氟喹诺酮类药物联合阿米卡星治疗MDR-TB疗效分析

目的分析和评价氟喹诺酮类药物联合阿米卡星在治疗耐多药结核病(MDR-TB)中的疗效。方法 107例患者随机分为治疗组(54例)和对照组(53例)。治疗组以左氧氟沙星、阿米卡星、丙硫异烟胺、帕司烟肼、吡嗪酰胺治疗方案,对照组以左氧氟沙星、丙硫异烟胺、帕司烟肼、吡嗪酰胺的治疗方案,疗程为24个月。结果 104例患者完成化疗疗程,痰菌阴转率:治疗组与对照组分别为85.5%和54.8%,治疗组显著高于对照组(P<0.01);治疗组与对照组分别为61.4%和41.7%,治疗组显著高于对照组(P<0.01)。结论氟喹诺酮类药物联合阿米卡星更能提高MDR-TB结核患者的痰菌转阴率。

母牛分枝杆菌菌苗联合抗结核药治疗老年MDR-TB疗效分析

目的观察和评价母牛分枝杆菌菌苗在老年MDR-TB免疫治疗中的临床效果。方法 113例老年MDR-TB患者随机分为治疗组(56例)和对照组(57例)。治疗组以阿米卡星、丙硫异烟胺、吡嗪酰胺、莫西沙星、帕司烟肼、母牛分枝杆菌苗治疗方案,对照组以阿米卡星、丙硫异烟胺、吡嗪酰胺、莫西沙星、帕司烟肼的治疗方案,疗程为24个月。结果 104例患者完成化疗疗程,6个月末痰菌阴转率:治疗组与对照组分别为57.7%和44.2%;12个月末痰菌阴转率为78.8%和51.9%;疗程结束痰菌阴转率分别为88.5%和53.8%,治疗组显著高于对照组(P<0.01)。空洞闭合率:治疗组86.5%,对照组57.7%,治疗组显著高于对照组(P<0.01)。结论母牛分枝杆菌菌苗用于老年MDR-TB患者的治疗能显著提高痰菌转阴率和空洞闭合率,有利于病灶吸收,临床上可作为老年MDR-TB的辅助手段。

MDR-TB的化疗和化疗实施

MDR-TB系指同时耐异烟肼(INH)和利福平(RFP),或还耐其他抗结核药的结核病.解决MDR-TB的化疗问题有两条路:一是研究开发新抗结核药;二是用好现有常用抗结核药,组成更为有效的治疗MDR-TB的标准化疗方案.本文仅就后者进行探讨,并提出标准化疗方案和化疗实施的规范化要求.

Smear-Negative Multidrug-Resistant Tuberculosis a Significance Hidden Problem for MDR-TB Control: An Analysis of Real World Data

Purpose: The drug resistance pattern in tuberculosis (TB) is still under investigated. We analyzed the clinical data from the patients with smear positive TB and applied the model to predict the patients with smear-positive TB. Materials and Methods: Medical records information of 6977 cases was included from 11,950 inpatients from January 2009 to November 2013. The cases data were divided into a training set, test set and prediction set. Logistic regression analysis was applied to the training set data to establish a prediction classification model, the effect of which was then evaluated using the test set by receiver operating characteristic (ROC) analysis. The model was then applied to the prediction set to identify incidence of snMDR-TB. Results: Sixteen factors which correlate with MDR-TB-including frequency of hospitalization, province of origin, anti-TB drugs, and complications, were identified from the comparison between SP-TB and spMDR-TB. The area under the ROC curve (AUC) of the prediction model was 0.752 (sensitivity = 61.3%, specificity = 83.3%). The percentage of all inpatients with snMDR-TB (snMDR-TB/Total) was 28.7% ± 0.02%, while that of all SN-PTB with snMDR-TB (snMDR-TB/SN-PTB) was 26.5% ± 0.03%. The ratio of snMDR-TB to MDR-TB (snMDR-TB/MDR-TB) was 2.09 ± 0.33. Conclusion: snMDR-TB as an important source of MDR-TB is a significant hidden problem for MDR-TB control and can be identified by the prediction model. A kind of vicious circle with a certain delay effect exists between snMDR-TB and MDR-TB. To better control MDR-TB, it is necessary to pay greater attention to snMDR-TB, conduct further research and develop targeted therapeutic strategies.

