不同时期住院肺结核患者初始耐药调查分析

Analysis on Primary Drug Resistant Rate in Hospitalized Patients with Pulmonary Tuberculosis in Different Periods

目的分析不同时期住院肺结核患者初始耐药的发生情况，为临床初治肺结核患者制订合理化疗方案提供依据。方法回顾分析北京市结核病胸部肿瘤研究所1986年～1988年（设为Ⅰ组）及2004年～2005年（设为Ⅱ组）住院的初治肺结核患者初始耐药情况。结果①初始耐药率：Ⅰ组患者为27．2％（25／92），Ⅱ组为39．6％（65／164），2组经统计学处理差异有统计学意义（x^2=4．00，JP：0．045）；②初始耐多药率：Ⅰ组患者为1．1％（1／92），Ⅰ／组为15．9％（26／164），2组经统计学处理差异有统计学意义（x^2=13．57，P=0．00023）。结论住院肺结核患者初始耐药、耐多药呈上升趋势，提示临床医生针对初冶患者也应行结核菌培养及药敏检查，及时发现初始耐药尤其是耐多药患者，选用敏感药物制订个体化初治方案，以减少延误，及早治愈患者。

Objective To provide reasonable evidence of chemotherapy for new patients with pulmonary tuberculosis based on analyzing the prevalence of primary drug - resistant patients hospitalized in different periods. Methods We divided patients hospitalized in different period into two groups： patients in group Ⅰ were hospitalized from 1986 to 1988, and patients in group Ⅱ hospitalized from 2004 to 2005. Primary drug resistance data was analyzed retrospectively in these patients. Results ① Primary drug resistant rate： the rate of primary drug resistance were 27.2% （25/92） in group Ⅰ and 39.6 %（65/164） in group Ⅱ. There was significant statistical difference on the rate of primary drug resistance （ x^ 2 = 4.00, P = 0.045）.② Primary multi-drug resistant rate ： the rate of primary multi-drug resistance were 1.1% （1/92） in group Ⅰ and 15.9% （26/164） in group Ⅱ. There was significant statistical difference on the frequency of primary multi-drug resistance （ x^2 = 13.57, P = 0.000 23）. Conclusion The rate of primary drug resistant and MDR-TB among hospitalized patients showed an increasing trend. It showed that initial patients with pulmonary tuberculosis should be detected by culture and drug susceptible test to identify patients with drug resistant timely and received a reasonable regimen.