148例耐多药和广泛耐药肺结核的临床特点

目的探索耐多药（MDR）和广泛耐药（XDR）肺结核的临床特点。方法对2008年9月—2009年6月在上海市肺科医院结核科住院的148例耐多药和广泛耐药肺结核患者的药敏试验、既往抗结核治疗史、病变范围、合并症等进行回顾性分析，组间比较采用χ²检验。结果148例MDR和XDR肺结核病中XDR肺结核高达33.1%（49/148），男、女之比为0.88∶1。MDR组耐4～5种抗结核药物者占82.8%，其中氧氟沙星耐药率为66.7%。XDR组和MDR组初始耐药者分别占据30.6%（15/49）和16.2%（16/99），以XDR组中的初始耐药构成比明显为高（χ²=4.13，P=0.04）。肺部病变累及≥4个肺野者分别为XDR组81.6% (40/49) 和MDR组65.7%(56/99），以XDR组病变累及范围更为广泛（χ²=4.06，P=0.04）。2组患者中有合并症者均超过60%，以糖尿病居多（23.0%）,XDR组较MDR组更多合并糖尿病，分别为28.6%和20.2%。结论MDR和XDR肺结核的临床特点表现为XDR的比例明显攀升，较多的MDR尤其是XDR初始耐药病例的出现，提示这类患者的管理可能存在缺陷。MDR肺结核耐氧氟沙星的严重性进一步说明了目前MDR的治疗难度和发展成为XDR的可能性在增加。高糖尿病合并为日后MDR和XDR的防治提供了线索。

Clinical features of Multidrug-resistant and extensively drug-resistant pulmonary tuberculosis

Objective To investigate the clinical features of multidrug-resistant（MDR） and extensively drug-resistant（XDR） tuberculosis. Methods Data of drug susceptible test, history of anti-TB treatment, scopes of disease,and complications in 148 patients with MDR-TB and XDR-TB was retrospectively analyzed. Chi square test was used for statistic analysis. Results The percentage of XDR-TB was 33.1%（49/148）. The ratio of men to wowen was 0.88 to 1. The proportion of drug resistance to 4 or 5 drugs was 82.8% in MDR-TB, and Ofloxacin-resistant rate was 66.7%. The initial drug-resistance rates of XDR and MDR were 30.6 % （15/49）and 16.2% （16/99）respectively （X^2= 4.13, P = 0.04）. The proportion of patients with lung lesions involved with more than 4 lung fields in XDR-TB and MDR-TB group were 81.6% （40/49） and 65.7%（56/99）respectively （Х^2=4.06,P=0.04）. The proportion of patients with complications in both groups was higher than 60%. Diabetes mellitus was the most common complication,especially in XDR-TB, with rates of 28.6% and 20.2% in XDR and MDR respectively. Conclusions This study showed that the rate of XDR was increasing obviously. More cases of initial drug-resistance emerging in MDR, especially in XDR group indicated that the management for these patients may be too weak. The severi-ty of Ofloxacin-resistant further showed that both the difficulty of the treatment for MDR and the possibility of MDR developing into XDR were increasing. And the phenomenon many patients complicated with diabetes mellitus might provide clues for the prevention and treatment for MDR and XDR.