依赖利福平菌肺结核43例临床分析  

Clinical Analysis of pulmonary tuberculosis in 43 cases cause by-depending strains

作　　者：钟明[1] 钟敏[1] 娄乐山[1] 温博海[2] 王安容[1] 曹沙莉[1] 孙川龙[1] 尹慧国[1] 

机构地区：[1]重庆市肺科医院,重庆400020 [2]第三军医大学微生物学教研室,重庆400038

出　　处：《中国防痨杂志》2003年第2期104-106,共3页Chinese Journal of Antituberculosis

基　　金：重庆市医学重点项目资助 (NO.99- 10 0 2 )

摘　　要：目的　探讨依赖利福平 (R)结核分支杆菌肺结核的临床特征、产生原因及防治对策。方法对实验室诊断为依赖R菌的肺结核患者进行治疗和随访追踪 ,对其临床资料进行回顾性分析。结果(1 ) 43依赖R菌肺结核患者中 ,年龄 2 0～ 3 9岁的占 60 .5 % (2 6/ 43 ) ,40～ 5 9岁的占 2 0 .9% (9/ 43 ) ;病灶范围≥ 3个肺野的占 88.4% (3 8/ 43 ) ,病变性质以干酪空洞为主的占 5 8.1 % (2 5 / 43 ) ;耐药种类≥ 3种抗结核药的占 88.4% (3 8/ 43 ) ,≥ 2种的为 1 0 0 % (4 3 / 43 ) ,至少耐异烟肼和利福平的耐多药肺结核(MDR -TB)占 74.4% (3 2 / 43 )。 (2 ) 5例初始患者均为MDR -TB ,且化疗全部失败 ;3 8例复治患者化疗失败率达 5 2 .6% (2 0 / 3 8) ,利福霉素类药物交替使用或不规则用药的占 76.3 %。结论　 (1 )依赖R菌肺结核以病情重 ,耐多药 ,化疗效果差和预后不良为主要临床特征。 (2 )肺结核患者长期不合理或不规则用利福霉素类药 ,可能是产生依赖R菌的主要原因。 (3 )建立结核菌耐药性检测的快速方法 ,并应用于临床 。Objective To evaluate the clinical feature of pulmonary tuberculosis by rifampin-depending strains,the produce cause and avoid countermove. Methods The pulmonary tuberculosis by rifampin-depending strains were analyzed retrospectively.Results It was 60.5% (26/43) and 20.9%(9/43) in the age of 22～39 and 40～59 years group respectively,the percent rates was 88.4% (38/43) in the cases of focus scope ≥3 field of lungs:88.4%(38/43), caseation and vacuolation:58.1%(25/43),and the multidrug resistance was 88.4(38/43).The chemotherapy of 5 patients,all of primary treatment and multidrug resistance,was entire failure,and the failure rates of chemotherapy was 52.6%(20/38) in the 38 cases with relapsing patients.The abusing rate of rifampin was 76.3% in this group researched.Conclusion (1)It is main clinical feature that the patients possesses severe condition,multidrug resistance and bad prognosis.(2)That is major reason possible to abuse the drugs of rifampins.(3)To establish the method for rapid detection of drug resistance is the key to prevent producing rifampin depending strains.

关 键 词：依赖性 利福平菌 肺结核 临床分析 结核分支杆菌 诊断 治疗 

分 类 号：R521[医药卫生—内科学]