耐多药肺结核患者565例治疗管理效果分析

The Management Effect of MDR-TB Treatment in 565 patients

目的通过对四川省2009-2014年6年间发现的耐多药肺结核患者的治疗和管理效果分析,探索适合四川省的耐多药结核病治疗管理策略,提高耐多药结核病患者治疗成功率。方法收集四川省6年间耐多药结核病监测季报表、年报表及全球基金结核病项目数据库,进行回顾性分析研究。结果 6年间四川省共确诊565例耐多药肺结核患者,纳入治疗412例(72.92%),新患者中MDR-TB患者纳入治疗的比例高于复治患者,91.26%的患者采用标准化治疗方案治疗,6月末培养阴转率79.95%,12月末培养阴转率63.28%,治疗成功率28%,新患者治疗成功率高于复治患者,差别有统计学意义(χ2=60.25,P<0.05);标准化治疗患者治疗成功率高于个体化治疗患者,差别有统计学意义(χ2=4.72,P<0.05)。治疗失败的原因中不良反应导致的失败占比例最大。未纳入治疗患者中拒治患者比例最高。结论四川省耐多药结核病患者纳入治疗率、6月末及12月末培养阴转率均较高,但治疗成功率较低,应加强MDR-TB患者第二年疗程的治疗管理。新患者中MDR-TB患者纳入治疗率和治疗成功率均高于复治患者,在新患者中开展MDR-TB筛查有一定意义。在制定MDR-TB患者治疗时应优先采用标准化治疗方案。

Objective To analyze the treatment and management of multidrug-resistant tuberculosis（ MDR-TB） patients during 2009-2014 in Sichuan province,explore the appropriate treatment strategy and improve the success rate of the treatment for MDR-TB. Methods Based on the MDR-TB prevention quarterly reports,annual reports and the Global Fund TB Project database,the data were retrospectively analyzed from2009 to 2014 in Sichuan Province. Results There were 565 MDR-TB cases were diagnosed and 412 cases（ 72. 92%） were included in the treatment cohort in Sichuan. The treatment proportion of patients in new MDR-TB was higher than that of patients in re-treatment,91. 26% of patients treated with standard therapy,the negative conversion rate at the end of 6 months was 79. 95%,the negative conversion rate at the end of the 12 months training was 63. 28 % and the success rate of treatment was 28%. The success rate of the new treatment was significant higher than re-treatment,（ χ2= 62. 25,P〈0. 05）; the success rate of standardized treatment was significant higher than individual treatment（ χ2=4. 72,P〈0. 05）. Adverse reactions were the main reason for treatment failure; treatment refusing was the main rea son for none-treatment. Conclusion The treatment proportion,the negative conversion rate at the end of 6months and 12 months in MDR-TB were high,but the success rate of treatment was low. Thus the management of treatment should be strengthened in second course. According to the high rate of treatment including and success in new treatment,it was important to screen the MDR-TB in new treatment. And the standard therapy should be the primary treatment for MDR-TB.