儿童结核治疗失败原因分析

目的:探讨儿童结核治疗失败的原因所在。方法:回顾性分析248例儿童结核患者的临床资料,分为治疗成功和治疗失败两组进行分析对比。结果:248例儿童结核患者满疗程后治疗成功187例(75.4%),失败61例(24.6%),肺结核的治愈率为96.0%,肺外结核的治愈率54.8%。PPD≥10mm(χ2=16.340,P=0.000)、痰结核菌涂片和/或培养阳性(χ2=6.073,P=0.014)多见于较大儿童组,未接种卡介苗多见于较小儿童组(χ2=10.811,P=0.001)。经多元Logistic回归分析,痰结核菌阳性[OR=1.161(95%CI=0.271-4.845)]、未接种卡介苗[OR=1.092(95%CI=0.850-4.934)]、肺外结核[OR=2.775(95%CI=0.477-8.791)]是与治疗失败有关的独立因素。结论:痰结核菌阳性、未接种卡介苗、肺外结核易导致治疗失败。儿童结核治疗疗程至少6个月以上,并建议给予全程DOT。国家结核病控制规划应包含预防接种计划的监督执行,以确保卡介苗接种100%的覆盖率。对疑似肺外结核的儿童及时给予经验性抗结核治疗也是减少治疗失败的重要措施。

Analysis of Reasons Associated with Treatment Failure in Childhood Tuberculosis

Objective:To approach the reasons associated with treatment failure in childhood tuberculosis. Methods:We retrospectively reviewed clinical data of 248 children with tuberculosis which were divided into cure group and failure group for research. Results:In all 248 cases,187(75.4%) children were cured and 61(24.6%) children were failure. The cure rate of pulmonary TB and extrapulmonary TB was 96.0%, 54.8% respectively. PPD≥10mm(χ2=16.340,P =0.000),sputum smear and/or culture AFB positive (χ2= 6.073,P =0.014)were more often founded in elder children. More younger children have got no BCG vaccination(χ2=10.811,P =0.001). On Logistic regression, sputum AFB positive [OR=1.161(95%CI=0.271-4.845)], non-re-ceipt of BCG [OR=1.092(95%CI=0.850-4.934)] and extrapulmonary TB [OR=2.775(95%CI=0.477-8.791)]were all independent variables associated with treatment failure. Conclusion:Sputum AFB positive and extrapulmonary TB can result in treatment failure. Regimen period should be at least longer than 6 months. DOT should be implemented for the whole course. The supervision of vaccination should be integrated into national TB control program so as to ensure its 100% coverage rate. Experienced anti-TB therapy can be initiated as soon as extrapulmonary TB becomes suspected.