复治涂阳肺结核病例治疗失败原因分析

Analysis on reasons for ineffective treatment of retreated smear-positive tuberculosis

目的分析复治涂阳肺结核病例标准化疗方案治疗失败的原因,为提高复治肺结核患者的疗效提供参考。方法选取复治涂阳肺结核患者435例,采用标准化疗方案进行治疗,定期进行涂片检查、分离培养及药物敏感性测定,获得治愈和失败患者耐药等信息。结果 435例复治涂阳病例治疗失败93例(21.38%),失败病例结核病知识知晓率低于治愈病例(P<0.01),本次治疗前自以为治愈而停止治疗的病例再治疗的失败率(55.56%)高于其他病例(P<0.01),既往治疗持续时间≥8个月的失败率(47.17%)明显高于治疗<8个月者的病例(P<0.01),治疗中出现漏服药患者的失败率高于规律用药者(P<0.01);治愈病例登记时的单一耐药率、多耐药率、耐多药率均低于失败病例(P<0.01),耐多药病例(MDR-TB)的治疗失败率高于非耐多药病例(P<0.01)。结论复治涂阳病例结核病知识知晓率低、对自身疾病认识不足、既往治疗持续时间≥8个月、治疗中出现漏服药、患者对抗结核药物耐药等原因导致治疗失败。

Objective To analyze the reason for ineffective treatment of standard chemotherapy of retreated smear posiitve tuberculosis （ TB）, and provide reference for improving the effect of retreated smear positve TB. Methods Collect 435 patients and conduct standard chemotherapy, do smear examination, isolation culture and drug susceptibility test regularly, and obtain resistance information of patients. Results 93 cases were failed among the 435 patients. The awareness rate of TB knowledge of failed cases was lower than that of cured patients （P 〈 0. 01 ） . The failure rate （55.56%） of retreated patients who stopped treating after recovery was higher than that of other cases （P 〈0. 01 ） . The failure rate （47. 17% ） of patient treating for more than 8 months was obviously higher than those patients treating for less than 8 months （ P 〈 0. 01 ） . The failure rate of patients missing to take drugs was higher than that of patients taking drugs properly （ P 〈 0. 01 ） . The resistance to drugs of cured patients was lower than that of failed cases （P 〈0. 01 ） . The failure rate of MDR TB patients was higher than that of non MDR patients （P 〈 0. 01 ） . Conclusions The reasons for ineffec tive reatment were low awearness rate of TB knowledge, lacking of knowing of disease, treating for more than 8 months, missing to take drugs, resistance to antituberculosis drugs and others.