3HRZ(E)S/6HR方案对原发耐药肺结核疗效观察

Observation on therapeutic effect of 3HRZ(E)S/6HR for the treatment of pulmonary tuberculosis with primary resistance

目的探讨3HRZS/6HR方案对原发耐药肺结核病人治疗的临床疗效。方法选择初治菌阳肺结核562例,根据治疗前药物敏感试验结果分成观察组Ⅰ101例,对单个药物耐药、观察组Ⅱ45例,对两个或以上药物耐药,对照组416例,全部敏感。采取3HRZ(E)S/6HR方案抗结核治疗,分别观察各组患者治疗后临床症状好转率、病灶吸收好转率和痰菌阴转率。结果原发耐药率26.0%。观察组Ⅰ和对照组治疗结果相近,差异无统计学意义,疗程末,临床症状好转率均>95%,病灶吸收好转率>99%,痰菌阴转率>97%,而观察组Ⅱ分别是71.1%、77.8%、73.3%,差异有统计学意义(P<0.05)。三组均无严重不良反应发生。结论原发耐两个或以上药物的肺结核应用3HRZS/6HR方案,疗效不够理想,有待合理方案治疗。原发耐单药与全敏感组应用3HRZS/6HR方案治疗是合理、安全的。要重视化疗管理,减少耐药病例发生。

Objective To observe the clinical therapeutic effect of 3HRZ（E）S/6HR on primary resistant tuberculosis.Methods All cases chosen were in a randomized way,whose sputum positive tuberculosis of initial treatment,were divided into the study groupⅠ（n=101,the primarily resistant drug was only one kind drug）,study groupⅡ（n=45,the primarily resistant drugs were two or more kind drugs）and control group（n=416,all sensitive）by drug sensitivity test.The treatment measures were 3HRZS/6HR.Results The rate of primary resistance in all was 26.0%.When the treatment was completed,the clinical symptom improvement rate,focus absorptivity rate and negative conversion rate in the study groupⅠwere similar to the control group,and the symptom improvement rate was95%,focus absorptivity rate was99%,negative conversion rate was97%,but the study groupⅡwere all worse than in the study groupⅠand control group（P〈0.05）,and the symptom improvement rate,focus absorptivity rate,negative conversion rate was 71.1%,77.8%and 73.3%.No obvious severe adverse effects were found in the three groups.Conclusion 3HRZS/6HR is not effective to the primary resistant tuberculosis with two or more kind drugs,but is possibly effective to the primary resistant tuberculosis with less than two kind drugs.More attention should be made to the management of chemotherapy,in order to reduce the level of drug-resistance.