耐药对肺结核病治疗效果的影响

The effect of drug resistance on treatment of tuberculosis

目的评价耐药对地区肺结核病治疗效果的影响。方法对上海地区2004年2月—9月新登记敏感及耐药肺结核病人1年治疗转归进行分析和比较。结果在全市各区(县)结核病定点医院新登记1 597例肺结核病病人中,805例培养阳性,其中731例经菌型鉴定为结核分枝杆菌的病人纳入分析。731例病人的总耐药率为18.7%,耐多药率为6.7%。敏感组治疗成功率达到93.0%,非MDR的耐药病人治疗成功率达到85%以上,MDR组治疗成功率为71.4%。经χ2检验,差别有统计学意义(χ2=83.996 8,P<0.01)。在68例治疗不成功的病人中,耐药病人占38.2%;而在30例治疗失败的病人中,耐药病人占60%。复治敏感病人的治疗成功率(92.0%)与初治敏感病人(93.1%)相当,但是复治耐药病人的治疗成功率远低于初治耐药病人。结论(1)上海地区肺结核病病人治疗管理效果良好;(2)耐药是肺结核病治疗失败的重要因素,应加强和改进对耐药结核病的治疗措施;(3)耐药和敏感病人治疗效果存在较大差异,应分别评价。

Objective To evaluate the effect of drug resistance on treatment of tuberculosis. Methods The treatment outcome of sensitive TB cases and drug resistant TB cases that weren ewly registered between February 2004 and September 2004 were analyzed and compared. Results Among the 1597 retrieved TB cases, 805 were culture positive cases from whom 731 were included in the mycobacterium tuberculosis group after isolate identification. The drug-resistant rate of 731 patients was 18.7% and the multi-drug-resistant rate was 6.7%. The assessment of one-year treatment outcomes showed that the treatment success rate was as high as 93.0% among the sensitive cases, the rate was more than 85.0% of patients who had drug-resistant but not MDR strains and the rate was 71.4% of MDR-TB patients. The X^2 testing showed that the difference was significant （X^2 = 82.996 8, P 〈 0,01 ）. Of the 68 patients who were not treated successfully, 38.2% were drug-resistant patients, while of 30 patients who were failed in treatment, 60% were drug-resistant patients.. Retreatment sensitive （92.0%） patients had approximate success rate of one-year treatment with new sensitive patients （93.1% ）, but retreatment drug-resistant patients had much lower success rate of treatment than drug-resistant new patients. Conclusion The performance of treatment and management of TB cases in Shanghai has achieved satisfied effect. Drug resistance is an important factor leading to the failure of the treatment and great efforts should be made to improve the treatment of drug resistant patients. There is big different between drug resistant patient and sensitive patient in the treatment outcome and further evaluation needed to be conducted.