2014—2019年度珠海市发现的耐多药肺结核患者治疗转归及现状调查分析

Investigation and Analysis of the Treatment Outcome and Current Status of Multidrug-resistant Tuberculosis Patients Discovered in Zhuhai City from 2014 to 2019

目的:珠海市2013年9月1日开始实施耐多药肺结核规范化治疗管理,通过对2014—2019年度珠海市发现的116例耐多药肺结核(MDR-PTB)患者治疗转归及现状调查分析,评估珠海市MDR-PTB规范化管理项目开展的成效,为珠海市MDR-PTB项目实施方案的修订提供理论依据。通过对珠海市2014—2019年度发现的116例MDR-PTB患者的诊疗资料进行回顾性分析;通过细菌学、影像学等检查资料,结合病史,判断患者疾病转归;通过电话访视、上门访视、问卷调查等方式,评估患者的诊疗现状。通过SPSS软件进行统计学处理分析,对珠海市MDR-PTB规范化治疗管理项目实施效果做出科学的研究和分析。结果:116例患者,纳入MDR-PTB规范化治疗管理项目45例(38.79%);规范性抗耐多药治疗31例(37.8%);治疗成功46例(56.10%),包括治愈38例,完成治疗8例;治疗失败19例(16.37%),包括因不规范抗MDR-PTB治疗未愈9例,广泛耐药未愈5例,死亡原因与MDR-PTB直接相关5例;未愈20例(26.64%),包括治疗失败14例(除去死因与结核病直接相关5例),拒绝抗MDR-PTB治疗未愈6例。死亡患者12例(10.34%),死亡原因与MDR-PTB直接相关5例,与非结核性疾病直接相关7例(3例与恶性肿瘤直接相关)。失访38例(32.76%),包括转诊后失访15例,抗MDR-PTB治疗后失访21例,诊断MDR-PTB长期拒绝治疗后失访2例。广泛耐药肺结核(XDR-TB)12例(10.34%),痊愈2例,死亡3例,治疗失败5例(一直抗MDR-PTB抑菌治疗);失访2例。结论:珠海市耐多药肺结核规范化治疗管理项目实施推进迟缓,MDR-PTB患者纳入项目率、规范性治疗率、完成疗程率和治愈率均较低,失访率高。通过对珠海市耐多药肺结核规范化治疗管理项目开展情况评估,找出项目实施薄弱环节,为珠海市《耐多药肺结核规范化治疗管理项目实施方案》的修订提供理论依据。

Objective:Zhuhai began to implement the standardized treatment and management of MDR-PTB on September 1,2013.This paper evaluates the effectiveness of the standardized management of MDR-PTB in Zhuhai by investigating and analyzing the treatment outcomes and status quo of 116 cases of MDR-PTB patients found in our city from 2014 to 2019.It provides a theoretical basis for the revision of the implementation plan of MDR-PTB project in our city.The diagnosis and treatment data of 116 MDR-PTB patients found in our city from 2014 to 2019 were retrospectively analyzed,and the disease outcome of patients was judged by bacteriological and imaging examination data combined with medical history.The diagnosis and treatment status of patients was evaluated by telephone interviews,home visits and questionnaires.SPSS software was used for statistical processing and analysis,and the implementation effect of MDR-PTB standardized treatment management project in our city was scientifically researched and analyzed.Results:Out of the 116 patients,45 cases(38.79%)were included in the standardized MDR-PTB treatment management program;31cases(37.8%)were treated with standard multidrug resistance;46 cases(56.10%)were successfully treated,including 38 cases cured and 8 cases who completed the course of treatment.Treatment failed in 19 patients(16.37%),including 9 cases that were not cured due to non-standard anti-MDR-PTB treatment,5 cases that were not cured due to extensive drug resistance,and 5 deaths directly related to MDR-PTB.There were 20 cases(26.64%)of uncured patients,including 14 cases of treatment failure(excluding 5 directly related to tuberculosis),and 6 who refused anti-MDR-PTB treatment.12 patients(10.34%)died,with 5 deaths directly related to MDR-PTB,and 7 related to non-tuberculosis-related illnesses(including 3 specifically linked to malignant tumors).38 cases(32.76%)were lost to follow-up,including 15 cases after referral,21 cases after anti-MDR-PTB treatment,and 2 long-term refusals of MDR-PTB treatment when diagnosed of MDR-PTB.In 12 cases of extensively drug-resistant tuberculosis(XDR-PTB),2 cases were cured,3 cases died,5 cases were treated with anti-MDR-PTB antimicrobial therapy and 2 cases were lost to follow-up.Conclusion:The implementation of the standardized treatment management project of MDR-PTB in our city is slow,and the inclusion rate,normative treatment rate,completion rate and cure rate of MDR-PTB patients are low,while the rate of lost to follow-up is high.Through the evaluation of the implementation of the standardized treatment and management project of MDR-TB in our city,the weak points of the implementation of the project are identified,and the theoretical basis is provided for the revision of the implementation plan of the standardized treatment and Management project of MDR-TB in Zhuhai.