115例结核性毁损肺的耐药分析及临床特点

An analysis on drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung

目的分析结核性毁损肺耐药情况及临床特征,为耐药肺结核的诊断与治疗提供依据。方法对2005年5月至2011年5月住院的结核性毁损肺患者115例的耐药分型、耐药的分布、病变部位情况、结核性毁损肺病程与耐药关系、耐药结核性毁损肺是否规律治疗情况、及肺内临床表现与耐药关系进行分析。并对结核性毁损肺耐药的60例患者,分为病程>5年、1年<病程≤5年和病程≤1年的3组,对病程与耐药情况进行进一步分析统计。应用SPSS 13.0软件进行统计分析。结果 115例结核性毁损肺中,耐药60例,非耐药55例。结核性毁损肺耐药率为52.2%。在60例耐药的结核性毁损肺中,单耐药3例,占5.0%;多耐药15例,占25.0%;耐多药(MDR-TB)29例,占48.3%;广泛耐药(XDR-TB)13例,占21.7%。单耐药、多耐药、耐多药、广泛耐药比较,耐多药易发生毁损肺,差异有统计学意义(χ2=22.933,P<0.001)。在60例耐药患者中,抗结核药物中最易发生耐药的是利福喷丁(Rft),占90.0%(54/60),其余依次为RFP(占86.7%,52/60)、INH(占71.7%,43/60)、S(占68.3%,41/60)、Lfx(占53.3%,32/60)、丙硫异烟胺(Pto)(占40.0%,24/60),其中卷曲霉素(Cm)和Ofx耐药最低[占10.0%(6/60)和13.3%(8/60)]。60例耐药患者病程与耐药关系:病程≤1年与其他比较易发生耐药,病程>5年(4例)、1年<病程≤5年(14例)和病程≤1年(42例)。3组相比较差异有统计学意义(χ2=38.800,P<0.001),耐药肺结核可能在短时间内(1年内)发生毁损肺,治疗耐药肺结核的关键是第一年。结核性毁损肺耐药患者,不规律治疗易发生耐药规律治疗17例(28.3%),不规律治疗43例(71.7%),差异有统计学意义(χ2=11.267,P<0.05)。结论结核性毁损肺耐药情况较为严重,耐药患者以耐多药多见,结核性毁损肺耐药的患者耐药率高与毁损肺本身是互为因果、相辅相成的。

Objective To analyze the drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung and provide the evidence for diagnosis and treatment for drug-resistant tuberculosis.Methods 115 tuberculosis cases hospitalized with collapsed lung were enrolled from May 2005 to May 2011 and we analyzed the relationship between drug-resistance with types of drug-resistance,distribution,lesions status,duration,and relationship between drug-resistance with treatment of drug-resistant tuberculosis and lung lesions.And according to the duration of three types of longer than 5 years,shorter than or equal to 5 years,shorter than of equal to 1 year,60 cases with drug-resistance tuberculosis collapsed lung were analyzed the relationship between duration and drug-resistance.Results Among 115 cases with collapsed lung,60（52.2%） cases were drug-resistant,55 were not.Of the 60 cases with drug-resistant collapsed lung,3（5.0%） cases had single drug resistance,15（25.0%） cases had polydrug resistance,29（48.3%） had multidrug resistance（MDR）,13（21.7%） cases had extensively drug resistance（XDR）.Compared with the status of single drug-resistance,polydrug resistance,MDR and XDR,the cases with MDR were prone to develop collapsed lung（χ2=22.933,P0.001）.Of the 60 cases with drug-resistance,the rates of resistance to anti-tuberculosis drugs were Rifapentine（90.0%,54/60）,Rifampin（86.7%,52/60）,isoniazid（71.67%,43/60）,streptomycin（68.3%,41/60）,Levofloxacin（53.3%,32/60）,Protionamide（40.0%,24/60）,Ofloxacin（13.3%,8/60）,capreomycin（10.0%,6/60）,in which Rifapentine were highest and Ofloxacin and capreomycin were lower.Of the 60 cases with drug-resistance,cases with duration shorter or equal to 1 year were prone to develop drug-resistance,compared with the other two types of duration（χ2=38.800,P0.001）.Of the cases who showed drug-resistance collapsed lung,the rate of drug-resistance was higher in those whose treatment was irregular than those who received regular treatment,with 43cases（71.7%）and 17 cases（28.3%）,respectively（χ2=11.267,P0.05）.The cases with multidrug resistance without regular treatment were prone to develop collapsed lung.Conclusion The situation of drug-resistance to tuberculosis collapsed lung is very serious,especially for multidrug resistance.It would be better to master the first-year which is the key time for treatment drug resistant tuberculosis to decrease the development of collapsed lung.The high rate of drug resistance of collapsed lung and itself is a reciprocal causation.