河南省结核病耐药水平对全程督导短程化疗效果的影响

Impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis patients receiving directly observed treatment strategy in Henan Province, China

目的探讨河南省结核病耐药水平对全程督导短程化疗效果的影响。方法于2001年8月至2002年6月,河南省与WHO合作开展了第2轮结核病耐药监测,采用比例法进行药敏试验,采用现代结核病控制策略的全程督导短程化疗技术(DOTS)对入选的痰涂片阳性肺结核患者1 571例进行化疗。结果痰涂片阳性肺结核患者的治疗成功率为85．5％(1 343／1 571),其中初治成功率为89．6％(1 159／1 293);耐药患者治疗成功率为76．6％(433／565),其中初治成功率为86．8％(341／393),复治成功率为53．5％(92／172);耐多药患者治疗成功率为58．6％(126／215),其中初治成功率为75．4％(83／110),复治成功率为41．0％(43／105)。耐2～4种药物的初治患者的治疗成功率均显著高于复治患者。多因素分析结果表明,与治疗失败有统计学意义的相关因素为复治和耐2种及以上药物,与因结核病死亡有统计学意义的相关因素为复治、年龄较大和耐多药。结论河南省采用DOTS技术对初治肺结核患者治疗效果较好,对复治患者,尤其是对耐多药复治患者的疗效非常差。复治、年龄较大、耐2种及以上药物或耐多药是导致患者化疗效果差的危险因素。

Objective To study the impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis （TB） patients receiving directly observed treatment strategy （DOTS） in Henan Province, China. Methods From Aug. 2001 to Jun. 2002, the second round surveillance of anti- TB drug resistance was carried out in cooperation with WHO in Henan Province, China. The proportion method was used for drug susceptibility test and all enrolled patients were administrated with DOTS. Results The treatment success rate of smear-positive patients was 85.5% （ 1 343/1 571 ）, of which the treatment success rate of initial-treatment cases was 89.6% （ 1 159/1 293 ）. The treatment success rates among 565 anti-TB drug resistant cases and 215 multi-drug-resistant-TB （MDR-TB） cases were 76. 6% （433/565） , （ initial treatment cases： 86. 8%, 341/393 ; re-treated cases： 53.5%, 92/172 ; being significandy different）, 58. 6% （ 126/215）, （initial treatment cases： 75.4% , 83/110; re-treated cases： 41.0%, 43/ 105; being significantly different）, respectively. For the cases being resistant to 2, 3 or 4 drugs, the treatment success rates in initial treatment cases were all higher than those in re-treatment cases. Multivariate analysis showed that re-treatment, resistance to 2 plus drugs or MDR were the significant risk factors for treatment failure, and that re-treatment, older age and MDR were the significant risk factors for TB death. Conclusion The treatment outcome of initial treatment of smear-positive patients with DOTS in Henan was satisfying, but that of retreated patients, especially retreated patients of MDR was very poor. Re-treatment, older age, resistance to 2 anti-TB drugs or MDR were the risk factors for the poor outcome of treatment with DOTS.