初治肺结核短程化疗后复发复治的分析

Analysis of the recurrent cases of initial-treated pulmonary tuberculosis after short course chemotherapy and the efficacy of re-treatment

目的 探讨初治肺结核短程化疗后复发病例的有关复发因素及复治效果。方法 对 1997年、1998年、1999年三年登记管理的初治肺结核病例进行调查 ,分析其复发时间、痰菌及年龄情况、疗程结束时肺部病灶与复发的关系以及复发病例复治效果。结果 1年内复发者占大多数 (77 5 5 % )。老年复发者病情较严重。复治后痰菌阴转率 94 12 % ,X线吸收率 77 78% ,空洞闭合 +吸收率 71 4 3% ,化疗失败率 5 88%。结论 复发病例大部分在疗程结束后 1年内复发 ;初治涂阳 ,病灶广泛、干酪或空洞病灶 ,是复发的危险因素。

Objective To explore the associ ated factors of relapse in the initial treated patients with pulmonary tuberculo sis(PTB) after short course chemotherapy and to observe the efficacy of re trea tment.Methods The newly diagnosed patients with PTB registered during the period from 1997 to 1999 were investigated,and the relapse cases wer e analyzed for the time of relapse,the sputum bacteria,the ages,and the relation ship between residual focus and relapse.The therapeutic efficacy of re treatmen t were observed.Results Most of the patients recurred within on e year(77.5%).The new smear positive patients with the lesion more than three l ung fields,casesation and cavities,caseous cavity with thick wall and average di ameter of cavity(d≥2cm) relapsed obviously earlier(P<0.01).It was serious of the old age relapse cases.Among the recurrent cases received re treatment of short course chemotherpay,the sputum bacteriological conversion rat e was 94.12%,the rate of chest X ray resolution was 77.78% and the rate of cavi ty close and absorption was 71.43%.Chemotherapy failed in 5.88% of the patients .Conclusion Among the initial treated PTB,most patients relapse within one year.The daugerous factors consist of initial treatment,sputum smear positive,old age patients extensive pulmonary residual focus,the lesions of ca seation or cavities,caseous cavities with thick wall,average diameter of cavity( d≥2cm),which may related to relapse.