早期广泛耐药肺结核近期临床疗效分析

Analysis of clinical efficacy early extensive drug resistant tuberculosis for 6 months

目的:对早期广泛耐药肺结核病近期临床疗效进行分析,探讨采用标准耐多药结核病方案治疗早期广泛耐药结核病的可行性。方法:回顾性分析2009-2013年在广州市胸科医院治疗的耐多药肺结核126例。根据治疗前喹诺酮类或氨基糖苷类药物的耐药情况分为耐多药结核(MDR-TB)组、早期广泛耐药结核(pre-XDR-TB)组和广泛耐药结核(XDR-TB)组。其中MDR-TB组50例,pre-XDR-TB组52例,XDR-TB组24例。所有患者采用含有阿米卡星(卷曲霉素)、左氧氟沙星(莫西沙星)、丙硫异烟胺、对氨基水杨酸、吡嗪酰胺组成的治疗方案,完成6个月注射期治疗。结果:(1)纳入研究126例中,氨基糖苷类耐药31例(24.6%),喹诺酮类耐药69例(54.8%)。(2)MDR-TB组痰菌阴转率为82.0%,pre-XDR-TB组痰菌阴转率为55.8%,XDR-TB组痰菌阴转率为29.2%(χ2=20.110,P<0.001)。(3)pre-XDR-TB组痰菌阴转率明显低于MDR-TB组(χ2=8.146,P=0.004);pre-XDR-TB组痰菌阴转率较XDR-TB组高(χ2=4.661,P=0.031)。结论:在耐多药结核病中,喹诺酮类药和氨基糖苷类耐药率高,临床治疗时应开展喹诺酮类和氨基糖苷类耐药检测。采用标准耐多药方案治疗,pre-XDR-TB治疗效果较MDR-TB疗效差。

Objective To analyze the clinical efficacy of pre-extensive drug resistant tuberculosis （pre- XDR-TB）, and to explore the feasibility of using the standard multidrug resistant tuberculosis （MDR-TB） therapeutic regimen to treat the patients with pre-MDR-TB. Methods A retrospective analysis was made for 126 cases of the MDR-TB patients who were received the treatment in Guangzhou chest hospital from 2009 to 2013. It was divided into MDR-TB group, pre-XDR-TB group and XDR-TB group according to the drug sensitive test （DST） of quinolone （levofloxacin, moxifloxacin） and aminoglycoside （amikacin）. All patients were treated for 6- months with the standard therapeutic regimen including Am（Cm）, Lfx（Mfx）, Pto, PAS and PZA. Results （ 1 ） There were 126 cases of the MDR-TB patients in the study, 31 cases （24.6%） complicate with aminoglycosidesresistance, 69 cases （54.7%） complicate with quinolone-resistance. （2） The negative rate of MDR-TB group, pre-XDR-TB group and XDR-TB group was 82.0%, 55.8% and 29.2% respectively （χ^2 = 20.110, P 〈 0.001）. （3）The negative rate of pre-XDR-TB group significantly lower than MDR-TB group （χ^2 = 8.146, P = 0.004）. The negative rate of pre-XDR-TB group higher than XDR-TB group （χ^2 = 4.661, P = 0.031）. Conclusions The situation of quinolone and aminoglycoside resistance was high in the patients with MDR-TB. We should carry out the detection of quinolone and aminoglycoside resistance in clinical treatment. The clinical efficacy for the patients with pre-XDR-TB was significantly poorer than the patients with MDR-TB using the standard MDR-TB therapeutic regiment treated.