黑龙江省耐多药与非耐多药肺结核患者在DOTS策略下远期治疗效果分析

目的 分析在DOTS策略下使用一线抗结核药治疗的耐多药与非耐多药肺结核患者成功治疗后的远期治疗效果。 方法 采用回顾性队列研究方法，随访2004年黑龙江省耐药监测期间确诊并成功治疗的耐多药肺结核（MDR-TB）患者（暴露组，随访194例患者，访视到111例）及按1：1比例为存活MDR-TB患者配对的非MDR-TB患者(对照组，选择并访视患者71例，其中对所有药物均敏感41例，耐多药以外耐药30例)，观察其4年来复发情况，分析存活病例中耐多药（71例）与非耐多药（敏感41例，耐多药以外耐药30例）、治疗分类（初治80例，复治62例）及治疗方案（规划方案124例，科研方案18例）对患者成功治疗后4年复发情况的影响。 结果 暴露组，4年复发率为46.85%（52/111）。在暴露组患者中死亡40例，4年复发率为67.50%(27/40)；存活71例，4年复发率为35.21%（25/71）。对照组71例，复发17例，4年复发率为23.94%（17/71）。存活MDR-TB的复发风险高于对一线抗结核药完全敏感患者（χ²=4.19，P=0.041；RR=2.06,95% CI：0.98～4.34)。复治患者的复发率（40.32%，25/62）高于初治（21.25%，17/80）（χ²=6.10，P=0.014；RR=1.90，95%CI：1.13～3.19)。采用规划方案、科研方案患者的4年复发率分别为29.84%（37/124）和27.78%（5/18），两者间差异无统计学意义（χ²=0.02，P=0.894)。结论 对MDR-TB患者采用DOTS策略治疗成功后的4年复发率高，复治患者复发风险高于初治。

The analysis of long-term treatment outcome of TB patients with or without multidrug-resistance under DOTS management in Heilongjiang province

Objective To evaluate the long-term treatment outcome of TB patients with or without multidrug-resistance after they were successfully treated by first-line TB drugs under DOTS strategy.Methods This is a retrospective cohort study design.The cohort study followed up the MDR-TB patients who were diagnosed in a drug-resistance survey in Heilongjiang province in 2004 and were later successfully treated under DOTS strategy.Of the 194 cases of MDR-TB patients successfully treated under the DOTS treatment,111 were followed up including 40 died during the 4 years and 71 still alive.One survival MDR-TB patients were matched with one Non-MDR-TB patients in control group(71 patients in control group,among which 41 were drug sensitive to any TB drugs,30 drug resistance cases were drug-resistant but non MDR-TB).The patients were observed for TB recurrence 4 years after successful completion of treatment.We analyzed the influence of MDR(71 MDR-TB cases,41 drug sensitive cases,30 non-MDR-TB cases),treatment classification(80 initial treatment cases,62 retreatment cases),treatment regimen(124 cases with NTP regimens,18 with research regimens) on the recurrence.Results In the exposed group,MDR TB recurred in 52(46.85%) of the 111 patients.This recurrence rate was 67.50% in the dead(27/40),and 35.21%(25/71)in survival 71 cases.In 71 controls,the recurrence rate was 23.94%(17/71).The risk of 4 year recurrence in living MDR-TB patients was significantly higher than those drug sensitive to any TB drugs(χ2=4.19,P=0.041;RR=2.06,95%CI=0.98-4.34).The risk of recurrence in retreatment TB patients(40.32%,25/62) was significantly higher than those of initial treatment cases(21.25%,17/80)(χ2=6.10,P=0.014;RR=1.90,95%CI:1.13-3.19).NTP regimen and research regimen had no significant impact on the long-term recurrence 29.84%(37/124) versus [27.78%(5/18),χ2=0.02,P=0.894].Conclusion The study showed that the 4 years recurrence rate of MDR-TB patients was high.The risk of recurrence is high in retreatment than initial treatment cases.