中国东部两县农村地区耐药结核病治疗效果的因素分析

目的 描述中国东部两个县农村地区耐药结核病治疗完成情况,评价短程督导化疗对耐药结核病的治疗效果及其影响因素.方法 将德清县182例和灌云县217例菌阳肺结核病患者为研究对象进行队列研究.患者在开始化疗时进入队列并接受问卷调查,在短程督导化疗期间(6-8个月)获得3次随访.药物敏感试验采用WHO推荐的直接比例法.通过χ2检验、Kaplan-Meier生存分析、Cox多元回归等方法分析耐药结核病患者在治疗阶段痰涂片转阴的过程、结局和影响因素.结果 德清县和灌云县耐多药、其他耐药和药物全敏感结核病治愈率分别为58.3%、91.0%、98.7%和51.3%、89.5%、93.5%.耐药类型和既往治疗史是影响耐药结核病治疗效果的主要因素.在耐多药结核病患者中,肝不良反应(RR=0.18,95%CI:0.04～0.69)和既往治疗史(RR=0.26,95%CI:0.07～0.93)严重影响治疗效果;而其他耐药结核病的治疗效果与既往治疗史(RR=0.66,95%CI:0.44～0.98)和病例延误(＞2周)(RR=0.67,95%CI:0.46～0.97)有关.结论 有效监测控制不良反应,发展快速的药物敏感试验并根据耐药类型调整治疗方案是提高耐多药结核病治疗效果的关键.

A-cohort study on the standard short-course chemotherapy program for drug resistant tuberculosis in the rural counties in Eastern China

Objective To investigate the therapeutic efficacy of short course chemotherapy (SCC)on drug resistant tuberculosis (DR-TB) cases and related influencing socioeconomic factors. TB patients registered in local county TB dispensaries of two rural counties were followed up in Deqing and Guanyun of Eastern China, during 2004/2005. Methods Culture-positive patients (Deqing: 182, Guanyun: 217)were selected as subjects of this study. A cohort of TB patients was established at the beginning of their treatment and each patient was followed-up three times by questionnaires. Proportional method of drug susceptibility test was used to define the resistance to the 1st-line anti-TB drugs.χ2 test Kaplan-Meier method and Cox analysis were applied in multivariate analysis to investigate the negative conversion of smear positive sputum, treatment result of SCC and its socioeconomic influencing factors. Results The cure rates of multi-drug resistant TB (MDR-TB),other drug resistant TB (ODR-TB) and pan-drug susceptible TB,were 58.3%, 91.0%, 98.7% and 51.3%, 89.5%, 93.5% respectively in Deqing and Guanyun. The liver dysfunction (RR = 0.18, 95% CI:0. 04-0. 69 ) and previous treatment history (RR = 0.26,95% CI:0.07-0.93) were associated with treatment result among MDR-TB. Result on treatment in ODR-TB was influenced by previous treatment history (RR = 0.66, 95% CI:0. 44-0. 98 ) and Patient delay (＞2 weeks)(RR = 0.67, 95% CI: 0.46-0.97). Conclusion The priority in treating MDR-TB would include:managing side effect, developing the fast sensitive drug susceptibility test and modifying the treatment regimen corresponding to drug resistance.