产生复治后耐多药肺结核病的有关因素及临床特点

Related factors and clinical characteristics of the MDR-PTB patients who received treatment before

目的 了解产生复治后耐多药肺结核病的有关因素及临床特点。方法 对 1992— 2 0 0 2年10年间收治的复治后耐多药肺结核病人 (MDR PTB)共 6 2 5例进行分析。结果 6 2 5例复治后MDR PTB病人占同期收治的复治菌 (阳 )病人的 30 .8% ,青壮年男性占大多数。药敏监测提示耐H、R 7例(1.1% ) ;耐 3种药 12 5例 (2 0 .0 % ) ;耐 4种药 4 93例 (78.9% )。初始耐药 19.4 % ,获得性耐药 80 .6 %。农村及城镇病人比例高 ,但有效率低于城市病人。结论 复治后MDR PTB较普通MDR PTB更难处理 ,除经济、文化、地区等因素外 ,医源性因素也是其发病率增高的重要原因。本组初始耐药感染高于全国平均水平。不同地区治疗有效率差异与缺乏专业人员的正规治疗及管理有关。个体化治疗。

Objective To determine the occurrence mechanism clinical characteristics multidrug resistant pulmonary tuberculosis (MDR PTB) who received treatment before.Methods The clinical data of 625 cases with MDR PTB received treatment before in Guiyang pulmonary Hospital from 1992 to 2002 was analyzed.Results 625 cases with MDR PTB received treatment before occupied 30.8% in patients of retreatment bacteriological positive PTB.Young and middle age females occupied majority.The results of susceptibility test wereas follows:7 cases with drug resistance results to H.R. (1.1%);125 cases with drug resistance results to 3 drugs (20.0%);493 cases with drug resistance results to H.R.S.E.( 78.9%); the initinl drug resistance rate was 19.4% and acquired resistance result was 80.6%.There were more patients in rural and town than ones in the city and the cure rate of patients come from rural area was lower than that of patients from urban area.Conclusion The treatment to post MDR PTB is more difficult than to general MDR PTB.Besides economic cultural and regional diffence,medical factor is one of mainly reasons of occurrence rate increasing.The rate of primary resistance in the cases is higher than the rate of national average resistance.The difference in effective rate of treatment in different area is because of there is short of regular treatment manage by specialist.The better effect can be got by the private treatment especially unite the operation treatment.