复治菌阳肺结核治疗成功后对再次复发患者的治疗方案合理性探讨  

Discussion on the rationality of treatment regimen for smear-positive re-treated pulmonary TB patients who relapsed after re-treatment success

作　　者：张立杰 谢仕恒 宁宇佳 舒薇[1] 刘宇红[1] 杜建[1] 高微微[1] ZHANG Li-jie;XIE Shi-heng;NING Yu-jia;SHU Wei;LIU Yu-hong;DU Jian;GAO Wei-wei(Beijing Chest Hospital Affiliated to Capital Medical University,Beijing 101149,China)

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,北京101149

出　　处：《临床肺科杂志》2020年第11期1621-1625,共5页Journal of Clinical Pulmonary Medicine

基　　金：“十一五”国家科技重大专项(No.2008ZX10003-015-2);“十二五”国家科技重大专项(No.2013ZX10003009-001-007);“十三五”国家科技重大专项(No.2018ZX10722302-003)。

摘　　要：目的探讨复治菌阳肺结核治疗成功后再次复发患者的治疗合理性。方法回顾调查"十一五"期间治疗成功的300例复治肺结核患者,在随访6年后复发患者23例,分析其化疗方案及治疗合理性。统计学计数资料采用χ^2检验,以P<0.05为差异有统计学意义。结果 23例复发组和277例未复发组患者,既往累计用药时间≥6个月的分别有18例(78.3%,18/23)和147例(53.1%,147/277),两组比较差异有统计学意义(χ^2=5.446,P=0.020)。药敏试验结果显示本次复治前和治疗后药敏结果不一致,且出现耐药演变不合逻辑的现象。结论复治新方案的制定要根据药敏试验,同时要密切参考临床既往用药史;临床医生对药敏试验发现不合逻辑现象时,需要做进一步验证。Objective To explore the rationality of the treatment regimen in smear-positive re-treated pulmonary TB patients who relapsed after re-treatment success.Methods 300 smear-positive re-treated pulmonary TB patients who got successful treatment outcome during the"11 th Five-year"period were followed up for 6 years and 23 out of 300 relapsed.Their treatment regimens and rationality of 23 cases were analyzed.Qualitative variables were analyzed using chi-square tests.A P-value of<0.05 was taken as statistically significant.Results The percentages of patients whose previous accumulated treatment duration no less than 6 months were 78.3%(18/23)in the relapse group and 53.1%(147/277)in the non-relapse group(χ^2=5.446,P=0.020).The results of drug susceptibility testing(DST)before and after re-treatment for patients relapsed presented inconsistent results,and the changes of drug resistance profiles were illogical.Conclusion Re-treated regimen should be designed based not only on the DST results but also taking patients’previous treatment history into consideration.It is necessary for clinicians to make further verification when the changes of drug resistance profiles are doubted illogically.

关 键 词：结核 肺 复治 再复发 治疗方案 合理性 

分 类 号：R521[医药卫生—内科学]