161例耐多药肺结核治疗随访结果

Follow-up on treatment outcome in 161 cases with multi-drug resistant pulmonary tuberculosis

目的探讨MDR-TB治疗效果及影响预后的因素。方法选择2006—2008年痰液经BACTECMGIT 960系统快速培养为结核分枝杆菌生长并同时耐异烟肼和利福平的MDR-TB住院患者161例,记录人口学资料、年龄分组、抗结核药物使用种类及使用时间、主要并存病及并发症、肺部病灶影像学改变等临床资料和药敏试验结果及随访结果。通过logstic多因素回归分析治疗最终结果的影响因素(包括性别、年龄、患者类型、是否使用二线药物、基线耐药种类和肺结核病情)。结果161例MDR-TB患者中男性116例,女性45例(年龄15～87岁)。161例MDR-TB患者中,曾使用二线药物者108例(67.08%)。肺部病灶程度中度者45例(27.95%),重度者111例(68.94%)。MDR-TB化学治疗方案其中氨基糖苷类注射剂[包括链霉素(部分对链霉素敏感患者)及阿米卡星(95/161)]或多肽类注射剂[主要为卷曲霉素(34/161)]使用率占80.12%(129/161),口服氟喹诺酮类使用率占95.65%(154/161),丙硫异烟胺使用率占72.67%(117/161),对氨基水杨酸异烟肼使用率占81.37%(131/161),吡嗪酰胺使用率占62.11%(100/161)。治疗结果显示:153例患者(失访8例)治愈45例(29.41%,45/153),死亡19例(12.42%,19/153),治疗失败89例。不同年龄组治愈比例为<30岁69.57%(16/23)、30～岁18.75%(15/80)、50～岁31.71%(13/41)、≥70岁11.11%(1/9)。是否使用二线药物、肺结核病情及年龄对MDR-TB治疗成败,差异有统计学意义(χ2=11.013,P<0.05;χ2=14.417,P<0.05;χ2=14.969,P<0.05)。结论年龄、是否使用二线药物以及肺结核病情对MDR-TB患者治疗成败有影响;MDR-TB治愈率低,死亡率高,应积极研发作用强、毒性低的新一代抗结核药物,控制耐药结核病的发展和蔓延。

Objective To evaluate the efficacy and risk factors of prognosis in multidrug-resistant tuberculosis（MDR-TB）.Methods One hundred and sixty-one patients conformed with MDR-TB,simultaneous resistance of isoniazid（INH）and rifampin（RFP） detected by BACTEC mycobacteria growth indicator tube（MGIT）960 culture system,received individualized protocol during hospitalization in Shanghai Pulmonary Hospital from 2006 to 2008.Data included demography,age,kinds and duration of anti-tuberculosis drugs,and main complications,radiogrphy,the results of drug susceptibility test and follow-up.The risk factors were analyzed with Logistic regression by SPSS 15.0 software.Results The patients with MDR-TB included 116 males and 45 females（age ranged from 15 to 87 years old）.67.08% of patients had a previous history of treatment with the second-line drugs.68.94% cases were classified as advanced disease according to the pulmonary lesions before treament.Patients received anti-tuberculosis drugs including aminoglycoside antibiotics injection（59.0%,95/161）,polypeptide injection（80.12%,129/161）,oral fluroquinolone（95.65%,154/161）,prothionamide（72.67%,117/161）,isoniazid combined with para-amino salicylic acid（81.37%,131/161）,and pyrazinamide（62.11%,100/161）.153 patients were available for evaluation,29.41%（45/153）of patients were cured,12.42%（19/153） died,and 58.17%（89/153） failed.Of 45 cured patients,there were 69.57%（16/23）in 〈30 years old,18.75%（15/80） from 30 to 50 years old,31.71%（13/41） from 50 to 70 years old,11.11%（1/9） in ≥70 years.The risk factors of failure included the previous second-line drugs treatment（χ2=11.013,P〈0.05）,advanced pulmonary lesions（χ2=14.417,P〈0.05） and age（χ2=14.969,P〈0.05）.Conclusion Age,the second-line drugs using or not and disease situation are risk factors of treatment outcome.In order to imporve the lower successful rate and high mortality and contorl tuberculosis,new anti-tuberculosis drugs with good efficacy and low toxicity should be developed.