耐药肺结核的成因与治疗

CAUSE AND TREATMENT OF DRUG-RESISTANCE TUBERCULOSIS

目的 总结分析耐药肺结核的成因和治疗方法。方法 对 1998年 1月～ 2 0 0 2年 1月期间收治的资料完整的耐药肺结核病例 6 2例进行回顾性分析。结果 6 2例耐药肺结核患者均为继发性肺结核 ,其中单纯对异烟肼耐药 10例 ,单纯对利副平耐药 3例 ,同时对利副平、链霉素耐药 2例 ,同时对异烟肼、利副平耐药 15例 ,同时对异烟肼、链霉素、乙胺丁醇耐药 3例 ,同时对异烟肼、利副平、链霉素、乙胺丁醇耐药 10例 ,同时对异烟肼、利副平、乙胺丁醇耐药 4例 ,同时对异烟肼、利副平、链霉素耐药 15例。 6 2例耐药肺结核患者中未完成规定疗程自行停药 2 2例 ,间断不规则用药2 0例 ,化疗方案不合理 6例 ,因肝功异常停药 10例 ,因药物过敏停药 2例 ,因严重胃肠反应被迫停药 2例。根据药敏试验应用力克肺疾、利福贲丁、丙硫异烟胺、吡嗪酰胺、氧氟沙星等组成治疗方案对上述耐药肺结核进行了治疗 ,治愈 4 0例 ,治愈率为 6 4%。结论 耐药肺结核的成因有医生、患者、药物 3方面的因素。耐药肺结核的治疗需要合理的治疗方案和良好的患者依从性。

Objective To analyse the cause and treatment of drug-resistant tuberculosis.Methods Data of 62 cases with drug-resistant tuberculosis from January,1998 to January,2002 were retrospectively analyzed.Results All cases were patients with secondary pulmonary tuberculosis.There were 41 men and 21 women.The cases with drug-resistant tuberculosis were as follows:INH-resistant in 10,RFP-resistant in 3,resistant to RFP and SM in 2,resistant to INH and RFP in 15,resistant to INH and SM and EMB in 3,resistant to INH RFP,SM and EMB in 10,resistant to INH,RFP and EMB in 4,and resistant to INH,RFP and SM in 15.The reasons for drug-resistance in 62 cases were as follows: 22 cases were due to stopping medical treatment,20 cases due to irregular treatment,6 cases due to improper treatment,10 cases were caused by liver dysfunction,2 cases by drug allergy and 2 cases by serious gastrointestinal reaction.According to the drug susceptibility testing,all cases were treated with pasiniazide,rifapendin,PZA and ofloxacin.40 cases of them were cured,and the curative rate was 64%.Conclusion The doctor,patient and drug factors play an important role in producing drug-resistanting.It is necessary for patients with tuberculosis to be treated rationally.