27例利福平依赖肺结核的临床特点及治疗结果分析

Clinical Characteristics and Treatment Results Analysis of 27 Cases with Rifampin Dependent Pulmonary Tuberculosis

目的探讨利福平依赖肺结核的临床特点及治疗结果。方法分析北京胸科医院收治的27例经细菌学证实为利福平依赖肺结核患者的人口学资料、合并症、病程、抗结核治疗时间、临床表现、影像学特征、分枝杆菌药物敏感试验结果及治疗转归。结果27例患者中，男14例，女13例，年龄25～59岁，平均40岁。合并糖尿病9例，矽肺3例，慢性病毒性肝炎2例，系统性红斑狼疮2例，慢性阻塞性肺疾病3例。病程3个月至13年。其中，初治2例，复治25例。患者表现为全身结核中毒症状突出，发热14例，乏力15例，体重下降16例呼吸道症状亦明显，咳嗽14例，咳痰12例。胸部CT检查提示干酪样空洞为主14例，纤维空洞为主4例，实变影为主5例，斑片影为主4例。结核分枝杆菌药敏结果：利福平单耐药肺结核1例（3．7％），耐多药肺结核10例（37．0％），广泛耐药肺结核16例（59．3％）。治疗转归：死亡1例（3．7％）；余26例患者，痰液分枝杆菌罗氏培养阴性者17例（63．0％），仍然阳性者9例（33．3％）；肺部病灶明显吸收11例（40．7％），吸收7例（25．9％），无变化3例（11．1％），恶化5例（18．5％）；18例有肺部空洞，闭合5例（27．8％），缩小5例（27．8％），不变4例（22．2％），增大4例（22．2％）。结论利福平依赖肺结核患者以青年、中年人为主，合并症多，结核中毒症状明显，肺部病灶重，均为利福平耐药结核病，给予合理抗结核治疗，预后尚满意。

Objective To investigate the clinical manifestations and treatment results of rifampin dependent pulmonary tuberculosis. Methods The demographic data, complications, duration of tuberculosis, course of treatment, clinical manifestations, imaging characteristics, drug sensitivity test, treatment and outcome of the 27 cases with rifampin dependent pulmonary tuberculosis confirmed by bacteriology studies were summarized. Results Among 27 cases, 14 were males and 13 were females, and their age ranged between 25 and 59 years old, and the average age was 40 years old. Nine cases were with diabetes mellitus, 3 cases were with silicosis, 2 cases were with chronic viral hepatitis, 2 cases were with systemic lupus erythematosus, 3 cases were with chronic obstructive pulmonary disease. The course of disease ranged between 3 months and 13 years. Two cases were initially pulmonary tuberculosis, 25 cases were retreated pulmonary tuberculosis. Systemic tuberculosis poisoning symptoms were obvious, 14 cases had fever, 15 cases were fatigue and 16 cases had weight loss. Respiratory symptoms were also remarkable. Cough occurred in 14 cases, expectoration occurred in 12 cases. The pulmonary CT showed caseous cavity and fibrous cavity in 14 cases and 4 cases, respectively; solid lesions and schistose lesions in 5 cases and 4 cases, respectively. Mycobacterium tuberculosis drug susceptibility test showed 1（3.7%） was rifampin mono-resistant tuberculosis, 10（37.0%） were multidrug- resistant tuberculosis, and 16（59.3%） were extensive drug-resistant tuberculosis.In the course of treatment, 1 case died（3.7%）, and in the end of the treatment, 17 cases of sputum Lowenstein-Jensen culture were negative（63.0%）, 9 cases were still positive（33.3%）; there were significant absorption of pulmonary lesions in 11 cases（40.7%）, absorption in 7 cases（25.9%）, unchanged in 3 cases （11.1%）, deteriorated in 5 cases（18.5%）; eighteen cases were with pulmonary cavity, and the cavity closed in 5 cases（27.8%）, decreased in 5 cases （27.8%）, unchanged in 4 cases（22.2%）, and increased in 4 cases（22.2%）. Conclusion Rifampin dependent pulmonary tuberculosis are mainly in young and middle- aged groups. Complications, tuberculosis poisoning symptoms and lung lesions are severe in most patients. All of them are rifampin resistant tuberculosis. A reasonable anti-tuberculosis treatment leads a satisfactory prognosis.