重庆市新结防模式下MDR-TB患者治疗现状及经济负担调查研究

本研究评估重庆市在新结防模式下MDR-TB患者的治疗现状及经济负担,为MDR-TB控制提供决策依据。研究表明患者接受正规治疗的比例较高,医保覆盖率也较高,但也还存在相关卫生服务可及性差、治疗副反应普遍、患者经济负担较重等问题。后续应加强重点人群和弱势人群MDR-TB的筛查,提升相关卫生服务的可及性,同时需要加强对患者的经济支持。

Pre-Extensively Drug Resistant Tuberculosis (Pre-XDR-TB) among Pulmonary Multidrug Resistant Tuberculosis (MDR-TB) Patients in Bangladesh

Background & Objectives: Emergence of drug resistant Tuberculosis (TB) is a major obstacle in the TB control programme of Bangladesh. This study was carried out to detect pre-extensively drug resistant TB (pre-XDR-TB) cases among the multidrug resistant TB (MDR-TB) patients in Bangladesh, as the early detection of pre-XDR-TB can guide clinicians in the appropriate modification of MDR-TB treatment regimen with effective drugs to prevent treatment failure. Methodology: A total of 68 MDR-TB cases were enrolled in this study. Multiplex Real-time PCR was done to detect pre-XDR-TB cases directly from sputum samples of MDR-TB patients. Results: Out of 68 MDR-TB cases 11 (16.18%) cases were detected as pre-XDR-TB. The resistant profile of the 11 pre-XDR-TB revealed 9 (81.82%) cases of fluoroquinolone (FLQ) resistant pre-XDR-TB and 2 (18.18%) cases of injectable second line (ISL) agent resistant pre-XDR-TB. Out of 11 pre-XDR-TB cases 7 (63.64%) cases had history of taking treatment for MDR-TB regularly, 1 (9.09%) case had history of taking treatment for MDR-TB irregularly and 3 (27.27%) cases had no history of taking treatment for MDR-TB. Conclusion: This study encountered a high rate of pre-XDR-TB cases along with a significant number of primarily resistant bacilli which is of concern in the management of MDR-TB. It is evident that Bangladesh is in urgent need to device strategies for rapid and early detection of pre-XDR-TB in order to prevent treatment failure of MDR-TB cases and also to halt the progression of MDR-TB cases to extensively drug resistant TB (XDR-TB), which is not only difficult but also very expensive to treat.

肺结核患者的MDR-TB知识知晓率调查

目的了解肺结核患者的MDR-TB知识知晓率情况,为有针对性开展健康教育工作提供参考。方法对肺科门诊跟踪治疗管理的肺结核患者进行询问式问卷调查。结果共调查159例肺结核患者,小学及以下学历占67.2%,"什么是MDR-TB"的知晓率为55.9%,"慢性排菌者/初治失败者/复发患者/密切接触MDR-TB患者的涂阳肺结核患者应怀疑得了MDR-TB"的知晓率为13.8%,"产生MDR-TB的原因"的知晓率为26.4%,"如何治疗MDR-TB"的知晓率为15.1%,"MDR-TB能治好吗"的知晓率为30.2%,"如何预防MDR-TB"的知晓率为23.9%。结论肺结核患者的MDR-TB知识知晓率低,应加强MDR-TB的宣传教育。

标准化治疗方案治疗MDR-TB 26例近期疗效分析

目的评价全球基金结核病项目标准化耐多药肺结核治疗方案对耐多药肺结核(MDR-TB)的疗效。方法观察26例MDR-TB采用标准化耐多药肺结核治疗方案后1个月、6月、12月的痰菌计数、病灶吸收、体重指数变化。结果在治疗后6个月,痰菌计数、病灶吸收、体重指数均较前改善,统计有差异性(P<0.05)。结论全球基金结核病项目标准化耐多药肺结核治疗方案对MDR-TB的近期疗效好,值得进一步临床观察及病例积累。

Descriptive Epidemiology of Multidrug Resistance Tuberculosis (MDR-TB) in Bangladesh

Background: The number of reported MDR-TB cases has been increasing in recent years. Objectives: To describe the epidemiological profile of MDR-TB cases in Bangladesh. Design: This was a descriptive cross-sectional study. Settings: The study was conducted among the multi drug resistant tuberculosis patient admitted in the National Institute of Diseases of the Chest and Hospital (NIDCH) Dhaka, Bangladesh. Samples: 148 confirmed cases of MDR-TB. Materials and Methods: Hospital admitted MRD-TB cases were randomly chosen from the above mentioned hospital. Semi-structured and pretested questionnaire were introduced by researcher. Clinical and treatment data i.e. duration of TB drug intake, report of sputum, X-ray and blood test etc. were extracted from the hospital record. Results: Study found, majority of the participants (56.1%) were in the age group of 16 - 30 years. 64.2% of the study subjects were married. Majority of the participants education were whether under primary or primary level. 24.3% participant’s family member and 14.5% of neighbor were having TB. Most common comorbidity were diabetes, pulmonary infection, hearing loss, psychiatric symptoms, chest pain, joint pain etc. 63.5% respondent had high degree of AFB for sputum positivity and more than 98% had positive finding in X-ray chest. On an average ESR was low and also few cases of extremely low ESR were found. 71.6% were under twenty four months regimen. Conclusion: We can conclude that, many possible factors for MDR-TB. There is an urgent need for further study to confirm the exact factors in Bangladesh and address those immediately.

