10 still failed after retreatments,of whom the initiative drug-resistant(IDR)rate was 20%and the acquired one was 50%.The IDR of young PTB in Wuhu was not optimistic.IDR mainly to isoniazid and irregular medication attributed to most failure of ATT,induced further DR and PTB relapse.For most young initiative PTB,good therapeutic efficacy could be achieved with short-term ATT,which could end after reaching the clinical curative standard.More attention should be given to initiative PTB cases of IDR,and more propaganda of PTB prevention and control should be given to high risky young groups like unemployed population.

关 键 词：结核病 结核分枝杆菌 耐药 耐多药 一线抗痨药物 异烟肼 

分 类 号：R378.91[医药卫生—病原生物学]