1447例耐多药肺结核患者治疗转归队列分析  

A cohort study on treatment outcomes of 1447 cases with multidrug-resistant pulmonary tuberculosis

作　　者：张梦娴 杨成凤[1] 叶建君[1] 张玉[1] 童叶青[1] 周丽平[1] 侯双翼[1] ZHANG Mengxian;YANG Chengfeng;YE Jianjun;ZHANG Yu;TONG Yeqing;ZHOU Liping;HOU Shuangyi(Institute for Infectious Disease Control and Prevention,Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China)

机构地区：[1]湖北省疾病预防控制中心传染病防治研究所,武汉430079

出　　处：《公共卫生与预防医学》2020年第3期68-72,共5页Journal of Public Health and Preventive Medicine

基　　金：中国全球基金结核病项目(CHN-S10-G14-T)。

摘　　要：目的分析湖北省耐多药结核病防治试点地区耐多药肺结核患者治疗转归情况。方法从2006—2017年,对纳入治疗的1447例耐多药肺结核患者治疗转归情况进行回顾性队列分析。利用结核病信息管理系统、月度报表和季度报表,采用Excel表格建立数据库,应用SPSS 21.0进行统计分析。结果纳入治疗的1447例耐多药肺结核患者中,男性1076例,女性371例,平均年龄(44.44±14.28)岁;798例患者治愈,63例完成疗程,总体治疗成功率为59.50%(861/1447)。初治患者治疗成功率为68.02%(268/394),复治患者治疗成功率为56.32%(593/1053),两者间差异有统计学意义(χ2=16.30,P<0.05)。分析6月末和12月末痰菌阴转情况看,6月末痰菌阴转患者的治疗成功率[78.41%(672/857)]明显高于12月末痰菌阴转患者治疗成功率[38.71%(12/31)],两者差异具有统计学意义(χ2=26.65,P<0.05)。比较6月末和12月末痰培养持续阳性情况,6月末痰培养持续阳性患者的治疗成功率为12.07%(14/116);12月末痰培养持续阳性患者治疗成功率为4.44%(2/45),两者不具有统计学差异(χ2=1.34,P=0.25)。结论对涂阳患者因及时进行耐药筛查,及时发现,及早治疗耐药患者是极其重要的。6月末痰菌阴转情况对耐多药结核病患者的治疗转归具有重要的预判意义,对6月末持续阳性患者要密切留意,依据患者病情进展情况及时调整治疗方案,积极探索缩短治疗疗程的可能性。Objective To analyze the treatment outcomes of multidrug-resistant pulmonary tuberculosis(MDR-TB)cases in Hubei Province.Methods From October 2006 to June 2017,a retrospective cohort analysis of treatment outcomes for 1447 patients with MDR-TB who were included in treatment was performed.Excel worksheet was created to establish database by monthly and quarterly reports.The statistical analysis of data was conducted using SPSS 21.0 software.Results Among 1447 MDR-TB patients,1076 were males and 371 were females,with an average age of 44.44±14.28 years.798 patients were cured,63 patients completed the course of treatment,and the overall treatment success rate was 59.50%(861/1447).The treatment success rate was 68.02%(268/394)in newly diagnosed cases,and 56.32%(593/1053)in relapse cases.There was a significance difference between the two groups(χ2=16.30,P<0.05).The treatment success rate[78.41%(672/857)]in patients with negative sputum culture at the end of 6th month was higher than the rate[38.71%(12/31)]of negative sputum culture at the end of 12nd month,with a statistical significance difference(χ2=26.65,P<0.05).The treatment success rate[12.07%(14/116)]in patients with continued positive sputum culture at the end of 6th month was higher than the rate[4.44%(2/45)]of negative sputum culture at the end of 12th month,with a significance difference(χ2=1.34,P=0.25).Conclusion It is extremely important to screen drug-resistant individuals for smear-positive patients,and to detect and treat drug-resistant patients timely.The negative conversion of sputum bacteria at the end of 6th month had important predictive significance for the treatment outcomes of MDR-TB patients.The patients with continued positive sputum at the end of 6th month should be closely monitored to adjust treatment according to the progress of the patient′s condition and to explore a way to shorten the treatment course.

关 键 词：肺结核 耐多药 治疗 分析 

分 类 号：R183.3[医药卫生—流行病学] R521[医药卫生—公共卫生与预防医学]