机构地区：[1]首都医科大学附属北京胸科医院中国疾病预防控制中心结核病防治临床中心,101149 [10]广州市胸科医院 [11]黑龙江省传染病防治院 [12]沈阳市第五人民医院 [13]山东省胸科医院五病区(疑难结核病) [14]天津市海河医院 [15]内蒙古自治区第四人民医院 [16]新疆维吾尔自治区胸科医院结核二科 [17]深圳市第三人民医院肺病三科 [18]宁夏回族自治区第四人民医院呼吸一科 [19]贵州医科大学附属医院呼吸科 [2]湖南省结核病防治所耐药专科 [3]安徽省胸科医院科教科 [4]中国人民解放军总保院第八医学中心全军结核病研究所 [5]成都市公共卫生临床中心 [6]陕西省结核病防治院 [7]长春市传染病医院 [8]枣庄市王开传染病医院 [9]西安市结核病胸部肿瘤医院结核内科
出 处：《中国防痨杂志》2019年第3期294-301,共8页Chinese Journal of Antituberculosis
摘 要：目的分析由6种药物组成、疗程为18个月的化疗方案对耐多药肺结核患者的治疗效果,为缩短耐多药肺结核患者的化疗疗程提供依据。方法纳入2009年7月至2015年12月在首都医科大学附属北京胸科医院等20家结核病专科医院确诊为耐多药肺结核的681例患者,按照所采用的化疗方案将患者分为观察组(18个月方案组,515例)和对照组(24个月方案组,166例)。收集治疗中结核分枝杆菌培养、血常规、肝肾功能、心电图检查等结果,观察药物不良反应,评估两组患者的治疗转归(治疗成功、失败、死亡、丢失等)。采用SPSS 22.0软件进行数据的统计学分析,计量资料采用t检验或Z检验,计数资料采用χ 2检验;两组患者治疗前有差异的临床指标与治疗成功率间的关系采用logistic回归分析,以P<0.05为差异有统计学意义结果观察组的治疗成功率(64.66%,333/515)高于对照组(54.22%,90/166)(χ 2=5.818, P=0.002),病死率(2.33%,12/515)低于对照组(5.42%,9/166)(χ 2=4.015, P=0.045)。而两组的失败率(17.86%,92/515;23.49%,39/166)、丢失率(11.46%,59/515;11.45%,19/166)、药物不良反应的总发生率(24.85%,128/515;25.90%,43/166)差异均无统计学意义(χ 2=2.561,P=0.109;χ 2=0.000,P=0.997;χ 2=0.095,P=0.757)。logistic回归分析显示年龄≥50岁[β=0.549,s-x=0.204,Wald χ 2=7.262,P=0.007,OR(95%CI)=1.731(1.161~2.579)]和使用乙胺丁醇[β=0.485,s-x=0.190,Wald χ 2=6.516,P=0.011,OR(95%CI)=1.625(1.119~2.359)]是影响治疗成功率的风险因素。结论采用6种药物组成、疗程为18个月的化疗方案能够达到24个月化疗方案的疗效,并获得较好的治疗成功率,且未增加药物不良反应发生率,具有临床可行性。关键词:Objective We observed and analyzed the effect of 18 months regimen containing 6 drugs in the treatment of multidrug-resistant pulmonary tuberculosis (MDR-PTB) with the purpose to provide evidence for shortening the treatment course of MDR-TB.Methods Six hundred and eighty-one confirmed MDR-TB patients were enrolled from 20 TB specialized hospitals in China from July, 2009 to December, 2015 among which 515 were treated with the 18 months regimen containing 6 drugs (observation group) and 166 were treated with 24 months regimen containing 5 drugs (control group). Results of TB bacilli culture, complete blood count, hepatic and renal function, electrocardiograph,etc were collected throughout the treatment. The treatment outcome (success, death, failure and lost to follow-up) and adverse effect were assessed at the end of treatment.Data were analyzed using SPSS 22.0 software. Measurement data were analyzed by t test or z test.Enumeration data were analyzed by Chi-square test.The clinical indicator with significant difference before treatment were further analyzed by logistic regression to identify the risk factors associated with treatment success rate.P<0.05 was considered significant difference statistically.Results The treatment success rate (64.66%, 333/515) in the observation group was higher than that of the control group (54.22%, 90/166)(χ 2=5.818, P=0.002) and the death rate in the observation group (2.33%, 12/515) was lower than that of the control group (5.42%, 9/166)(χ 2=4.015, P=0.045). The rate of failure (17.86%(92/515) vs 23.49%(39/166))(χ 2=2.561, P=0.109) and lost to follow-up ((11.46%, 59/515) vs 11.45%(19/166)(χ 2=0.000, P=0.997)) were similar between the two groups. The total incidence of adverse reactions in the observation group (24.85%, 128/515)was close to that of the control group (25.90%, 43/166)(χ 2=0.095, P=0.757). Analysis using logistic regression showed that ≥50 age (β=0.549,s-x=0.204,Wald χ 2=7.262,P=0.007,OR(95%CI)=1.731(1.161-2.579)) and selection of ethambutol (β=0.485,s-x
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
正在载入数据...
