复发肺结核的耐药状况及化疗效果

Resistance and efficacy of treatment in relapse pulmonary tuberculosis

目的 了解复发肺结核的耐药状况及有关因素 ,评价复发肺结核的化疗效果。方法 分析北京市 1988～ 1997年培养阳性 ,有药物敏感试验结果的 44 8例复发肺结核病例的耐药状况和既往化疗史。所有新登记复发病例在全程监督下采用 2RHZS(E) / 4RHE或 2RHZS(E) / 6RH方案 ,并进行逐年转归的队列分析。结果 44 8例复发病例中耐 1种或以上抗结核药物者 15 3例 (34 2 % ) ,耐H2 0 9%、S 17 6 %、R 11 1%、P 7 8%和E 2 9% ,同时耐RH 6 2 % ,始治规律化疗和不规律化疗患者的耐药率分别为 2 2 3%和 5 5 8% ,耐R率分别为 6 3%和 2 0 8%。复发病例一年转归治愈率为 80 5 %～ 89 6 %。结论 北京市复发肺结核患者耐药率为 34 2 % ,耐药的发生与始治时是否规律用药有关 ,显示耐H和S者最多 。

Objective To investigate the resistant status and factors involved and to evaluate the efficacy of treatment in relapse pulmonary tuberculosis Methods The analysis of history of chemotherapy and resistant status in 448 relapse pulmonary tuberculosis cases with culture positive and susceptibility test was conducted All new registered relapse cases during 1988～1997 in Beijing were treated with regimen of 2RHZS(E)/4RHE or 2RHZS(E)/6RH under fully supervision and prognosis was evaluated with cohort analysis Results Of 448 relapse cases 153 (34 2%) were resistant at least to 1 antituberculosis drug, 20 9% resistant to INH, 17 6% to SM, 11 1% to RFP, 7 8% to PAS, 2 9% to EMB, and 6 2% resistant to both INH and RFP The resistance rates in the cases of compliance and default in initial treatment were 22 3% and 55 8%, respectively, and resistance to RFP were 6 3% and 20 8% respectively The sputum conversion rate in relapse cases during 1988～1997 were 80 5%～89 6% Conclusions The resistant rate in relapse cases in Beijing was 34 1% The higher compliance in the chemotherapy, the lower resistant rate, conversely the higher default the higher resistance The majority of resistant cases were resistant to INH, SM and RFP, and it is important in making a rational regimen