The Prediction Factors of Pre-XDR and XDR-TB among MDR-TB Patients in Northern Thailand

Background: Molecular diagnosis based on the detection of mutations conferring genetic drug resistance is useful for early diagnosis and treatment of Pre-XDR and XDR-TB patients. However, the study of mutation as a marker to predict Pre-XDR and XDR-TB is rare. Methods: Thirty-four Mycobacterium tuberculosis (MTB) isolates from MDR, Pre-XDR and XDR-TB patients in the upper north of Thailand, who had been identified for drug susceptibility using the indirect agar proportion method from 2005-2012, were examined for genetic site mutations of katG, inhA, and ahpC for isoniazid (INH) drug resistance, rpoB for rifampicin (RIF) drug resistance, gyrA for ofloxacin (OFX), and rrs for kanamycin (KAN). Associations between resistant genes and Pre-XDR and XDR-TB in the MDR patients were performed using exact probability tests. Univariable logistic regression was used to quantify the strength of association between the gene mutation with Mycobacterium tuberculosis and the prevalence of Pre-XDR and XDR-TB in the MDR patients. Results: The mutations in the region of the rpoB gene at codon 445 (C445T) in the Pre-XDR or XDR-TB patients were significantly 20.6 times more prevalent among the MDR-TB patients. The inhA gene mutation at codon 114 (T114G) was also significantly 8.1 times more prevalent. Conclusion: The findings can be used to predict the odds of Pre-XDR and XDR-TB in MDR-TB patients, as a guide for prevention and treatments.

Identifying Factors that Affect the Probability of Being Cured from MDR-TB Disease, KwaZulu-Natal, South Africa: A Competing Risks Analysis

Setting: Four decentralised sites are located in rural areas and one centralised hospital in KwaZulu-Natal province, South Africa. Objective: To analyse risk factors associated with multidrug-resistant tuberculosis (MDR-TB) using competing risks analysis. Understanding factors associated with MDR-TB and obtaining valid parameter estimates could help in designing control and intervention strategies to lower TB mortality. Method: A prospective study was performed using a competing risk analysis in patients receiving treatment for MDR-TB. The study focused on 1542 patients (aged 18 years and older) who were diagnosed of MDR-TB between July 2008 and June 2010. Time to cure MDR-TB was used as the dependent variable and time to death was the competing risk event. Results: The Fine-Gray regression model indicated that baseline weight was highly significant with sub-distribution hazard ration (SHR) = 1.02, 95% CI: 1.01 - 1.02. This means that weight gain in a month increased chances of curing MDR-TB by 2%. Results show that lower chances to cure MDR-TB were among patients between 41 to 50 years compared to those patients who were between 18 to 30 years old (SHR = 0.80, 95% CI: 0.61 - 1.06). The chances of curing MDR-TB in female patients were low compared to male patients (SHR = 0.84, 95% CI = 0.68 - 1.03), however this was not significant. Furthermore, HIV negative patients had higher chances to cure MDR-TB (SHR = 1.07, 95% CI: 0.85 - 1.35) compared to HIV positive patients. Patients who were treated in the decentralised sites had lower chances to be cured of MDR-TB (SHR = 0.19, 95% CI: 0.07 - 0.54) as compared to patients who were treated in the centralised hospital. Conclusion: Identifying key factors associated with TB and specifying strategies to prevent them can reduce mortality of patients due to TB disease, hence positive treatment outcomes leading to the goal of reducing or end TB deaths. Urgent action is required to improve the coverage and quality of diagnosis, treatment and care for people with drug-resistant TB.

