86例复治涂阳肺结核患者的耐药分析

Analysis of drug resistance among 86 patients with retreated pulmonary tuberculosis

目的探讨复治涂阳肺结核患者对抗结核药物的耐药特点。方法回顾性分析86例复治涂阳肺结核患者的单耐药、多耐药及耐多药的情况及治疗转阴率和不良反应。结果所有患者中,任何形式耐药占100%,多耐药占91.9%,耐多药占65.1%,一线药物耐药顺位为H>R>S>E,二线药物以对左氧氟沙星耐药的比例最高,占37.21%;3个月后痰菌转阴率仅为60.46%,复治病例中耐药比例最高的人群为40～60岁的中老年人,占68.96%;不良反应主要为过敏反应(54.65%)和肝功能异常(8.14%)。结论复治涂阳的肺结核耐药率高,且以中老年人为主,应当重视结核患者耐药性的检测及用药的规律性、足量性。

Objective To investigate the features of drug resistance in the patients with retreated pulmonary tuberculosis. Methods Single drug resistance, Poly-drug resistance, and multidrug resistance, treatment rate and adverse reactions in 86 patients were analyzed retrospectively. Results 100% patients showed resistance to any drug. 91.9% patients were poly-drug resistance and 65.1% patients were multidrug resistant. The sequence of the first-line anti-tuberculosis drug usage was HR SE. Levofloxacin had highest resistance （37.21%） in the second line drugs. The negative conversion rate of phlegm germ was 60.46% after treatment for 3 months. The 40～60 year old patients had highest rate of resistance to drugs （68.96%）. The mainly adverse reactions were allergy （54.65%） and abnormal liver function （8.14%）. Conclusion The patients with retreated pulmonary tuberculosis had higher rate of drug resistance, especially the old patients. We should pay more attention to TB culture and drug sensitivity test, and choose treatment according to the test results.