起始耐药与非耐药肺结核患者近、远期疗效观察  

The short-term and long-term treatment outcomes in patients with pulmonary tuberculosis positive for drug-resistant and sensitive strains

作　　者：韩建平[1] 孙淑丽[1] 李仁忠[1] 张福生[1] 王仕昌[1] 程峻[1] 邓云峰[1] 王燕[1] 于春宝[1] 

机构地区：[1]山东省结核病防治中心,济南250013

出　　处：《中华结核和呼吸杂志》2003年第2期70-73,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：山东省医药卫生科研项目 [1998( 10 4) ]

摘　　要：目的　观察起始耐药与非耐药肺结核患者使用 2H3 R3 S3 Z3 / 4H3 R3 方案的近远期治疗效果 ,分析不同耐药程度对患者疗效的影响。方法　于 1998年开始 ,对山东省 30个耐药监测点上的777例初治涂阳肺结核患者进行近远期治疗效果随访。结果　疗程结束时痰菌阴转率为 98 2 % ,总失败率为 1 8% ,其中敏感患者失败率为 1 6 % ,耐药患者为 2 6 %。随访半年复阳率为 2 7% ,敏感患者和耐药患者的复阳率分别为 1 2 %和 8 5 % (P <0 0 0 5 )。 1年复阳率为 2 6 % ,敏感患者和耐药患者的复阳率分别为 1 6 %和 6 9% (P <0 0 0 5 ) ;2年复阳率为 1 3% ,敏感患者和耐药患者的复阳率分别为 1 3%和 1 0 %。 15 2例耐药患者中 ,疗程结束时 ,痰菌仍阳性者 2 6 % ,而耐多药病例为 10 3% ;半年随访复阳率为 8 5 % ,耐多药病例复阳率为 37 0 % ;1年复阳率为 6 9% ,耐多药病例为 6 3% ;2年复阳率为 1 0 % ,而耐多药病例为 6 7%。结论　在国家结核病防治规划下 ,初治肺结核患者使用 6个月间歇方案是可行的。耐多药患者的近期治愈率低 ,远期复发率很高。Objectives To analyze the treatment outcomes in patients with smear positive tuberculosis, and to compare the difference in treatment response among patients infected with drug sensitive and drug resistant strains Methods From 1998 to 2000, seven hundred and seventy seven patients with primary smear positive tuberculosis , which were from 30 surveillance sites, were followed for two years to monitor their treatment outcomes Results At the completion of the 6 months′ therapy, the overall rate of treatment failure was 1 8%, 2 6% for the drug resistant cases and 1 6% for the drug sensitive cases Six month follow up showed a positive conversion rate of 2 7% in all the cases, 8 5% and 1 2%( P <0 005)in the drug resistant and the drug sensitive cases respectively One year follow up showed that the positive conversion rate was 2 6% in all the cases, 6 9% and 1 6%( P <0 005) in the drug resistant and the drug sensitive cases, respectively Two year follow up showed an overall positive conversion rate of 1 3%, 1 0% and 1 3% in the drug resistant and the drug sensitive cases, respectively Of the 152 drug resistant cases, the rate of treatment failure was 2 6% at the completion of 6 months′ therapy, but in cases with MDR TB the rate was 10 3% Six month follow up showed an overall positive conversion rate of 8 5%, but the rate reached 37 0%in cases with MDR TB One year and two year follow up showed that the positive conversion rates were 6 9% and 1 0% respectively in all the drug resistant cases, but 6 3% and 6 7% respectively in the MDR cases Conclusions Under the guidelines of the National Tuberculosis Program (NTP), the 2H 3R 3S 3Z 3/4H 3R 3 regimen for primary smear positive pulmonary TB was effective But the cure rate was lower and the positive conversion rate higher in patients with MDR TB

关 键 词：起始耐药 非耐药 肺结核 疗效观察 

分 类 号：R521[医药卫生—内科学]