长治地区MDR-TB流行趋势研究

目的：探讨长治地区ＭＤＲ－ ＴＢ 流行情况。方法：从１９９７ 年１２ 月到１９９８ 年１２ 月对长治地区１２５ 例结核病患者的标本，采用涂片，抗酸染色，分离培养等方法，分离出结核杆菌４２ 株，并通过间接法对４２ 株ＴＢ 菌进行了耐药性测定。结果：阳性分离率３３ ．６ ％ ，１４ 种抗痨药物耐药情况为，无耐药者８ 例，为１９ ．４ ％ ，耐一种药者８ 例，为１９ ．４ ％ ，耐二种药者９ 例，为２１ ．４ ％ ，耐三种药者６ 例，为１４ ．２ ％ ，耐四种药６ 例，为１４ ．２ ％ ，耐５ 种药者４ 例，为９ ．４ ％ ，耐二种以上药２５ 例，为５９ ．５ ％ 。结论：长治地区ＭＤＲ－ＴＢ正在增多，ＭＤＲ－ ＴＢ不断扩散，有可能使目前治疗结核病的化疗方法失去应有的控制作用，对结核病的流行产生严重的影响，因此，将耐药性测定，耐药趋势的追踪和流行病学的分析，作为本地区结核病的流行控制监测的重要手段，应受高度的重视。

二线药治疗耐多药结核病(MDR-TB)应否纳入结核病规划?

21世纪的结核病控制规划问题,例如耐多药结核病(定义为结核菌至少对异烟肼和利福平耐药),需要21世纪的解决方案。传统的结核病政策集中在实行DOTS,通过治愈新病例以预防耐药结核病的出现。当然,提高病例发现率和新病例治愈率将防止它们转为慢性,因而使耐药性降得最低。

母牛分枝杆菌菌苗联合抗结核药在MDR-TB中的应用价值分析

目的对母牛分枝杆菌菌苗联合抗结核药治疗耐多药结核(MDR-TB)的应用价值进行探讨。方法将84例耐多药肺结核患者随机分为观察组和对照组,给予对照组患者常规疗法,给予观察组患者母牛分枝杆菌菌苗联合抗结核药治疗。结果观察组患者的痰菌阴转率、病状吸收情况均优于对照组(P<0.05)。结论治疗MDR-TB采取母牛分枝杆菌菌苗联合抗结核药物,有利于提高痰菌阴转率,加快病灶吸收。

血清sIL-2R水平对MDR-TB的临床意义及IL-2治疗的研究

目的探讨血清 sIL-2R 水平对耐多药肺结核(MDR-TB)的临床意义及免疫增强剂的疗效。方法将130例耐多药肺结核患者随机分为2组,均以力克肺疾为基础并与临床上尚可供配伍的抗痨药物3种以上组成联合治疗方案,总疗程为18个月。Ⅰ组患者在抗痨基础上最初6个月加用白细胞介素-Ⅱ(IL-2)。观察2组病例的血清白细胞介素-Ⅱ受体水平下降情况、痰菌阴转率、空洞好转率和远期复发率。结果疗程结束时,Ⅰ组和Ⅱ组痰菌阴转率分别为87.5%、72.7%,2组比较 P<0.05。空洞缩小或闭合率分别为70.7%、44.4%(P<0.05)。治疗6个月时血清白细胞介素-Ⅱ受体Ⅰ组与Ⅱ组分别为321±38.4U/ml 和382±61.5U/ml(P<0.01)。随访18个月痰菌复阳率Ⅰ组为11.1%,Ⅱ组为23.9%(P<0.05)。结论 MDR-TB 患者存在免疫功能低下,采用 IL-2长程间歇治疗,不良反应较轻,可明显提高疗效,降低远期复发率。

血清胱抑素C在MDR-TB患者化疗中的临床应用

目的探讨血清胱抑素C(CysC)在耐多药结核(MDR-TB)患者化学治疗中的临床应用。方法对MDR-TB患者按照化疗时间不同分7组检测血清CysC,来判断患者化疗过程中氨基糖甙类注射剂及高尿酸血症对患者肾功能损伤情况,同时将7个组的血清肌酐(Scr)、尿素(Urea)、尿酸(UA)的浓度作为观察指标来测定。结果七组的血清CysC、Scr、UA的差异有显著性意义(P<0.05),血清Urea的差异无显著性意义(P>0.05),但与治疗前组相比血清CysC的浓度的变化较Scr的浓度变化出现早;在MDR-TB患者化疗过程中血清SCr、Urea无一例异常,血清UA在治疗不同时期大多数患者间或或者持续升高,血清CysC有两例在治疗2个月后出现异常,经调减注射剂剂量后恢复正常。结论血清CysC是监测MDR-TB患者化疗过程中早期肾功能损伤更敏感的指标。

