78例耐多药肺结核全程督导化疗疗效分析

The full supervision of chemotherapy for 78 cases of multidrug-resistant tuberculosis

目的通过全程督导在耐多药肺结核治疗中化疗的疗效,探讨更快捷有效治愈慢性耐药结核的治疗方式。方法选取1997年至2007年间大连市结核病医院登记的耐多药结核患者,排除糖尿病、肝肾器质性病变,及免疫系统疾病者,获得观察对象78例。采用门诊治疗全程管理,总疗程不少于22个月。结果慢性MDR第4月痰阴转率与治愈率远低于原始MDR、继发MDR,差异有统计学意义(P<0.05)。原始MDR与继发MDR化疗效果比较差异无统计学意义(P>0.05)。结论采用WHO的耐药指导原则对原发和继发耐多药结核患者开展门诊全程督导化疗,使患者的化疗方案坚持率大大增加,总治愈率达64.3%;对慢性耐多药治愈率仅为33.3%。药物耐受性差、抗结核药物肝功损害和耳毒性损害是影响规律治疗的主要原因。巩固期治疗中的阴转阳病例失败的机会大大增加,主要原因可能是难以保证患者规律治疗。开展慢性耐多药结核的特异性治疗是提高其治愈率的根本途径。

Objective To explore more effective cures for chronic drug-resistant tuberculosis（TB） treatment according to the reference of full supervision in multidrug-resistant tuberculosis chemotherapy.Methods 78 cases of multi-drug resistant TB was selected in 1997 to 2007 registration,excluding diabetes,liver and kidney of organic disease and immune system diseases.The outpatients were treated with whole management,and the course was not less than 22 months.Results The results of the fourth month of the chronic MDR sputum negative conversion rate and cure rate was far lower than the original of MDR and secondary of MDR（P0.05）.There was no significant difference of chemotherapy effects between original MDR and secondary MDR（P0.05）.Conclusion The patients＇ chemotherapy rates increased by carrying out outpatient full supervision of chemotherapy in the guidence of WHO for primary and secondary MDR-TB,the total cure rate is 64.3% and the chronic multidrug-resistant cured rate is 33.3%.Poor drug tolerance,anti-TB drugs of liver damage and ototoxic damage are the main reasons effects treatment.The failure chance of negative turning into positive cases has increased in consolidate period treatment,Perhaps the main cause is difficult to ensure patient receive regular treatment.Carrying out specific treatment of chronic multidrug resistance tuberculosis is the basic way to improve the cure rate.