汕头市两种耐多药结核病治疗管理模式实施效果分析

Effect of implementation of two models for treatment and management of multi- drug resistant tuberculosis in Shantou City

目的 分析汕头市实施全球基金耐多药结核病项目（简称“项目”）的阶段性效果,探讨汕头市耐多药结核病控制模式,为今后耐多药结核病控制工作提供科学依据。方法 收集2009年4月~2011年6月“项目”执行期间筛查出的耐多药结核病患者资料,按是否纳入项目管理分为项目组与非项目组,比较分析项目组与非项目组耐多药结核患者防治情况。结果 2009年4月~2011年6月汕头市共筛查符合筛查条件的结核病人1 264例,筛查出耐多药患者178例,失联系9例,20例病情复杂不纳入项目,符合纳入“项目”条件的患者有149例,93例患者纳入项目治疗,非项目对照组56例,对项目组采取以项目标准方案治疗为主的耐药肺结核管理策略（PMDRT）、对非项目组采用个体化化疗方案进行治疗管理,两组开始治疗时间均为2009年7月,疗程24个月,考核两组患者治疗后各项指标：项目组6月末痰培养阴转率为58.0%（54/93）,明显高于非项目组的41.1%（23/56）（χ2=4.04,P〈0.05）;项目组治愈率为52.7%（49/93）,明显高于非项目组的35.7%（20/56）（χ2=4.05,P〈0.05）;项目组治疗成功率69.9%（65/93）也明显高于非项目组的53.6%（30/56）（χ2=4.03,P〈0.05）。结论 汕头市实施全球基金耐多药结核病项目患者6月末痰菌阴转率、治愈率和治疗成功率均较非项目组有显著提高,以地（市）为中心开展耐多药结核病治疗管理的模式、标准化治疗方案为主的治疗策略是可行的,与结核病定点医院的协作需要进一步加强。

Objective To assess the results of multi-drug resistant tuberculosis control program implemented in Shantou city supported with Global Fund, to analyze tuberculosis control model in Shantou city and offer reference for formulating multiple drug-resistant tuberculosis. Methods The data of multiple drug resistant tuberculosis cases screened during implementation of tuberculosis control program supported with Global Fund from April 2009 to June 2011 were collected and divided into program group and non-program group based upon the condition of the cases covered by the program and those not included in the program.The effect in both groups were analyzed. Results During the program period 1 264 tuberculosis cases and 178 nulti-drug resistant tuberculosis cases were screened in Shantou city, 9 cases lost follow-up and 20 cases with complicated illness were excluded from the program. Finally 149 cases met the criteria and divided into program group consisted of 93 cases treated with standard program management strategy （ PMDRT ）and the control group occupied 56 cases treatment with individualized management scheme both for a course of 24 months. The sputum negative conversion rate in the program group six months after treatment was 58.0%（54/93）significantly higher than that of 41.1%（23/56）in the control group（χ2=4.04, P〈0.05）. The cure rate in the program group was 52.7%（49/93）also significantly higher than that of 35.7%（20/56）in the control group;（χ2=4.05, P〈0.05）. The successful rate in the program group was 69.9%（65/93）higher than that of 53.6%（30/56）in the control group（χ2=4.03,P〈0.05）. Conclusion The six month sputum negative conversion rate, cure rate and success rate of of multiple drug-resistant tuberculosis control program implemented in Shantou city have been significantly enhanced .The multiple drug resistant tuberculosis control pattern and standard treatment scheme are practicable in Shantou city. Besides the collaboration with designated hospital for management of tuberculosis cases be further strengthened.