耐多药结核病成因及治疗效果的分析

Analysis on the Occurrence and Treatment Effect of MultidrugresistantTuberculosis

目的比较分析初、复治肺结核患者耐多药状况、治疗效果及影响因素。方法收集整理2009年10月至2014年6月徐州市实施全球基金耐多药结核病项目的筛查和治疗资料,分析初、复治肺结核患者耐多药结核病情况、治疗效果,采用多因素Logistic回归模型分析两组患者耐多药的危险因素和影响治疗转归的因素。结果 3 614例耐多药结核病可疑者中,确诊耐多药结核病患者253例,总耐多药率为7.00%,复治患者耐多药率（22.53%）高于初治患者（2.93%）;≥60岁组为两组耐多药结核病的保护性因素（初治组OR=0.58,95%CI=0.35～0.96,复治组OR=0.32,95%CI=0.22～0.47）,非农民为耐多药结核病的危险因素（初治组OR=2.26,95%CI=1.42～3.59,复治组OR=1.59,95%CI=1.05～2.42）。130例完成治疗周期的耐多药结核病患者治疗成功率为59.23%,初、复治耐多药结核病患者治疗成功率（初治组67.86%、复治组56.86%）（P〉0.05）;有糖尿病合并症（OR=6.75,95%CI=1.23～37.05）、结核病灶双侧分布（OR=19.36,95%CI=2.34～159.81）、12月末痰培养阳性（OR=26.70,95%CI=4.01～177.61）是复治组治疗成功的危险因素;治疗周期长是初、复治组治疗成功的保护性因素（初治组OR=0.09,95%CI=0.02～0.60,复治组OR=0.02,95%CI=0.01～0.10）。结论重点加强对青壮年、城市人群中肺结核患者尤其是复治患者的耐多药筛查,做好复治耐多药结核病患者强化期规范化、个体化药物治疗,积极改善糖尿病等相关病症,是控制耐多药结核病发生和提高治疗成功率的关键措施。

Objective To compare and analyze the status of multidrug-resistant and treatment effect and the influencing factors among the initial treatment pulmonary tuberculosis patients and retreatment patients. Methods The screening and treatment data of multidrug-resistant tuberculosis from Global Fund Project implemented in Xuzhou during October 2009-June 2014 were enrolled. The status of muttidrug-resistant tuberculosis and treatment effectamong the initial treat- ment patients and retreatment patients was analyzed and multivariate logistic regression model was used to determine the risk factors of multidrug-resistant and the factors affecting the treatment outcome. Results A total of 253 of 3 614 sus- pected patients were diagnosed definitely as multidrug-resistant tuberculosis, The overall multidrug-resistant rate was 7.00 %, the multidru g-resistant rate of retreatment patients（22.53 % ）wassignificantly higher than that of the initial treat- ment patients（2.93 % ）. The age（≥ 60 years）was the protective factor of multidrug-resistant tuberculosis in two group（the initial treatment group OR =0.58,95% CI =0.35-0.96,the retreatmentgroup OR =0.32,95% CI =0.22 0.47）. The oc cupation（non-peasant） was the risk factorof multidrug-resistant tuberculosis （the initial treatment group OR --2.26, 95 % CI ： 1.42-3.59, the retreatment group OR = 1.59,95 0% （71 = 1.05-2.42）. The treatment success rate was 59.23 in 130 multidrug-resistant tuberculosispatients complete the treatment cycle. The difference of the treatment success rate had no significance among the initial treatment multidrug-resistanttuberculosis patients and retreatment patients（the initial treatment group 67.86% ,the retreatment group 56.86%）. The combined with diabetes mellitus（ OR = 6.75,95% CI = 1.23-37.05） tuberculosis lesions of bilateral distribution（ OR = 19.36,95 % CI = 2.34-159.81）, the sputum culture posi- tive at the end of 12 th month（ OR =26.70,95% CI =4.01-177.61）might be the risk factors of the treatment success of the retreatment group. The long treatment cycle（the initialtreatment group OR =0.09,95% CI = 0.02 0.60, the retreat- ment group OR =0.02,95% （71 = 0. 01-0.10）might be the protective factor of the treatment success. Conclusion The key measures for the control of multidrug-resistant tuberculosis incidence and improvement of the success rate of treat-ment are to carry out the screeningon key object as the young adults and the urban population especially in the retreatment patients, complete the standardized and individualized drug therapyof retreatment patients in the intensive period, and actively improve diabetes related disorders.