湖南省全球基金耐多药结核病项目患者治疗情况分析

Treatment status of patients of Global Fund MDR-TB Project in Hunan

目的分析湖南省中国全球基金耐多药结核病项目患者治疗情况,为今后耐多药肺结核患者的治疗提供参考依据。方法分析2011年2月1日—2013年12月31日湖南省确诊的耐多药肺结核患者纳入治疗及治疗转归情况。共确诊377例耐多药肺结核患者,285例纳入项目进行标准化方案6Z-Km(Cm)-Lfx-Pto-PAS(Cs)/18Z-Lfx-Pto-PAS(Cs)治疗,纳入率75.6%。结果治疗成功率(治愈+完成治疗)60.7%(173/285);女性治疗成功率(治愈+完成治疗)为69.7%(53/76),死亡患者均为男性共12例,不同性别的治疗成功率间差异无统计学意义(P=0.060)。<20岁年龄组治疗成功率(治愈+完成治疗)最高为73.3%(11/15);≥60岁年龄组治疗成功率最低为44.4%(4/9),各年龄组治疗成功率间差异有统计学意义(Z=-3.007,P=0.003)。不同登记分类中,初治失败者治疗成功率最高为81.8%(18/22),复治失败者治疗成功率较低为53.9%(89/165),不同登记类别患者治疗成功率间差异有统计学意义(Fisher确切概率法P=0.018)。新患者治疗成功率为72.4%(21/29),既往使用过一线抗结核药患者治疗成功率为71.1%(108/152),既往使用过一线+二线抗结核药患者治疗成功率为42.3%(44/104),不同用药史患者治疗成功率差异间有统计学意义(P<0.001)。结论在目前实验室开展二线药敏试验能力和资源有限的条件下,对于同一类别的所有患者使用同一治疗方案的标准化治疗策略是可行的。

Objective To understand the treatment status of patients of Global Fund Multi-Drug Resistant Tuberculosis（MDR-TB） Project in Hunan Province,so as to provide the evidence for improving the treatment of MDR-TB patients in thefuture. Methods The status of the treatment of MDR-TB patients and treatment results were analyzed. There were 377 MDR-TB patients diagnosed in Hunan Province from February 1,2011 to December 31,2013,and 285 MDR-TB patients wererecruited in the project of standardized regimen treatment 6Z-Km（Cm）-Lfx-Pto-PAS（Cs）/18Z-Lfx-Pto-PAS（Cs）,with arecruiting rate of 75.6%. Results The treatment successful rate（cure ＋ completed） was 60.7%（173/285）,and the treatmentsuccessful rate in the women was 69.7%（53/76）. Twelve death patients were male. There was no significant difference betweenthe genders in the treatment successful rate（P=0.060）. The treatment successful rate was highest in the 20 years age group（73.3%,11/15） and the rate was lowest in the ≥60 years age group（44.4%,4/9）,and there was a significant difference amongdifferent age groups（Z=-3.007,P=0.003）. The treatment successful rate was 81.8%（18/22） in the initial treatment failuregroup,and the rate was 53.9%（89/165） in the retreatment failure group,and there was a significant difference between them（Fisher exact probability,P=0.018）. The treatment successful rate of new patients was 72.4%（21/29）. The treatment successfulrate was 71.1%（108/152） in the patients who previous had first-line anti-TB drugs but the rate was 42.3%（44/104） in thepatients who previous had the first-line and second-line anti-TB drugs,and there was a significant difference between them（P〈0.001）. Conclusion In the laboratory,under the condition of carrying out the second-line drug sensitive test ability and limited resources,it′s feasible for all patients to use the same treatment of standardized treatment strategy.