武汉市359例耐多药肺结核患者治疗效果分析

Therapeutic effect of 359 cases of multi-drug resistant pulmonary tuberculosis in Wuhan

目的分析武汉市耐多药肺结核(multi-drug resistance tuberculosis,MDR-TB)治疗效果,为进一步开展耐多药肺结核防治提供参考。方法对2006年12月1日—2014年6月30日武汉市结核病防治所治疗的全球基金结核病项目359例MDR-TB患者,采用标准化与个体化方案相结合的方式进行治疗,分析治疗转归及不良反应发生情况。结果 359例MDR-TB患者治愈率为73.3%(263/359),初治涂阳和复治涂阳患者治愈率分别为76.6%(95/124)和71.5%(168/235),复治涂阳患者中的复治失败者的治愈率最低(57.9%,22/38)。359例MDR-TB患者不良反应发生率为87.7%(315/359),耳鸣或听力下降、胃肠道反应和关节肿痛发生率分别为50.8%(160/315)、46.0%(145/315)和43.2%(136/315);环丝氨酸导致抑郁症状发生率为5.3%(6/113)。不良反应发生的时间多为治疗后的2~6个月。结论武汉市MDR-TB治愈率较高,其中全程免费政策、合理治疗方案、规范化管理及患者社会支持和人文关怀策略是关键措施。

Objective To explore the therapeutic effect of multi-drug resistant pulmonary tuberculosis（MDR-TB） inWuhan City,so as to provide the reference for further development of MDR-TB control and prevention. Methods FromDecember 1th,2006 to June 30 th,2014,359 MDR-TB patients from the Global Funds＇ MDR-TB Program in Wuhan Cityreceived the standardized anti-MDR-TB chemotherapy regimen supplemented with individualized drug choices. The treatmentoutcomes and adverse reactions were observed and the results were analyzed. Results Among the 359 MDR-TB patients,the cure rate was 73.3%（263/359）,of which,the cure rates of the new smear positive and relapsed TB cases who turned out tobe MDR-TB,were 76.6%（95/124） and 71.5%（168/235） respectively,and the MDR-TB patients who registered under theclassification of retreatment failure had the lowest cure rate of 57.9%（22/38）. The overall incidence of adverse reaction was87.7%（315/359）,and the incidence rates of tinnitus or hearing loss,gastronomical reactions and joint pain were 50.8%（160/315）,46.0%（145/315） and 43.2%（136/315） respectively. The incidence of cycloserine inducing depression was 5.3%（6/113）.The adverse reactions occurred mostly during the period of the 2nd month to 6th month after the treatment. Conclusion Thecure rate of cases of MDR-TB is relatively high in Wuhan City,in which the entire free policy,reasonable treatment,standardization management,social support,and humanistic care are the key measures.