抗结核药联合不同生物免疫制剂治疗MDR-TB疗效分析

目的观察和分析不同生物免疫制剂在耐多药结核病(MDR-TB)治疗中的临床效果。方法将204例耐多药肺结核患者随机分为母牛分枝杆菌、草分枝杆菌、卡介苗多糖核酸3个治疗组和对照组,每组各51例。治疗组以阿米卡星、丙硫异烟胺、乙胺丁醇、左氧氟沙星、帕司烟肼分别联合母牛分枝杆菌、草分枝杆菌和卡介菌多糖核酸治疗;对照组仅以阿米卡星、丙硫异烟胺、乙胺丁醇、左氧氟沙星和帕司烟肼治疗,疗程均为18个月。结果 204例患者均完成化疗疗程,痰菌转阴率:3个月末,3个治疗组分别为49.0%、45.1%和43.1%,对照组为33.3%;6个月末,3个治疗组分别为76.5%、72.5%和70.6%,对照组为41.2%;18个月疗程结束时,3个治疗组分别为88.2%、84.3%和80.4%,对照组为56.9%;所有治疗组痰菌转阴率均高于对照组。空洞闭合率:3个治疗组分别为86.3%、82.4%和78.4%,对照组为54.9%,治疗组高于对照组。结论生物免疫制剂用于MDR-TB患者治疗,能有效提高痰菌转阴率和空洞闭合率,有利于病灶吸收,临床上可作为治疗MDR-TB的辅助手段。

中药苦参提取物对MDR-TB感染小鼠细胞免疫的调节作用

目的探讨苦参提取物对耐多药结核分枝杆菌(multiple drugs resistant bacillus tuberculosis,MDR-TB)感染小鼠免疫功能的调节作用。方法采用静脉注射建立小鼠MDR-TB感染模型,将30只健康雄性小鼠随机分为3组(正常组、模型组和苦参提取物组),每组10只,采用酶联免疫吸附试验(ELISA)法检测小鼠血清中与结核免疫密切相关的细胞因子γ-干扰素(IFN-γ)、白介素-4(IL-4)、白介素-10(IL-10)和白介素-12(IL-12)含量的变化,同时分离出单个核细胞(PBMC),抽提全部核糖核酸(RNA),采用逆转录PCR(RT-PCR)法检测PBMC中IFN-γ、IL-4、IL-10、IL-12及颗粒裂解肽(GLS)的信使核糖核酸(mRNA)变化。结果苦参提取物组与模型组比较,小鼠血清中的IFN-γ、IL-12含量明显升高,IL-4、IL-10含量明显下降,差异有统计学意义(P<0.05);与正常组比较,IFN-γ、IL-4、IL-10和IL-12的含量差异无统计学意义(P>0.05)。在mRNA表达水平上,苦参提取物组小鼠PBMC中IFN-γ、IL-12、GLS表达明显升高,IL-4、IL-10mRNA表达明显下降,差异有统计学意义(P<0.05)。结论苦参提取物可以通过上调基因转录水平增强小鼠的细胞免疫功能,具有较明显的抗MDR-TB作用,为临床治疗尘肺合并结核患者感染的MDR-TB提供了理论依据。

Ventricular tachycardia in a disseminated MDR-TB patient： a case report and brief review of literature

Although significant breakthroughs have been achieved in tuberculosis management, we still encounter numerous difficulties in diagnosis and treatment of the disease. Additionally, a new challenge, multidrug-resistant tuberculosis （MDR-TB） with unspecific clinical presentation, often results in delayed diagnosis. In this paper, we reported a case of disseminated tuberculosis with rare presentation of ventricular fibrillation, which proved resistant to both isoniazid and rifampicin. A review of literature showed that ventricular fibrillation or tachycardia in tuberculosis patients with pericarditis or myocarditis has been sporadically reported in the past, but none has been conducted involving patients with MDR-TB infections.

综合性护理模式对耐多药结核病(MDR-TB)患者负性情绪及生活质量的影响

分析耐多药结核病(MDR-TB)患者使用综合性护理模式的具体内容,探讨其对生活质量、负性情绪产生的影响。方法:本次共将84例2019.1-2020.8期间收治的耐多药结核病(MDR-TB)患者纳为研究对象,以随机抽签分组的原则将患者平均纳入两组,包括接受常规护理模式的对照组(n=42)、接受综合性护理模式的研究组(n=42),对护理效果展开分析及探讨。结果:研究组患者护理后各项负面情绪评分统计结果相较于对照组均显著更低,P<0.05;其护理后各项生活质量评分相较对照组显著更高,P<0.05;其护理总有效率以及护理总满意度均较对照组显著更高,P<0.05,组间数据差异均存在意义。结论:通过采取综合性护理模式,可以使耐多药结核病(MDR-TB)患者负性情绪有效改善,其生活质量优,对提升护理效果以及护理总满意度均具有重要作用,因此值得普及推广使用。