复治涂阳肺结核患者化疗后2个月末痰涂片阴转与未阴转情况分析

Analysis of sputum conversion after two months treatment in retreated smear-positive pulmonary tuberculosis patients

目的分析2011—2012年复治涂阳肺结核患者强化期2个月末痰涂片检查的阴转情况,探讨当前影响复治涂阳肺结核阴转的相关因素及对转归的影响。方法对广州市胸科医院第二门诊辖区内登记的复治涂阳肺结核患者131例化疗后2个月末的痰进行2次抗酸染色和镜检,痰培养阳性的标本采用绝对浓度间接法进行耐药性测定。同时分析可能对痰阴转产生影响的各种因素。结果 131例患者中化疗后2个月末未查痰涂片者13例,查后发现阴转者91例,未阴转者27例;后者3个月末阴转者15例,4个月末阴转者6例,5个月末阴转者6例。通过研究5个大变量因素,发现造成复治涂阳肺结核患者2个月末痰未能阴转的主要原因在于是否多耐药[阴转患者5.3%(3/57),未阴转患者10.0%(2/20);χ2=4.457,P<0.05]或者耐多药[阴转患者28.1%(16/57),未阴转患者70.0%(14/20);χ2=5.456,P<0.05]、是否合并糖尿病[阴转患者12.1%(11/91),未阴转患者25.9%(7/27);χ2=3.973,P<0.05]。结论耐药或合并糖尿病是影响复治涂阳肺结核患者2个月末痰涂片阴转的关键因素。

Objective To investigate the situation of the sputum conversion after two months treatment of retreated smear-positive pulmonary tuberculosis patients registered in 2011—2012, and to explore the influencing factor and their effects on treatment outcome. Methods Acid-fast staining and microscopic examination were performed twice on 131 retreated smear positive tuberculosis patients registered in the Second Outpatient Department of Guangzhou Thoracic Hospital. Absolute concentration method was used on the culture positive samples for drug resistance test and related factors on sputum conversion were also investigated. Results Among the 131 retreated patients, 91 showed sputum conversion, and 27 showed non-conversion after 2 months of treatment （sputum examinations were not performed on 13 of the patients due to their unavailability of the patients）. There were 15, 6, and 6 patients showed sputum conversion after 3 months, 4 months, and 5 months treatment respectively. After analyzing 5 variable factors, we found that the main reasons for non-conversion after 2 months treatment in retreatment smear-positive pulmonary tuberculosis were poly resistance （5.3%,3/57） for patients with sputum conversion and 10.0% （2/20） for non-conversion patients） （χ2=4.457, P〈0.05） or multidrug-resistance （28.1%,16/57） for patients with sputum conversion and 70.0% （14/20） for non-conversion patients） （χ2=5.456, P〈0.05）, or with diabetes mellitus （12.1%,11/91） for patients with sputum conversion and 25.9% （7/27） for non-conversion patients） （χ2=3.973, P〈0.05）. Conclusion sputum non-conversion after 2 months treatment is found to be closely related to drug resistance or with diabetes mellitus.