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。     

Cost effectiveness of decentralised care model for managing MDR-TB in India

Background

In India, multidrug-resistant tuberculosis (MDR-TB) patients are usually treated in hospitals. Decentralised care model, however, has been suggested as a possible alternative by the World Health Organization (WHO). In the “End TB Strategy”, the WHO highlights, as one of the key targets for 2035, that ‘no TB-affected families should face catastrophic hardship due to the tuberculosis’. Removal of financial barriers to health-care access and mitigation of catastrophic expenditures are therefore considered vital to achieve the universal health coverage (UHC) goal. Since forgoing healthcare due to the financial constraints is a known fact in India, decentralised care as an intervention choice (as against hospital-based care) might enhance equity provided it is an affordable choice. Thus, an economic evaluation was conducted, from the perspective of the national health system in India, to assess the cost-effectiveness of decentralised care compared to centralised care for MDR-TB.

A study on pattern of resistance to second line anti tubercular drugs among multi drug resistant tuberculosis patients

Aims and objectives

To determine the prevalence and pattern of resistance to second line drugs among multi drug resistant (MDR) tuberculosis patients being treated on category IV regimen.

Opportunities and challenges of using five-membered ring compounds as promising antitubercular agents

Tuberculosis (TB), a chronic infectious disease, is one of the greatest risks to human beings and 10 million people were diagnosed with TB and 1.6 million died from this disease in 2017. In addition, with the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), the TB situation has become even worse, which has aggravated the mortality and spread of this disease. To overcome this problem, research into novel antituberculosis agents with enhanced activities against MDR-TB, reduced toxicity, and shortened duration of therapy is of great importance. Fortunately, many novel potential anti-TB drug candidates with five-membered rings, which are most likely to be effective against sensitive and resistant strains, have recently entered clinical trials. Different five-membered rings such as furans, pyranoses, thiazoles, pyrazolines, imidazoles, oxazolidinone, thiazolidins, isoxazoles, triazoles, oxadiazoles, thiadiazoles, and tetrazoles have been designed, prepared, and evaluated for their antimycobacterial activity against Mycobacterium tuberculosis. In this article, we highlight the recent advances made in the discovery of novel five-membered ring compounds and focus on their antitubercular activities, toxicity, structure–activity relationships, and mechanisms of action.     

中青年人初治耐多药肺结核的胸部CT征象分析

目的 分析中青年人初治耐多药肺结核患者的CT表现,探讨其影像学特点.方法 回顾性分析2013年1月至2014年12月本院经药敏试验证实的28例中青年人耐多药(观察组)及同期84例中青年人非耐药(对照组)肺结核患者的CT影像资料;运用统计学方法检验两组间影像表现差异.结果 两组间具有统计学意义的CT表现:(1)观察组少于对照组:病灶内钙化(x2 =5.60,P＜0.025);(2)观察组多于对照组:肺毁损(x2=11.03,P＜0.005)、胸膜钙化(x2=16.85,P＜0.005)、脓气胸(x2=14.54,P＜0.005)、支气管扩张(x2 =8.82,P＜0.01).两组间无统计学意义的CT表现(P＞0.05):斑片灶(x2=0.39)、结节灶(x2=0.9)、斑条灶(x2=2.68)、播散灶(x2=0.63)、空洞分布(x2=0.018)、多发空洞(x2=0.59)、空洞内液平(x2=0.11)、胸腔积液(x2=1.96)、纵隔肺门淋巴结肿大(x2=2.09)、纵隔肺门淋巴结钙化(x2 =0.72).结论 两组患者病灶内钙化的差异具有统计学意义(P＜0.025);在肺毁损、胸膜钙化、脓气胸、支气管扩张的征象上差异具有显著统计学意义(P＜0.01).在CT诊断肺结核时,除斑片、结节、斑条、播散灶及多发空洞、胸腔积液等结核征象外,如存在肺毁损、胸膜钙化、脓气胸、支气管扩张等征象,要高度怀疑为耐多药肺结核.     

2010-2013年如皋市耐多药肺结核患者分析

目的通过对如皋市耐多药肺结核(MDR-TB)患者的来源及转归进行分析,探索适合该地区MDR-TB的发现策略。方法 2010-2013年收集该市所有涂阳结核病患者的痰标本,开展药敏检查,分析不同来源患者中的MDR-TB发现及转归情况。结果 4年间确诊MDR-TB患者36例,结核病患者中MDR-TB检出率为9.3%,其中86.1%的MDR-TB患者来源于MDR-TB高危人群。初治凃阳者MDR-TB检出率为1.7%,MDR-TB高危人群为34.8%,差异有统计学意义(P0.001)。MDR-TB高危人群中,慢性排菌患者MDR-TB检出率为57.1%,复发患者为34.7%,其他复治患者为22.2%,2月或3月末未发现涂片仍阳性者。纳入治疗的MDR-TB患者治疗成功率为67.7%。不同来源的MDR-TB高危人群MDR-TB检出率及治疗成功率差异均无统计学意义(P0.05)。结论该市MDR-TB疫情低于全国水平,MDR-TB高危人群是该市发现耐多药肺结核最主要人群。     

氟喹诺酮类药物在耐多药结核病治疗中的应用

随着对结核病化学治疗研究的深入，尤其是短程化疗的问世，已可使85％以上初治肺结核患者痊愈，但由于耐药结核病，尤其是耐多药结核病（MDR—TB）的出现，使结核病又迅速成为全球性危机，开发、研制高效的新型抗结核药物已成为迫切任务。氟喹诺酮类药物无论在体内或体外均对结核分枝杆菌有一定的杀灭作用，可作为治疗MDR—TB的又一有力武器。     

强力阿莫仙治疗耐多药肺结核病探讨

目的评价强力阿莫仙治疗耐多药肺结核的情况。方法采用中华医学会结核病分会耐多药肺结核诊断标准[1]。随机分组,69例耐多药肺结核病用强力阿莫仙治疗,为治疗组;66例耐多药肺结核采用常规抗痨药,为对照组。结果治疗2个月末痰菌阴转两组差异具有非常显著性（P〈0.01）。3个月末、6个月和12个月末痰涂阴转差异均无显著性。3个月末胸部X线检查差异有显著性（P〈0.05）,6个月末和12个月末其差异分别有非常显著性（P〈0.01）。初始耐药率为52.2%,而获得性耐药率为47.8%。69例病例中,60例是暂住户口居民,9例为常住户口居民。结论强力阿莫仙对治疗肺结核治疗有效。在初结核病例中,治疗6个月末X线检查病灶吸收低于90%,或病灶边缘仍模糊,应考虑是初始耐多药病例。建议药敏试验列为肺结核综合治疗前的常规项目。