复治肺结核耐药性与用药史关系研究

目的了解复治肺结核患者的用药史和耐药情况,为评价复治肺结核标准化疗方案适用性提供依据。方法采用WHO/IUATLD《结核病耐药监测指南》要求的整群抽样方法,在浙江省随机抽取30个监测县,药敏试验采用比例法,详细询问复治涂阳肺结核患者用药史并填写临床资料调查表,对药敏结果和用药史进行相关分析。结果复治肺结核病人耐药率和耐多药率分别为52.9%和29.7%,对4种抗结核药物的耐药率顺位由高到低依次为:H(38.1%)、R(34.8%)、S(29.7%)、E(13.5%);其中复治标准化疗方案治疗失败的患者耐药率和耐多药率最高,分别为77.3%和52.3%,首次复治患者的耐药率和耐多药率分别为45.1%和23.2%;耐药率和耐多药率均随用药时间和种类的增加呈升高趋势。结论不同用药史的肺结核病例耐药率差异悬殊,现行标准复治化疗方案对部分患者可能无效,提示复治病人化疗方案应多元化。

Relationship of drug resistance retreated smear-positive tuberculosis and chemotherapy history

Objective To understand the chemotherapy history and the antituberculosis drug resistance among the retreated smear-positive tuberculosis patients in Zhejiang,and to provide evidence for estimating applicability of standard chemical therapy regiment for retreated smear-positive tuberculosis patients. Methods According to the Guidelines for Surveillance of Drug Resistance in Tuberculosis of WHO/IUATLD,30 counties were randomly selected with population proportionate cluster sampling method.Proportion method was used for drug sensitivity test.The data of the drug resistant surveillance and the clinical information questionnaire recording treatment history of all retreated smear positive pulmonary tuberculosis cases enrolled were analyzed. Results The rate of drug resistance and multi-drug resistance was 52.9% and 29.7% respectively,the order of drug resistance rate arranged from high level to low level was H(38.1%),R(34.8%),S(29.7%),E(13.5%).Any drug resistance rate and multi-drug resistance(MDR) rate in the finished treatment course cases were 77.3% and 52.3% respectively,which was the highest among all cases,and the second highest rate was that in the first time treatment cases with the drug resistant rate and MDR rate were 45.1% and 23.2%. The trends of any drug resistant rate and MDR rate increased with the increasing of treatment period and drug variety. Conclusion Drug resistance rate varies in different types of the first time retreated pulmonary tuberculosis patients due to the history of drug use,which indicates that the current standard retreatment regimen is probably ineffective for some patients.It is suggested that chemical therapy regiment for retreated smear-positive tuberculosis patients should be various.