新疆克拉玛依市1993—2004年登记复治涂阳病例成因分析

The cause analysis of retreated smear-positive cases with pulmonary tuberculosis in kalamay (1993—2004)

目的了解复治涂阳肺结核病例成因,为减少复治涂阳病例的产生提供预防对策。方法对1993—2004年间登记管理的179例复治涂阳病人资料进行回顾性分析。结果179例复治病人平均年龄为38．1岁,男女性别之比为2．3:1,民汉之比为1．7:1。病变范围在4个肺野及以上者占50．8％。复发病例占病例总数的46．4％,41．9％的病例为初次治疗时不规则治疗超过1个月;初治涂阳失败占3．9％,涂阴治疗期间和结束后转阳的占7．8％。结论复治涂阳病例存在青壮年多、男性多、民族多及病变范围广等特点,多因不规则治疗、化疗方案不合理、原发和继发耐药等原因引起,应采取提高DOTS管理质量、开展痰培养和加强健康教育等措施,减少和切断复治传染源的来源,达到控制结核病的目的。

Objective To study the cause of retreated smear-posistive cases with pulmonary tuberculosis, and to provide the measure of control to reduce retreated smear-posistive cases. Methods The data of 179 retreated smear-positive cases from 1993 to 2004 were analysed retrospectively. Results Of 179 retreated smearpositive cases, their average age was 38.1 years old, the ratio of male to female was 2.3 ： 1, ethnologic ratio was 1.7 ： 1. The ratio of cases whose range of pathological changes included four lung fields was 50.8 %. The retreated cases were 46.4% at the total number of cases, in which 41.9% cases were treated irregularly more than one month at initial treatment, the initial treatment of 3.9% smear-positive cases was failure. 7.8 % smear-negative cases changed into smear-positive cases during the treatment or after the treatment. Conclusion Retreated smear-positive cases were caused by irregular therapy, irrational treatment regimen, drug resistance. We should decrease and cut off epidemical origin, improve the quality of DOTS management, develop the sputum culture, and strength health education to accomplish the aim of tuberculosis control.