异烟肼和利福平治疗方案对单耐异烟肼或利福平肺结核患者的治疗效果

The therapeutic effect of regimens containing isoniazid and rifampicin for pulmonary tuberculosis with single isoniazid or rifampicin resistance

目的 探讨采用含异烟肼和利福平治疗方案对单耐异烟肼或利福平肺结核患者的治疗效果.方法 收集2009年1月至2012年12月在广州市胸科医院治疗的异烟肼或利福平耐药的肺结核患者80例,采用异烟肼（H）、利福平（R）、吡嗪酰胺（Z）及乙胺丁醇（E）治疗2个月后痰菌仍阳性者的细菌耐药性进行回顾性分析.根据患者治疗前对异烟肼和利福平的耐药情况分为敏感组、单耐药组（异烟肼或利福平）和耐多药组（异烟肼和利福平均耐药）.80例中男57例,女23例;年龄16～ 80岁,平均45岁;初治29例,复治51例.按治疗前对异烟肼和利福平是否敏感分为：（1）敏感组：37例,其中初治肺结核18例,复治肺结核19例;（2）单耐药组：15例,其中初治肺结核3例,复治肺结核12例;（3）耐多药组：28例,其中初治肺结核8例,复治肺结核20例.结果 采用含异烟肼和利福平方案治疗后敏感组转为耐多药肺结核者2例,单耐药组8例,二者比较差异有统计学意义（x2=12.849,P=0.000）;其中单耐异烟肼和利福平的患者治疗后转为耐多药肺结核的患者分别为6例和2例（RR=18.0,P＜0.05）,单耐异烟肼较单耐利福平更易发展为耐多药结核.结论 异烟肼或利福平单耐药患者中复治肺结核多见,采用含异烟肼和利福平方案治疗较易转变为耐多药结核病.临床上对复治肺结核患者应尽早进行异烟肼和利福平耐药检测,尽快采用针对异烟肼或利福平耐药的治疗方案.

Objective To study regimens containing isoniazid and rifampicin for the treatment of pulmonary tuberculosis with isoniazid or rifampicin resistance.Methods Eighty patients with isoniazid or rifampicin resistance,and whose sputum were still positive at the end of 2-month therapy with isoniazid （H）,rifampicin （R）,pyrazineamide （Z） and ethambutol （E）,were retrospectively analyzed from Jan.2009 to Dec.2012 in Guangzhou Chest Hospital According to the Mycobacterium drug sensitive test （DST） before the treatment with isoniazid and rifampicin,the patients were divided into the sensitive group （either H or R sensitive）,the multidrug-resistance group （both H and R resistance） and the single-resistance group （H or R resistance）.There were 80 patients（57 females,23 males） whose sputum was still positive at the end of 2 month treatment.Their ages ranged from 16-80 （average 45） years.Among them,29 received the firsttreatment,while 51 received retreatment.There were 37 cases in the sensitive group,with 18 first-treatment patients and 19 retreatment patients.There were 15 cases in the single-resistance group,with 3 first-treatment patients and 12 retreatment patients.There were 28 cases in the multidrug-resistance group,with 8 firsttreatment patients and 20 rctreatment patients.Results After treatment,mycobacterial conversion to MDRTB occurred in 2 patients in the sensitive group,and in 6 patients in the single-resistance group.The rate of conversion to MDR-TB was higher in the single-resistance group than that in the sensitive group （x2 =12.849,P =0.000）.Six patients with single H resistance converted to MDR-TB and 2 patients with single R resistance converted to MDR-TB （P 〈 0.05,RR =18.0）.Conclusions Single H or R drug-resistance was more common in retreated patients with pulmonary tuberculosis.If regimens containing isoniazid and rifampicin was used to treat patients with single H or R drug-resistance,resistant enlarging effect may appear and lead to MDR-TB.The retreated patients should be monitored as soon as possible for detection of Mycobacterium resistance to H and R,and regimens for H or R-resistance should be used to prevent resistant enlarging effect.