一线抗结核药物治疗初治耐多药肺结核的效果及转归
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摘要
目的观察一线抗结核药物治疗初治耐多药肺结核的临床效果,并初步分析可能影响治疗转归的因素,为合理治疗初治耐多药肺结核提供依据。方法选取我院2015年9月至2017年9月的79例初治耐多药肺结核患者为研究对象,患者均应用一线抗结核药物治疗,治疗成功者纳入病例组,治疗失败者纳入对照组。初步分析可能影响其临床转归的因素。结果使用一线抗结核药物治疗初治耐多药肺结核的整体有效率为27.8%,药敏提示为耐多药肺结核后,继续使用一线抗结核药物者31例,完成疗程22例,治疗有效率为71.0%(22/31)。病例组患者居住地为农村、痰涂片++及以上、病灶范围2个肺野及以上、采用2种及以上药敏方法的比例低于对照组,有空洞的比例高于对照组,差异具有统计学意义(P<0.05)。结论一线抗结核药物治疗初治耐多药肺结核有一定疗效,但确定是否调整抗结核治疗方案时应结合多种因素进行综合考量,尽可能减少对患者的损害。
Objective To observe the clinical efficacy of first-line anti-tuberculosis drugs in the treatment of initial treatment of multidrug-resistant pulmonary tuberculosis, and to preliminarily analyze the factors that may affect the outcome of treatment, provide basis for the rational treatment of multidrug-resistant pulmonary tuberculosis. Methods A total of 79 newly treated patients with multidrug-resistant pulmonary tuberculosis in our hospital from September 2015 to September 2017 were selected as the study objects. All patients were treated with first-line antituberculosis drugs. Patients who successful treated were enrolled into case group and patients who failed were enrolled into control group. The possible factors affecting clinical outcome were preliminarily analyzed. Results The overall effective rate of first-line anti-tuberculosis drugs in the treatment of multidrug-resistant pulmonary tuberculosis was 27.8%, drug susceptibility showed that after multidrug-resistant pulmonary tuberculosis, 31 cases continued to use first-line anti-tuberculosis drugs, and 22 cases completed the course of treatment, the effective rate of treatment was 71.0%(22/31). The proportions of patients living in rural areas, sputum smear + + and above, lesion range was 2 lung fields or more, using 2 or more drug sensitivity methods in the case group were lower than those of the control group, the proportion of voids in the case group was higher than that in the control group, the differences were statistically significant(P <0.05). Conclusion First-line anti-tuberculosis drugs in the treatment of multidrug-resistant pulmonary tuberculosis have certain curative effect, however,when deciding whether to adjust the anti-tuberculosis treatment regimen, comprehensive consideration should be taken in combination with multiple factors, as far as possible to reduce the damage to the patients.
Objective To observe the clinical efficacy of first-line anti-tuberculosis drugs in the treatment of initial treatment of multidrug-resistant pulmonary tuberculosis, and to preliminarily analyze the factors that may affect the outcome of treatment, provide basis for the rational treatment of multidrug-resistant pulmonary tuberculosis. Methods A total of 79 newly treated patients with multidrug-resistant pulmonary tuberculosis in our hospital from September 2015 to September 2017 were selected as the study objects. All patients were treated with first-line antituberculosis drugs. Patients who successful treated were enrolled into case group and patients who failed were enrolled into control group. The possible factors affecting clinical outcome were preliminarily analyzed. Results The overall effective rate of first-line anti-tuberculosis drugs in the treatment of multidrug-resistant pulmonary tuberculosis was 27.8%, drug susceptibility showed that after multidrug-resistant pulmonary tuberculosis, 31 cases continued to use first-line anti-tuberculosis drugs, and 22 cases completed the course of treatment, the effective rate of treatment was 71.0%(22/31). The proportions of patients living in rural areas, sputum smear + + and above, lesion range was 2 lung fields or more, using 2 or more drug sensitivity methods in the case group were lower than those of the control group, the proportion of voids in the case group was higher than that in the control group, the differences were statistically significant(P <0.05). Conclusion First-line anti-tuberculosis drugs in the treatment of multidrug-resistant pulmonary tuberculosis have certain curative effect, however,when deciding whether to adjust the anti-tuberculosis treatment regimen, comprehensive consideration should be taken in combination with multiple factors, as far as possible to reduce the damage to the patients.
