69例耐多药肺结核个体化治疗的疗效分析

目的　观察与分析69例耐多药肺结核病人个体化综合治疗的疗效。方法 根据耐药情况将病人分为3组,HR耐药组(Ⅰ组)、HR+1药耐药组(Ⅱ组)和≥HR+2药耐药组(Ⅲ组)制定个体化方案,观察痰菌阴转率及胸部X线好转率。结果 3组6、12及24月的痰菌阴转率及胸部X线好转率各为Ⅰ组:76.5%,94.1%,94.1%,94.1%;Ⅱ组:60.0%,65.0%,70.0%,80.0%;Ⅲ组:46.9%,50.0%,46.9%,56.3%。Ⅰ组、Ⅲ组疗效比较均有显著性差异(P<0.05,P<0.01,P<0.01)而与Ⅱ组比较无显著性差异。结论 个体化方案治疗失败与耐多种药物、肺部不可逆性病变及病变广泛有关。根据药敏结果及早建立个体化的合理、有效的化疗方案对MDRTB是十分重要的。

Analysis of therapeutic effect on the individualized regimens for 69 patients with multi-drug resistant pulmonary tuberculosis

Objective To observe and analyse the therapeutic effects of individualized regimens for 69 patients with multi drug resistant pulmonary tuberculosis (MDR TB).Methods The patients were divided into 3 groups according to the result of susceptibility test.Three groups were HR resistant group (Group Ⅰ),resistant to 3 drugs including HR (Group Ⅱ) and resistant to 4 or more drugs including HR group (Group Ⅲ).And the patients received individualized regimens for treatment.Sputum negative conversion rates and chest X ray improvement rates were observed.Results The sputum conversion rates and chest X ray improvement rates of 3 groups in the treatment of 6,12 and 24 months:the sputum conversion rates and chest X ray improvement rates in Group Ⅰ were 76.5%,94.1%,94.1,94.1,Group Ⅱ were 60.0%,65.0%,70.0%,80.0% and Group Ⅲ were 46.9%,50.0%,46.9%,56.3% respectively.The rates of Group Ⅰ were higher significantly than that of Group Ⅲ ( P<0.05,P<0.01,P<0.01). There was no difference between Group Ⅰ and Ⅱ/Conclusion Individualized regimens therapeutic effects were associated with the number of resistant drugs and irreversible lesions.Our Results obtained in this study suggested that timely individualized regimens were provided to MDR TB patients based on the susceptibility test is improtant for the treatment.