87例耐多药肺结核并伪膜性肠炎患者的临床特征

Clinical Analysis of 87 Cases of Multidrug-Resistant Tuberculosis with Pseudomembranous Colitis

目的总结耐多药肺结核并发伪膜性肠炎(pseudomembranous colitis,PMC)患者的临床特征,为疾病的诊治提供参考依据。方法回顾分析昆明市第三人民医院2014年1月至2018年1月间收治的耐多药肺结核伴PMC患者87例临床资料,统计并对比分析相关临床资料。结果87例患者均使用2种及以上抗生素。全部患者均有腹痛、腹泻症状,发热46例(52.87%)。血白细胞及中性粒细胞升高78例(89.66%),粪便难辨梭状杆菌毒素A检测阳性26例(29.89%)。直肠、乙状结肠均受累72例(82.76%)。治疗后,死亡3例,死亡率3.45%,其余84例中19例显效,63例有效,无效2例,总有效率97.62%。初治耐药患者腹泻前抗生素使用时间明显长于复治耐药患者(P=0.002,且内镜下病变严重程度轻于复治耐药患者(P=0.045)。结论耐多药肺结核患者联合使用抗生素应规范合理,对并发PMC应早期及时发现、积极干预,严格控制病情进展。

Objectives To summarize the clinical characteristics of patients with multidrug-resistant pulmonary tuberculosis complicated with pseudomembranous colitis(PMC),and to provide reference for the diagnosis and treatment of the disease.Methods We retrospectively analyzed the clinical data of 87 patients with multidrug-resistant pulmonary tuberculosis with PMC who were admitted to our hospital from January,2014 to January,2018.Statistics and comparative analyses of relevant clinical data were compared.Results More than two antibiotics were used in the 87 patients.All patients had abdominal pain,diarrhea.46 cases(52.87%)had fever.White blood cells and neutrophils were elevated in 78 cases(89.66%),and 26 cases(29.89%)were positive for Clostridium difficile toxin A.The rectum and sigmoid colon were involved in 72 cases(82.76%).After treatment,3 patients died,the mortality rate was 3.45%,19 of the remaining 84 cases showed marked effect,63 cases were effective,2 cases were ineffective,and the total effective rate was 97.62%.The time of antibiotic use in diarrhea patients with newly diagnosed drug-resistant patients was significantly longer than that in patients with retreatment(P=0.002,and the severity of endoscopic lesions was lighter than that of relapsed patients(P=0.045).Conclusion The combination of antibiotics for multidrug-resistant tuberculosis patients should be standardized and reasonable.The concurrent PMC should be detected and actively intervened at an early stage to strictly control the progress of the disease.