初次复治涂阳肺结核初治失败原因分析

Factors influencing the failure of initial treatment of smear-positive pulmonary tuberculosis with first retreatmen

目的探讨初次复治涂阳肺结核患者初治失败原因,为提高肺结核的治愈率及结核病的防治管理工作提供依据。方法收集2014年1月至2015年12月河北省胸科医院收治的第1次复治痰液或支气管肺泡灌洗液浓缩集菌抗酸染色阳性患者的临床病历资料,并对其进行分析。结果共收集病例267例,大部分为农民,123例患者合并其他疾病,其中合并糖尿病、慢性阻塞性肺疾病(COPD)最常见。53.6%患者有不规律治疗史,因主观因素自行停药患者占不规律治疗患者的71.2%,不能耐受药物不良反应者占23.2%,医源性原因占5.6%,药物不良反应以胃肠道反应、肝功能损伤为主,在结核分枝杆菌培养阳性患者中对抗结核药物任一耐药率为45.6%。结论主观因素、药物不良反应、医源性原因、合并基础疾病、细菌耐药、诊断错误是初次复治涂阴肺结核患者初治失败的主要原因。

Objective To investigate factors influencing the failure of initial treatment of smear-positive pulmonary tuberculosis with first retreatmen,and to increase cure rate of retreatment pulmonary tuberculosis patients,and to provide evidence for strengthen management work of prevention and treatment.Methods We collected and analysed clinical information of smear-positive pulmonary tuberculosis with first retreatmen in Hebei Chest Hospital from January 2014 to December 2015.Results We collected 267 first retreatment pulmonary tuberculosis patients, most of them were farmers.123 patients had complications and the most common complications were diabetes and COPD.53.6% of the patients had irregular antituberculosis treatment history,there were 71.2% patients had irregular antituberculosis treatment because of subjective factors,there were 23.2% because of drug-related adverse effects, there were 5.6% because of iatrogenic etiology.The major drug-related adverse effects were gastrointestinal reactions and liver damage.In Mycobacterium tuberculosis culture positive patients,the any drug resistance rate was 45.6%. Conclusions Subjective factors,drug-related adverse effects,iatrogenic etiology,complications,bacterial resis-tance and error of diagnosis are the factors influencing the failure of initial treatment of smear-positive pulmonary tuberculosis with first retreatmen.