影响新发涂阳肺结核治疗失败的常见因素分析

Factors influencing the treatment outcome of failure in new smear positive pulmonary tuberculosis patients

目的通过对广州市2003-2007年新发涂阳肺结核治疗病例的分析,找出治疗失败常见因素,为防痨医生治疗患者提供经验借鉴,达到提高治愈率,降低疫情的目的。方法将2003-2007年登记的广州市户籍的新发涂阳肺结核病人的病历资料、服药查痰资料填写统一的《结核病人登记管理卡》,并录入电脑统计。结果 45岁以下患者治疗失败率达4.32%;离退休患者失败率为7.39%,自由职业为6.63%;症状数量5种以上和6个肺野病变的失败率分别为3.80%、5.56%;合并肺外结核、糖尿病、空洞的失败率分别为6.20%、10.69%、4.18%;发现延迟120d的失败率为4.88%;满疗程失败率为2.37%,不满疗程的失败率为10.28%,其中在满疗程规则治疗的失败率为2.31%,不规则治疗的失败率为5.03%;采用2H3R3Z3S3/4H3R3方案和自由组合的其他方案失败率分别为5.48%、5.26%,采用2H3R3Z3E3/4H3R3方案的失败率为0.89%。结论影响新发涂阳肺结核治疗失败的常见因素有很多,除性别外,年龄、职业、症状数量、病变肺野数量、有无空洞、是否合并肺外结核、糖尿病、发现治疗延迟时间、是否全程规则服药、化疗方案是否合理等因素均与治疗失败有关。

Objective To analyze factors influencing the treatment outcome of failure in new smear positive pulmonary tuberculosis patients.Methods The data of treatment history and outcomes were collected for new smear positive TB patients in Guangzhou from 2003 to 2007.We analyzed the factors associated with treatment failure.Results We confirmed 14 233 cases of new smear positive pulmonary tuberculosis patients in the five years and among which,439（3.08%） cases were treatment failure.The treatment failure rate increased significantly in new smear positive pulmonary tuberculosis patients aged over 45 years（4.32%）,especially in those retired patients（7.39%）.The high rate of treatment failure was also observed in the occupation of self-employed professionals（6.63%）.The rates of treatment failure were 3.80%,5.56%,6.20%,10.69% and 4.18% respectively for patients with more than 5 typical clinical symptoms,6 fields of lung lesions,extra-pulmonary tuberculosis,diabetes and empty holes in lung tissue.The failure rate of full course treatment was 2.37%.However,the rates of treatment failure were 10.28% and 5.03% for patients with incomplete and irregular courses of treatment,respectively.The failure rates of medication were 5.48%,0.89% and 5.26% for 2H3R3Z3S3/4H3R3,2H3R3Z3E3/4H3R3 and other drug combinations.Conclusion The treatment failure of new smear positive pulmonary tuberculosis is associated with sex,age,occupation,severity of the disease,physical condition and adherence to medication.Early diagnosis and complete medication are critical in improving treatment efficacy for new pulmonary tuberculosis patients.