基于药敏试验比例法的耐多药肺结核精准治疗效果的分析

Efficacy of precision treatment in multidrug-resistant pulmonary tuberculosis based on proportion method for drug susceptibility test

目的探讨基于药敏试验比例法的耐多药肺结核(multidrug-resistant pulmonary tuberculosis,MDR-PTB)患者精准治疗的效果,为制订MDR-PTB治疗方案提供科学依据。方法选取2016年1月5日至2018年4月30日在深圳市慢性病防治中心行结核病治疗的180例MDR-PTB确诊患者,初始治疗方案为6个月阿米卡星、吡嗪酰胺、左氧氟沙星、乙胺丁醇、丙硫异烟胺/18个月吡嗪酰胺、左氧氟沙星、乙胺丁醇、丙硫异烟胺。根据是否完善10种常用药物的药敏试验比例法分为精准治疗组和经验治疗组,精准治疗组根据药物敏感试验结果调整治疗方案。回顾性分析两组患者治疗方案及病情转归等资料。统计学分析采用χ^(2)检验。结果180例患者中,精准治疗组113例,经验治疗组67例。精准治疗组药物的耐药率从低到高依次为:卷曲霉素(0,0/113)、阿米卡星(2.65%,3/113)和卡那霉素(2.65%,3/113)、对氨基水杨酸(7.96%,9/113)、丙硫异烟胺(11.50%,13/113)、氧氟沙星(38.05%,43/113)、乙胺丁醇(39.82%,45/113)、链霉素(76.99%,87/113)。精准治疗组患者在治疗过程中根据药敏试验比例法进行药物调整104人次,从低到高依次为:阿米卡星(3人次)、丙硫异烟胺(13人次)、左氧氟沙星(43人次)、乙胺丁醇(45人次)。精准治疗组治疗成功率为78.8%(89/113),高于经验治疗组的52.2%(35/67),差异有统计学意义(χ^(2)=13.805,P=0.0002)。精准治疗组和经验治疗组患者治疗过程中,丙氨酸转氨酶升高[32.3%(31/96)比34.0%(18/53)]、血肌酐升高[4.2%(4/96)比5.7%(3/53)]、白细胞计数减少[24.0%(23/96)比22.6%(12/53)]患者比例差异均无统计学意义(均P>0.05)。结论基于药敏试验比例法的传统MDR-PTB治疗方案具有较高的治疗成功率,仍是值得选择的治疗方式。

Objective To explore the precision treatment effect of multidrug-resistant pulmonary tuberculosis(MDR-PTB)based on the proportion method for drug susceptibility test,and to provide a scientific basis for formulating MDR-PTB treatment plan.Methods One hundred and eighty patients with MDR-PTB treated in Shenzhen Center for Chronic Disease Control from January 5,2016 to April 30,2018 were enrolled.The initial treatment plan after diagnosis was six months of amikacin(AM),pyrazinamide(Z),levofloxacin(LFX),ethambutol(E),prothionamide(PTO)and 18 months of Z,LFX,E,PTO.According to whether proportion method for drug susceptibility test for 10 commonly used drugs was implemented,patients were divided into precision treatment group and empirical treatment group.In the precision treatment group,the treatment plans were adjusted according to the results of the drug susceptibility test.The treatment plans and disease outcomes of the two groups of patients were retrospectively analyzed.Chi-square test was used for statistical analysis.Results Among the 180 patients,there were 113 patients in the precision treatment group and 67 patients in the empirical treatment group.The drug resistance rates of the precision treatment group from low to high were:capromycin(CM)(0,0/113),AM(2.65%,3/113)and kanamycin(KM)(2.65%,3/113),para-aminosalicylic acid(PAS)(7.96%,9/113),PTO(11.50%,13/113),ofloxacin(OFX)(38.05%,43/113),E(39.82%,45/113),and streptomycin(S)(76.99%,87/113).In the precision treatment group,the drugs were adjusted for 104 person-times according to the proportion method for drug susceptibility test during the treatment,from low to high:AM(3 person-times),PTO(13 person-times),LFX(43 person-times)and E(45 person-times).The treatment success rate of the precision treatment group was 78.8%(89/113),which was higher than that of the experience treatment group(52.2%(35/67)),the difference was statistically significant(χ^(2)=13.805,P=0.0002).In the precision treatment group and empirical treatment group,there were no statistically significant differences of alanine aminotransferase elevated(32.3%(31/96)vs 34.0%(18/53)),serum creatinine elevated(4.2%(4/96)vs 5.7%(3/53)),and white blood cell count decreased(24.0%(23/96)vs 22.6%(12/53))(all P>0.05).Conclusion The traditional treatment plan based on the proportion method for drug susceptibility test has a high success rate in the treatment of MDR-PTB,which is still a worthy choice.