116例耐多药肺结核治疗转归情况影响因素分析

Analysis of the factors affecting the treatment outcome of 116 multidrug-resistant pulmonary tuberculosis patients

目的探讨现阶段广州市耐多药肺结核患者化疗效果及相关影响因素。方法采用logistic回归分析法对2003年1月至2007年12月在广州市胸科医院和广州市结核病防治所接受二线抗结核药物个体化治疗的116例耐多药肺结核患者化疗效果的诸多影响因素进行回顾性分析。结果116例耐多药肺结核患者中男性75例,占64.7%;女性41例,占35.3%。年龄在20～84岁之间,平均年龄(44.26±17.57)岁。116例耐多药肺结核患者治愈率55.2%(64/116);失败率25.0%(29/116);因结核病死亡8例,因其他疾病死亡5例,死亡率11.2%(13/116)。多因素logistic回归模型分析结果显示:未规则治疗(OR=13.745;95%CI:3.147～60.034)、化疗方案不合理(OR=9.897;95%CI:2.528～38.747)、肺部空洞性病灶(OR=10.295;95%CI:2.002～52.949)是现阶段广州市耐多药肺结核患者治疗失败和病死的危险因素。结论根据药敏结果和肺部空洞情况制定合理的治疗方案,强化对耐多药肺结核患者治疗督导管理,可以降低耐多药肺结核患者治疗失败率和病死率,控制耐多药肺结核的流行。

Objective To explore the treatment outcome and related influencing factors of multidrug-resis-tant pulmonary tuberculosis（MDR-TB） in Guangzhou.Methods Logistic regression analysis was adopted to analyze the factors affecting the chemotherapeutic results of 116 MDR-TB patients registered in Guangzhou Chest Hospital and Guangzhou Center for TB Control and Prevention from January 2003 to December 2007.Results There were 75 male patients accounting for 64.7% and 41 female patients accounting for 35.3% of 116 patients.The age ranged from 20 to 84 years old and the average age was（44.26±17.57） years old.The cure rate of MDR-TB patients was 55.2%（64/116）and the failure rate was 25.0%（29/116）.Eight patients died of TB and 5 patients died of other diseases,the death rate was 11.2%（13/116）.Multivariate logistic regression analysis showed that irregular treatment（OR=13.745;95%CI：3.147-60.034）,irrational chemotherapy regimens（OR=9.897;95%CI：2.528-38.747） and with lung cavitary lesions（OR=10.295;95%CI：2.002-52.949）were risk factors for treatment failure and death of MDR-TB.Conclusion Based on the drug susceptibility results and the extent of lung cavity,to developing the reasonable treatment regimens and strengthen the treatment supervision of MDR-TB patients could reduce the treatment failure and mortality of MDR-TB and control the epidemic of MDR-TB.