老年肺结核非标准化疗的形成原因及其疗效

ANALYSIS OF CLINICAL CAUSATION AND T HERAPEUTIC EFFECT OF NON-STANDARD ANTI-TUBERCULOSIS CHEMOTHERAPY IN AGED PATIENTS WITH PULMONARY TUBERCULOSIS

目的探索老年肺结核非标准化疗的形成原因及疗效。方法本文对我院1998年至2000年244例老年肺结核(≥60岁)的抗结核化疗方案的标准情况和相关因素进行分析和相应的卡方检验,并对标准组和非标准组的短期疗效进行比较。结果244例老年肺结核的化疗方案不标准率为73%。有影响用药的禁忌和体质是非标准化疗方案形成的最主要因素。耐药原因者在初治组占26%,复治组占45%,两者差异有显著性,P<0.05。标准组和非标准组药物不良反应发生率分别为32%和25%,P>0.05,差异并无显著性,以肝损和胃肠道反应为主。对其中135例病例的1个月的痰菌阴转率进行比较,标准组(占37%)和非标准组(占36%)差异无显著性,P>0.05。结论老年肺结核病人抗结核化疗方案的非标准化程度高,形成的原因主要是有影响用药的禁忌或体质,对抗结核药物产生不良反应及耐药,选用非标准抗结核化疗方案的药物不良反应发生率不会增高,因地制宜地及时选用适合于患者的个体化抗结核方案同样可以获得较好的效果。

Objective To explore clinical causa tion and therapeutic effect of non -s tandard anti -tuberculosis chemotherapy in aged patients with p ulmonary tuberculosis.Methods 244elderly(above 60years old)cases with pulmonary tuberculosis in our hospital,from 1998～2000,were retrospectively stu died,Their clinical data of whether using standard anti -TB chemotherapy and its correlative factors were assessed by chi -s quare test.The short -term therapeu tic effective rates between non -standard group an d standard group were also checked.Results The rate of taking non -standard anti-TB chemotherapy in 244elderly cases was 73%.Contraindications or intolerable conditions for anti -TB drug i s the most important causation for taking non -standard chemotherapy.The rate of d rug resistance leading to non -stand ard chemotherapy in the initial treatme nt group was 26%,while in retreatmen t group it was 45%;there was signific ant difference between them,P<0.05.The side -effect rates in stan dard treatment group and non -standard group were 32%and 25%respectively.There was no signific ant difference P>0.05.The most frequently seen side-effects in elderly cases were gastrointestinal discomfort and hepatitis.To evaluate the difference of therapeutic effect between stand ard chemotherapy and non -standard chemotherapy,the neg ative -conversion rates of sputum sm ear after one month treatment in 135e lderly pul-monary tuberculosis cases were asse ssed by chi -square test.The data showed that there was no significant dif ference between the two groups.Conclusions The rate of taking non -standard anti-TB chemotherapy in aged patients wi th Pulmonary TB was high.Three major causations were contraindications or intolerable conditions for anti -TB drug,side -e ffects of anti -TB chemotherapy and drug resistance;w hereas adjusting chemotherapy to in dividual conditions in time can also acquire satisfied therapeutic effects without high side -effect rate.