耐多药肺结核患者化学治疗疗效及其影响因素分析

目的 分析耐多药肺结核(MDR-PTB)患者化学治疗疗效及其影响因素。方法 收集2012年1月至2013年12月湖南省胸科医院符合中国全球基金结核病项目纳入要求确诊的267例MDR-PTB患者。分别采用耐多药肺结核标准化化疗方案(6Z-Km(Am,Cm)-Lfx(Mfx)-Cs(PAS,E)-Pto/18-Z-Lfx(Mfx)-Cs(PAS,E)-Pto)和个体化化疗方案治疗。对267例患者的治疗效果(包括治愈、完成疗程、死亡、失败、丢失和其他)及其影响因素(包括性别、年龄、职业、登记分类、耐药情况、既往抗结核药物治疗史、治疗方案、并发其他疾病、药物不良反应以及服药是否规律等可能相关因素)进行分析。用χ ²检验进行单因素分析;用二分类logistic回归分析法进行多因素分析,均以P<0.05为差异有统计学意义。 结果 267例MDR-PTB患者的治疗效果为:治愈138例(51.7%),完成疗程13例(4.9%),死亡10例(3.7%),失败23例(8.6%),丢失78例(29.2%),其他5例(1.9%)。影响治愈率的单因素分析显示:治疗方案[个体化方案:38.0%(27/71);标准化疗方案:56.6%(111/196)]、并发症[有:39.7%(27/68);无:55.8%(111/199)]、药物不良反应[有:31.1%(32/103);无:64.6%(106/164)]、服药是否规律[是:94.9%(129/136);否:6.9%(9/131)]4个因素是影响治疗效果的相关因素(χ ²=7.224,P=0.007;χ ²=5.243,P=0.022;χ ²=28.545,P=0.000;χ ²=206.846,P=0.000)。logistic多因素回归分析显示:规律服药[Wald χ ²=84.656,P=0.000;OR(95%CI)=229.019(71.974~728.737)]是耐多药肺结核患者成功治疗的保护因素;而有并发其他疾病[Wald χ ²=9.652,P=0.002;OR(95%CI)=0.138(0.040~0.482)]、有药物不良反应[Wald χ ²=5.317,P=0.021;OR(95.0%CI)=0.313(0.117~0.840)]是耐多药肺结核患者成功治疗的危险因素。 结论 耐多药肺结核患者化学治疗疗效不够理想,其影响因素较多。坚持规律服药、积极治疗其他疾病和减少药物不良反应的发生,可提高耐多药肺结核患者的化疗效果。

Analysis of chemotherapy efficacy and its influencing factors of multi-drug resistant pulmonary tuberculosis patients

Objective To Analysis of chemotherapy efficacy and its influencing factors of multi-drug resistant pulmonary tuberculosis patients.Methods Two hundred and sixty-senven patients with MDR-PTB of Hunan Chest Hospital were collected who conformed China Global Fund TB Program Inclusion Requirements Confirmed. The patients were adopted multi-drug resistant tuberculosis standardized chemotherapy(6Z-Km(Am,Cm)-Lfx(Mfx)-Cs(PAS,E)-Pto/18-Z-Lfx(Mfx)-Cs(PAS,E)-Pto) and individualized chemotherapy to treat. Treatment effect (including healing, completion of treatment, death, failure, loss and other) and influencing factors (Including gender, age, occupation, registration classification, drug resistance, history of previous anti-tuberculosis drug treatment, treatment options, complications, adverse drug reactions, and the medication was regular or not) of 267 patients were analyzed. Univariate analysis using χ ² test and multivariate analysis using binary logistic regression analysis, P<0.05 was considered statistically significant. Results The therapeutic effect of 267 patients with MDR-PTB included 138 cases cured (51.7%), 13 cases completed course of treatment (4.9%), 10 cases deaths (3.7%), 23 cases failed (8.6%), loss of 78 cases (29.2%) and other 5 cases (1.9%). Single factor analysis of affecting the cure rate showed treatment programs (individualized program: 38.0% (27/71), standard chemotherapy program: 56.6% (111/196)), complication (appeared 39.7%(27/68), not appeared 55.8%(111/199)), medical side effects (appeared 31.1%(32/103), not appeared 64.6%(106/164)), taking medicine regularly or not ( regular 94.9%(129/136); not regular 6.9%(9/131)). The four factors was a related factor affecting the treatment effect. (χ ²=7.224,P=0.007;χ ²=5.243,P=0.022;χ ²=28.545,P=0.000;χ ²=206.846,P=0.000). Conclusion Multivariate regression analysis showed that regular medication (Wald χ ²=84.656,P=0.000;OR(95%CI)=229.019(71.974-728.737)) was a protective factor for successful treatment of multidrug-resistant tuberculosis patients. Complication (Wald χ ²=9.652,P=0.002;OR(95%CI)=0.138(0.040-0.482)) and medical side effects (Wald χ ²=5.317,P=0.021;OR(95%CI)=0.313(0.117-0.840)) were risk factor for successful treatment of multidrug-resistant tuberculosis patients.