引文
[1]World Health Organization.Global tuberculosis report 2018[R/OL].Geneva:World Health Organization,2012(2018-9-18).https://www.who.int/tb/publications/global_report/en/.
[2]高谦,梅建.传播才是造成我国结核病高耐药率的主要原因[J].中国防痨杂志,2015,37(11):1091-1096.
[3]周建文.耐药结核病现状及影响因素研究新进展[J].世界最新医学信息文摘,2016,16(42):23-26.
[4]潘毓萱.结核分枝杆菌常规药物敏感性测验和临床化疗疗效相关性的再认识[J].中华结核和呼吸杂志,2006,29(8):514-516.
[5]肖和平.关注《耐药结核病化学治疗指南(2015)》实施中的常见问题[J].中国防痨杂志,2015,37(11):1089-1090.
[6]闫丽萍,吴哲渊,张祖荣,等.初治耐多药肺结核患者采用初治标准方案治疗的前瞻性临床研究[J].中国防痨杂志,2017,39(1):33-38.
[7]张日东,陈小燕,吴智龙.40例初治复治耐多药肺结核临床疗效分析[J].临床肺科杂志,2009,14(4):471-472.
[8]王甦民,王雪静,赵新平,等.浙江、广东省耐药监测项目中耐药肺结核治疗现况研究[J].中国防痨杂志,2005(06):370-373.
[9]皮锐,柳清云,高谦.耐药结核分枝杆菌的适应性代价与补偿性进化[J].微生物与感染,2017,12(6):362-368.
[10]张琳琳,杨华,肖和平.结核分枝杆菌联合药敏试验的研究进展[J].中国防痨杂志,2015,37(1):86-89.
[11]潘毓萱.有关结核分支杆菌耐药性测定几个问题的看法[J].中华结核和呼吸杂志,2000,23(2):75-76.
[2]高谦,梅建.传播才是造成我国结核病高耐药率的主要原因[J].中国防痨杂志,2015,37(11):1091-1096.
[3]周建文.耐药结核病现状及影响因素研究新进展[J].世界最新医学信息文摘,2016,16(42):23-26.
[4]潘毓萱.结核分枝杆菌常规药物敏感性测验和临床化疗疗效相关性的再认识[J].中华结核和呼吸杂志,2006,29(8):514-516.
[5]肖和平.关注《耐药结核病化学治疗指南(2015)》实施中的常见问题[J].中国防痨杂志,2015,37(11):1089-1090.
[6]闫丽萍,吴哲渊,张祖荣,等.初治耐多药肺结核患者采用初治标准方案治疗的前瞻性临床研究[J].中国防痨杂志,2017,39(1):33-38.
[7]张日东,陈小燕,吴智龙.40例初治复治耐多药肺结核临床疗效分析[J].临床肺科杂志,2009,14(4):471-472.
[8]王甦民,王雪静,赵新平,等.浙江、广东省耐药监测项目中耐药肺结核治疗现况研究[J].中国防痨杂志,2005(06):370-373.
[9]皮锐,柳清云,高谦.耐药结核分枝杆菌的适应性代价与补偿性进化[J].微生物与感染,2017,12(6):362-368.
[10]张琳琳,杨华,肖和平.结核分枝杆菌联合药敏试验的研究进展[J].中国防痨杂志,2015,37(1):86-89.
[11]潘毓萱.有关结核分支杆菌耐药性测定几个问题的看法[J].中华结核和呼吸杂志,2000,23(2):75-76.