摘要
目的了解重庆地区成人耐多药肺结核(MDR-PTB)患者的化学治疗疗效及其转归情况,探讨分析其影响因素,为合理制定MDR-PTB患者的治疗措施提供参考依据。方法回顾性分析重庆市公共卫生医疗救治中心2013年1月至2016年1月收治住院分枝杆菌培养阳性且具有完整病历记录的548例成人耐多药肺结核患者临床资料,并分组分析初复治患者的治疗效果与转归情况,采用χ^(2)检验进行组间比较,采用wilcoxon秩和检验进行两组等级资料的比较,以P<0.05为差异具有统计学意义。结果复治组对乙胺丁醇、左氧氟沙星的耐药率(分别为77.3%、63.0%)均高于初治组(分别为37.4%、7.1%),且差异具有显著的统计学差异(χ^(2)值分别为61.607、101.947,P值均小于0.05)。初治患者3月末痰菌阴转率为76.1%,疗程结束时痰菌阴转率为95.7%;复治患者3月末痰菌阴转率为48.2%,疗程结束时痰菌阴转率为60.1%,两组的阴转率比较差异有统计学意义(χ^(2)值分别为23.548、42.719,P值均小于0.05)。548例MDR-PTB患者治疗成功率为58.8%(322/548),治愈率为48.9%(268/548),初治组治愈率74.7%(74/99)远高于复治组43.2%(194/449)。"初治复治分组"和"是否有并发症"对MDR-PTB患者治疗转归有着显著的影响,其差异具有统计学意义(Z=-5.314,P=0.000;χ^(2)=93.324,P=0.000)。结论重庆地区初治MDR-PTB患者抗结核治疗效果较好于复治患者,但均有待进一步提升。积极治疗并发疾病,一次性治愈结核病人是提高成人MDR-PTB患者疗效和转归成功的有效手段。
Objective To analyze the treatment outcome and and its influencing factors of multi-drug resistant tuberculosis(MDR-TB)patients in Chongqing area,so as to provide reference for the rational formulation of treatment measures for MDR-TB patients.Methods The clinical data of 548 adult MDR-TB patients with positive mycobacterium culture and complete medical records admitted to Chongqing Public Health Medical Treatment Center from January 2013 to January 2016 were retrospectively analyzed,and the treatment effect and outcome of the initial treatment and re-treatment patients were analyzed byχ^(2)test and Wilcoxon rank sum test,and P<0.05 was considered statistically significant.Results The drug resistance rates to ethambutanol and levofloxacin were higher in the re-treatment group than in the initial treatment group,and the differences were statistically significant(χ^(2)=61.607 and 101.947 respectively,P<0.05).The sputum negative conversion rate in relapse patients was 76.1%at the end of the third month and was 95.7%at the end of the treatment period,and the rate in new patients was 48.2%at the end of the third month and 60.1%at the end respectively(χ^(2)=23.548 and 42.719,respectively,P<0.05).The success rate of 548 MDR-PTB patients was 58.8%(322/548),and the cure rate was 48.9%(268/548).The cure rate of 74.7%(74/99)in new patients was much higher than 43.2%(194/449).“Whether to have complications”and“past medication history”had significant effect on the outcome of MDR-PTB patients(Z=-5.314,P=0.000;χ^(2)=93.324,P=0.000).Conclusion The efficacy of chemotherapy for MDR-TB patients is slightly betterin the initial treatment group than in the re-treatment group,but both of them needs to be further improved.Treating actively other diseases and curing TB patients at one time could improve the efficacy of chemotherapy in patients with MDR-TB.
作者
李同心
周刊
李晓旭
周奉
杨伏萍
周刚
马旭玥
蒋明英
LI Tong-xin;ZHOU Kan;LI Xiao-xu;ZHOU Feng;YANG Fu-ping;ZHOU Gang;MA Xu-yue;JIANG Ming-ying(Central Laboratory,Chongqing Public Health Medical Center,Chongqing,Sichuan 400036,China;Preventive Medicine Department,Chongqing Public Health Medical Center,Chongqing,Sichuan 400036,China;Tuberculosis Unit 3,Chongqing Public Health Medical Center,Chongqing,Sichuan 400036,China)
出处
《临床肺科杂志》
2022年第2期237-241,共5页
Journal of Clinical Pulmonary Medicine
基金
重庆市科卫联合医学科研项目(No.2019MSXM065,2020FYYX001)
重庆市技术创新与应用发展专项(No.cstc2019jscx-msxmX0152)。
关键词
结核
肺
结核分枝杆菌
耐多药
治疗结果
因素分析
统计学
pulmonary tuberculosis
mycobacterium tuberculosis
multi-drug resistant
treatment results
factor analysis
statistics
作者简介
通信作者:蒋明英,E-mail:591641804@qq.com。
